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心脏刀刺伤的诊断和治疗(附6例报告) 总被引:1,自引:0,他引:1
目的探讨心脏刀刺伤的诊治方法,以提高早期诊断和急救水平.方法回顾性分析6例心脏刀刺伤患者的临床资料和有关文献.结果抢救成功5例,死亡1例,抢救成功率83.3%,死亡原因与未能及时确诊、手术有关.结论迅速解除心脏压塞和纠治休克,尽快手术,是心脏刀刺伤患者抢救成功的关键. 相似文献
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赵伟 《武汉大学学报(医学版)》2013,(5):727-729
目的:分析14例心脏刀刺伤患者的救治经过,提高早期救治和诊断水平。方法:回顾性分析14例心脏刀刺伤患者资料。根据患者外伤史和临床表现,迅速诊断分型,缩短病发至有效治疗时间,对临床型患者开放急救手术绿色通道,对亚临床型患者,可进行必要的扩大探查及其他辅助检查,明确病情后实施手术救治。结果:死亡1例,死亡率7.1%。救治成功13例。结论:建立院前急救-手术绿色通道-急诊手术的一体化先进急救模式,对病人分型救治,提高了心脏刀刺伤的救治成功率。 相似文献
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目的 探讨心脏刀刺伤的诊断与治疗经验.方法 回顾性分析13例心脏刀刺伤的病历资料.结果 13例均行手术治疗,其中11例治愈,2例死亡.结论 心脏刀刺伤常常会在短时间内使病人出现休克及心包填塞,危及生命.对心脏刀刺伤的治疗原则是早诊断,及时果断采取手术治疗. 相似文献
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[目的]分析大连医科大学第一临床学院1988年2月~2006年6月27例心脏刀刺伤患者的抢救经过和结果,以提高早期诊断和急救水平。[方法]根据外伤史和临床表现,迅速确定诊断,避免不必要的辅助检查,果断施行急诊心脏修补手术。[结果]抢救成功痊愈24例,心脏修补成功但术后长期昏迷1例,死亡2例,手术成功率为92.6%,死亡率7.4%。[结论]心脏刀刺伤抢救成功的关键在于及时明确诊断,抗休克的同时果断剖胸手术解除心包填塞,修补心肌裂口。 相似文献
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目的:探讨心脏刀刺伤的急救体会。方法:对12例心脏刀刺伤患者仅作简单检查,抗休克的同时送手术室开胸探查心脏修补。结果:11例患者救治成功,术后康复好,无并发症发生,1例术中出血过多死亡。结论:及时快速的诊断和开胸心脏修补是心脏刀刺伤抢救成功与否的关键。 相似文献
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自1989年1月~1993年3月我院收治胸部刀刺伤病人56例。治愈53例,死亡3例。心脏破裂12例,进行性血胸18例,膈破裂14例,膈及腹腔器官破裂10例。立即手术探查39例(69.6%)。抢救治疗成功的关键在于观察认真,处理及时准确。本文讨论了胸部刀刺伤的手术探查指征,低位胸部刀刺伤和心脏刺伤的处理方法。 相似文献
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目的探讨心脏破裂伤的早期诊断和治疗方法。方法对12例心脏破裂伤患者的临床资料进行回顾性分析。全组患者男8例,女4例,平均年龄38岁。其中刀刺伤6例,高处坠落伤1例,车祸伤5例。需心肺转流8例。结果12例经手术治疗后痊愈出院。结论早期诊断、尽快建立周围体外循环是救治心脏破裂伤成功的关键。 相似文献
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目的总结创伤性心包积液的外科急诊救治的临床经验。方法回顾性分析2007年7月至2010年7月间,上海两所三甲医院所收治的创伤性心包积液患者的病史资料和外科治疗效果。结果总计有26例发生创伤性心包积液。16例刀刺伤,10例交通伤。中等量以上积液者17例,少量积液者9例,7例发生心包填塞。心脏损伤17例,心包破裂2例,原因未定者7例。手术行心脏修补术17例,心包开窗术4例,心包穿刺术2例,无特殊处理者3例。死亡5例,其中3例手术失败,1例死于延迟性心脏破裂,1例死于支气管肺动脉瘘和低氧血症。结论创伤性心包积液与心脏损伤密切相关,多数需手术治疗。早期诊断和及时手术救治是挽救生命的关键。 相似文献
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JM Plummer M Condell D Ferron-Boothe P Johnson PA Leake AH McDonald 《The West Indian medical journal》2014,63(3):258-261
Objective:
To determine the impact of trans-thoracic ultrasound (TTUS) in patients with chest trauma and potential cardiac injuries and to determine the outcome of patients with cardiac injury detected on TTUS.Method:
Data were obtained from the Trauma Registry for all patients presenting alive to the University Hospital of the West Indies during the 10-year period commencing January 1, 2001 and who were subjected to a TTUS or emergency thoracotomy for cardiac injuries, or had cardiac injuries at postmortem. In addition to demographics, variables analysed included mechanism and site of injury and outcome.Results:
Of 405 patients being subjected to a TTUS during the period, 12 (3%) had cardiac injuries. During the same period, 63 patients in the Trauma Registry had proven cardiac injuries. Transthoracic ultrasound was thus conducted on 19% of all patients with cardiac injuries. Three patients had positive TTUS but no cardiac injuries. Of the patients with injuries, the mean age was 30.4 years, 92.1% were male and 65% were as a result of stab wounds, while 22% were as a result of gunshot wounds. The right ventricle was the most common site of injury, accounting for 41% of cases, while the left ventricle, both ventricles and other sites accounted for 27%, 17% and 14%, respectively. Ninety per cent of the group was subjected to emergency thoracotomy; mortality of the entire group was 48%, including one patient who had TTUS.Conclusions:
This review demonstrates that cardiac injuries remain lethal, diagnosis is largely clinical and TTUS may be over-utilized, having little impact on clinical outcome of patients presenting with this injury. 相似文献17.
