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中华卫生应急电子杂志 ›› 2024, Vol. 10 ›› Issue (01) : 5 -9. doi: 10.3877/cma.j.issn.2095-9133.2024.01.002

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提高钝性心脏损伤的早期救治水平
高劲谋1,()   
  1. 1. 400014 重庆,重庆大学附属中心医院、重庆市急救医疗中心创伤科
  • 收稿日期:2024-01-11 出版日期:2024-02-18
  • 通信作者: 高劲谋

Improving the early treatment level of blunt heart injury

Jinmou Gao()   

  • Received:2024-01-11 Published:2024-02-18
  • Corresponding author: Jinmou Gao
引用本文:

高劲谋. 提高钝性心脏损伤的早期救治水平[J]. 中华卫生应急电子杂志, 2024, 10(01): 5-9.

Jinmou Gao. Improving the early treatment level of blunt heart injury[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2024, 10(01): 5-9.

随着交通事故迅速增长,钝性心脏损伤(blunt cardiac injury,BCI)已成为常见损伤,并且是创伤后主要死亡原因之一[1,2]。提高对BCI的认识和诊断治疗水平,以降低其病死率,是摆在创伤外科医师面前一个刻不容缓的任务。

图1 大量血心包患者手术前后X线胸片比较注:a为术前X线片示大量血心包,严重心包压塞;b为急诊手术,控制性心包减压和心脏修补;c为术后2 d;X线片示心包压塞消失
图2 气心包并气胸患者手术前后CT比较注:a为术前轴向位CT示左胸壁塌陷,多根肋骨骨折,皮下气肿,左大量气胸,气心包,心脏右移;b为术前矢状位CT示气心包;c为术后2 d,CT示皮下气肿、左气胸和气心包基本消失,有肺挫伤和少量血胸
图3 血心包患者手术前后CT比较注:a为术前轴向位CT示血心包;b为术前冠状位CT示血心包;c为术后2 d,CT示血心包消失,仅双血胸
图4 心包疝和心脏脱位患者手术前后CT比较注:a为术前CT示心包疝,心脏向左脱位,大血管严重牵拉扭曲;b为紧急手术心脏复位心包修补固定;c为术后3 d,X线片示心脏已复位
图5 急诊室剖胸术成功救治严重心包压塞所致心搏骤停注:a为急诊室剖胸术,紧急心包减压和心脏按压复跳;b为指压破口先做一针U形控制性缝合;c为行确定性心脏修补
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