CAJ | 학술논문

目的：探讨闭合性心脏创伤的早期诊断和治疗方法。方法将75例心脏创伤区患者用院前评分中的创伤指数(TI)量化伤情分为轻中度伤(36例)、重度伤(23例)、危重伤组(16例)。胸片、心电图、彩超、血清学检查均在伤后24 h内进行，重点观察患者24 h内、1 d、3 d、5 d的心肌肌钙蛋白I (cTnI)、心肌肌钙蛋白T (cTnT)、血清心肌酶(CK-MB)的动态变化，严密监护及控制心律失常，视病情选择治疗方案。结果本组病例痊愈70例，死亡5例。ECG与血清cTnI、cTnT和CK-MB含量的变化比较，ECG在预测心肌损伤时具有很高的灵敏性，cTnI、cTnT异常时则对心肌损伤具有很高特异性。结论心脏闭合性创伤易误诊、漏诊，cTnI、cTnT、CK-MB和心电图结合影像检查可以大大提高早期诊断准确率。
목적：탐토폐합성심장창상적조기진단화치료방법。방법장75례심장창상구환자용원전평분중적창상지수(TI)양화상정분위경중도상(36례)、중도상(23례)、위중상조(16례)。흉편、심전도、채초、혈청학검사균재상후24 h내진행，중점관찰환자24 h내、1 d、3 d、5 d적심기기개단백I (cTnI)、심기기개단백T (cTnT)、혈청심기매(CK-MB)적동태변화，엄밀감호급공제심률실상，시병정선택치료방안。결과본조병례전유70례，사망5례。ECG여혈청cTnI、cTnT화CK-MB함량적변화비교，ECG재예측심기손상시구유흔고적령민성，cTnI、cTnT이상시칙대심기손상구유흔고특이성。결론심장폐합성창상역오진、루진，cTnI、cTnT、CK-MB화심전도결합영상검사가이대대제고조기진단준학솔。
Objective To investigate the early diagnosis and treatment of nonpenetrating cardiac trauma. Methods Seventy-five patients with cardiac trauma quantified by the score in pre-hospital trauma index (TI) were divid-ed into three groups:mild to moderate injury group (n=36), severe injury group (n=23), and critical injury group (n=16). X-ray chest film, electrocardiogram, ultrasound, serum examination were checked within 24 hours after injury. The dynam-ic changes of cardiac troponin I (cTnI), cardiac troponin T (cTnT), cardiac enzymes (CK-MB) within 24 h, 1 d, 3 d, 5 d were observed. Intensive care, control of arrhythmia, and appropriate treatment were performed. Results Seventy patients were cured and 5 died. ECG was found more sensitive than cTnI, cTnT, CK-MB in the evaluation of cardiac trauma, while cTnI, cTnT were more specific when they were abnormal. Conclusion Nonpenetrating cardiac trauma is often misdi-agnosed or ignored. The combined detection of cTnI, cTnT, CK-MB and ECG, as well as imaging can greatly improve the accuracy of early diagnosis.