OBJECTIVE--To determine the impact of the pneumatic antishock garment on survival in patients with cardiac wounds. DESIGN--A retrospective review of a 6.5-year experience in a population of patients with gunshot or stab wounds to the heart (N = 70). SETTING--The city and county of Denver, Colo, where all patients were transported by paramedic ambulances to Denver General Hospital, an urban, level 1 trauma center. PATIENTS--All patients were analyzed, including those transported to the emergency department with no vital signs at the trauma scene. Only patients with definite penetrating cardiac injuries were included. METHODS--Paramedic trip sheets and emergency department, operating room, in-hospital, and autopsy records were reviewed. Demographic, clinical outcome, and treatment data were collected. A multiple logistic regression model was developed to determine which characteristics and treatment variables were independently predictive of patient outcome. The ability of each independent variable to predict outcome was determined by calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS--Seventy patients (31 gunshot and 39 stab wounds) had a revised trauma score of 2.8 +/- 4.0 (mean +/- SD; range, 0-12; median, 0). Thirty-two (46%) had cardiac tamponade. Overall, 21 (30%) of the patients survived. In the logistic model, the presence of cardiac tamponade (OR, 9.1; 95% CI, 1.5 to 56.1) and a higher revised trauma score were associated with higher survival. Inflation of the pneumatic antishock garment was associated with sevenfold lower survival (adjusted OR, 0.14; 95% CI, 0.02 to 0.86); the effect was negative across all trauma score groups. CONCLUSION.--Survival in patients with penetrating cardiac wounds is highly associated with anatomic and physiologic factors, while application of the pneumatic antishock garment appears to be detrimental. 相似文献
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目的总结胸部创伤的诊治经验.方法回顾性分析1990年1月至1997年9月我院收治的232例胸部创伤病人.结果平均年龄33.9岁,男女比例5.4:1;致伤原因以车祸及刀刺伤为主,各占36.2%和24.6%.其中连枷胸20例,膈肌损伤9例,心脏刀刺伤4例,其它严重胸外伤37例.合并其它部位损伤84例,占36.2%.治愈221例(占有95.2%),死亡10例(占4.3%),出现各种并发症72例次.结论(1)疑有心脏锐器伤者,直接送入手术室有助于提高抢救成功率.(2)创伤性膈破裂者,X线及床旁B超检查有较高的阳性率.(3)肺挫伤者应重视急性呼吸窘迫综合症(ARDS)的预防.(4)连枷胸的治疗应在重视肺挫伤治疗的基础上,采取各种措施最大限度地减轻连枷胸的损害. 相似文献
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目的:分析并探讨四维超声时空关联成像(STIC)技术对胎儿心脏畸形的特点及诊断价值。方法对2009年6月~2013年7月珠海市妇幼保健院入院检查的2000例孕妇的临床资料进行回顾性分析,统计二维及四维超声诊断胎儿心脏畸形的确诊人数和检出阳性率。结果2000例孕妇共检查出胎儿心脏畸形21例(1.05%)。21例心脏畸形胎儿中经四维超声STIC技术诊断检出18例,其检出阳性率为85.7%;经二维超声诊断检出16例,检出阳性率为76.2%。二者联合诊断下检出20例。联合诊断的诊断阳性率高于单一四维超声STIC技术诊断和单一二维超声诊断,差异有统计学意义(P<0.05)。单一四维超声STIC技术诊断和单一二维超声诊断二者诊断阳性率间的差异无统计学意义。结论四维超声STIC技术成像动态形象,准确率高,可以作为临床上诊断胎儿心脏畸形的首选检查方法。四维超声STIC技术联合二维超声诊断胎儿心脏畸形检出阳性率高,可以作为常规诊疗手段协助临床初筛,指导早期对症治疗。 相似文献
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心脏占位病变的临床症状复杂,且缺乏行之有效的诊断学方法,给临床的诊断及治疗带来困难。笔者选取3例心脏占位病变(心房血管肉瘤、左室室壁瘤、左室憩室各1例),对比三者的临床特点、影像学检查(包括心脏超声、心脏CT和MRI)、术中所见及术后病理检查结果。分析三者在临床表现、占位病变的形态学、组织学、血流动力学等方面的差异,并以术中所见和病理学检查进一步核实诊断。发现心脏彩超、心脏CT血管成像术及MRI均有助于心脏占位病变的诊断,术前心脏占位病变的准确诊断有利于术式的选择,降低手术风险及有效评估术后转归。 相似文献