心脏穿透性损伤11例诊治分析

目的: 总结心脏穿透性损伤(penetrating card iac traum a,PCT)的诊治体会。方法: 回顾性分析1995年12月~2005年12月手术治疗心脏穿透性损伤11例。术前对10例患者行心包穿刺,9例获阳性结果,经穿刺针放置中心静脉导管入心包引流减压。11例心脏穿透性损伤患者均行手术治疗,手术室剖胸10例,急诊室剖胸手术1例。10例选择左前外侧切口,1例经胸骨正中切口施行手术。结果: 11例均治愈,无并发症。结论: 根据胸壁伤口及临床表现作出早期诊断是心脏穿透伤抢救成功的先决条件。心包穿刺不仅能确立诊断,而且作为术前准备能为手术治疗赢得时间。紧急剖胸手术是心脏穿透性损伤救治成功的关键,应根据心脏伤口的部位、大小选择手术方式。

Analysis of diagnosis and treatment of penetrating cardiac trauma

Objective: To summarize the experience in diagnosis and treatment of penetrating cardic trauma(PCT).Methods: A retrospec-tive study was carried out in 11 PCT patients treated with surgical approaches from December 1995 to December 2005.Pericardiopuncture was performed in 10 patients with a deep venous puncture needle,and 9 cases obtained positive results;a central venous catheter was put in the pericardial cavity of the patients for decompression drainage.All the patients received surgical treatment.Ten patients were operated on in the operating room and one in the emergency room.In this study,anteriolateral thoracotomy was performed in 10 cases and midsternal thoracotomy in one.Results: All the patients were cured,leaving no complications.Conclusions: Early diagnosis is the precondition of successful treatment.Diagnosis is made according to the wound of chest wall and clinical manifestation.Pericardiopuncture can not only confirme the diagnosis,but also win time for the surgery before operation.Emergency thoracotomy is essential for patients with PCT,and the operative approach is based on the site and size of the wound of heart.