CAJ | 학술논문

目的：心脏钝性破裂伤是心脏外伤的一种，多合并其他外伤形成复合伤，诊断困难，病死率高。文中总结16例心脏钝性破裂伤的快速准确诊断及手术治疗的经验体会。方法回顾性分析南京军区南京总医院2006年7月至2013年6月收治的16例心脏钝性破裂伤患者的临床资料。患者为在急诊室经检查结合胸部CT、心脏超声检查进行快速准确诊断，急诊开胸手术修补心脏破口。1例左心室裂伤患者行急诊体外循环下修补，其余15例行非体外循环下修补，其中9例右心室裂伤患者用间断褥式缝合破口，1例合并有右冠状动脉损伤的患者行急诊右冠状动脉搭桥术；4例右心房裂伤的患者行直接往返连续缝合修补；2例右肺静脉开口裂伤患者行间断缝合修补。2例合并二尖瓣腱索断裂的患者未同期处理；2例合并脾破裂腹腔大出血患者在心脏修补完成后行开腹探查及脾切除术。所有患者术后均放置胸腔闭式引流管，密切心电监护，行呼吸机辅助呼吸等治疗。结果16例患者中1例左心室裂伤因术后低心排出量死亡，其余15例均手术修补成功，顺利康复出院。随访1年后2例合并二尖瓣腱索断裂的患者分别于术后1年出现不同程度的活动后心慌、胸闷，均已给予换瓣治疗，其余13例健康状况良好。结论心脏钝性破裂伤的治疗关键在于快速准确的诊断和及时合理的手术治疗。
목적：심장둔성파렬상시심장외상적일충，다합병기타외상형성복합상，진단곤난，병사솔고。문중총결16례심장둔성파렬상적쾌속준학진단급수술치료적경험체회。방법회고성분석남경군구남경총의원2006년7월지2013년6월수치적16례심장둔성파렬상환자적림상자료。환자위재급진실경검사결합흉부CT、심장초성검사진행쾌속준학진단，급진개흉수술수보심장파구。1례좌심실렬상환자행급진체외순배하수보，기여15례행비체외순배하수보，기중9례우심실렬상환자용간단욕식봉합파구，1례합병유우관상동맥손상적환자행급진우관상동맥탑교술；4례우심방렬상적환자행직접왕반련속봉합수보；2례우폐정맥개구렬상환자행간단봉합수보。2례합병이첨판건색단렬적환자미동기처리；2례합병비파렬복강대출혈환자재심장수보완성후행개복탐사급비절제술。소유환자술후균방치흉강폐식인류관，밀절심전감호，행호흡궤보조호흡등치료。결과16례환자중1례좌심실렬상인술후저심배출량사망，기여15례균수술수보성공，순리강복출원。수방1년후2례합병이첨판건색단렬적환자분별우술후1년출현불동정도적활동후심황、흉민，균이급여환판치료，기여13례건강상황량호。결론심장둔성파렬상적치료관건재우쾌속준학적진단화급시합리적수술치료。
other trauma.The diagnosis of blunt cardiac rupture is difficult and the mortality rate is high .The experience of rapid and accurate di-agnosis and operation on 16 cases of blunt cardiac rupture was summarized in this article . Methods The clinical data of 16 cases of blunt cardiac rupture in Nanjing General Hospital of Nanjing Military Region from July 2006 to June 2013 were retrospectively re-viewed.All of the 16 patients were diagnosed by physical examination , chest CT and cardiac ultrasound accurately in the emergency room.The treatment of emergency chest operation was conducted to repair the broken sites of heart .One case with left ventricular rup-ture was treated with emergency repair through cardiopulmonary bypass .The remaining 15 cases were repaired without cardiopulmonary bypass.Nine cases suffered rupture of right ventricle were treated with interrupted mattress sutures , 1 case suffered accompanying inju-ry of the right coronary artery was treated with emergency right coronary artery bypass grafting , 4 cases suffered rupture of right atrium were treated with direct sutures , 2 cases suffered rupture of the opening of pulmonary vein were treated with interrupted mattress su -tures.Two cases combining rupture of mitral chordae tendineae did not receive any special treatmen simultaneously and two cases combining with splenic rupture received laparotomy and splenectomy after cardiosurgery .Thoracic drainage tube , ECG monitoring , ventila-tor assisted breathing and so on were used in all patients . Results <br> One case with left ventricular rupture died of low cardiac output after operation , the rest 15 cases recovered successfully .Two cases combining with mitral chordae tendineae received mitral valve replacement because of mitral severe insufficiency after 1 year. Conclusion Rapid and accurate diagnosis and timely and reasonable operation were the key treatments of blunt cardiac rupture .