| 摘要: |
| 目的 分析创伤性心脏撕裂患者的临床特征及预后的影响因素。方法 收集美国国家创伤数据库（NTDB）中2012年所有诊断为心脏创伤的成年患者的临床资料，比较其中心脏撕裂伤患者与其他心脏创伤患者的临床特征及预后情况。通过单因素及多因素分析判断心脏撕裂伤患者院内死亡的影响因素。结果 NTDB 2012年收入的全部830 785例创伤患者中心脏创伤患者占0.41%（3 387例），其中心脏撕裂伤患者有1 437例（42.43%），其他心脏创伤患者有1 950例（57.57%）。与其他心脏创伤患者相比，心脏撕裂伤患者表现为年龄较低，白色人种、存在合并症者占比均较低，而男性、无医疗保险者、一级创伤中心及教学医院收治者、火器伤或爆炸伤及切割伤或锐器伤患者、心腔穿透性损伤者、合并胸壁穿透性损伤者、创伤性血气胸或肺挫伤者、接受手术治疗的患者占比均较高，入院时生命体征及创伤评分更危重（P均<0.01）。1 437例患者中467例于院前死亡，507例于院内死亡，463例存活出院。多因素logistic回归分析显示，年龄≥ 50岁、无医疗保险、存在合并症、心脏撕裂伤为交通事故致伤、损伤严重程度评分≥ 25分、发生严重心律失常、合并肺挫伤、入院时收缩压<90 mmHg（1 mmHg=0.133 kPa）、入院时氧饱和度<90%、入院时体温<36℃和进行开胸探查术是成人心脏撕裂伤患者院内死亡的独立危险因素（P均<0.01），心脏撕裂伤为切割或锐器致伤、入院时呼吸频率≥ 20 min-1和进行心脏或心包修补术是成人心脏撕裂伤患者院内死亡的独立保护因素（P均<0.01）。结论 心脏创伤患者中创伤性心脏撕裂发生比例高、患者存活率低，比其他类型心脏损伤更危重，预后影响因素众多，需研究者进一步关注。 |
| 关键词: 心脏创伤 心脏撕裂伤 临床特征 预后 医院死亡率 |
| DOI：10.16781/j.0258-879x.2021.10.1124 |
| 投稿时间：2021-04-23修订日期：2021-08-26 |
| 基金项目:军队后勤科研重大项目（AWS15J002），军队后勤科研重点项目（BWS13J010），上海市领军人才计划（2015044），海军军医大学（第二军医大学）舰载机飞行人才航空医学保障专项，海军军医大学（第二军医大学）长征医院人才建设三年行动计划——"金字塔人才工程"优秀青年医师项目. |
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| Clinical characteristics and prognosis analysis of 1 437 patients with traumatic cardiac laceration |
| WANG Jun-nan1,YANG Qian1,YU Yue1,XI Wang1,CHENG Peng-chao1,WANG Pei1,LI Xiao-guang2*,WANG Zhi-nong1* |
(1. Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University(Second Military Medical University), Shanghai 200003, China;
2. Department of Cardiovascular-Thoracic Surgery, the First Hospital of Sanming, Fujian Medical University, Sanming 365000, Fujian, China
*Corresponding authors) |
| Abstract: |
| Objective To analyze the clinical characteristics and prognostic factors of patients with traumatic cardiac laceration. Methods The clinical data of adult patients diagnosed with cardiac trauma in 2012 were collected from the American National Trauma Data Bank (NTDB) database, and the clinical characteristics and prognosis of cardiac laceration patients and other cardiac trauma patients were compared. The influencing factors of in-hospital death in cardiac laceration patients were determined using univariate and multivariate analyses. Results Among all 830 785 trauma patients in NTDB database in 2012, cardiac trauma patients accounted for 0.41% (3 387 cases), including 1 437 (42.43%) patients with cardiac laceration and 1 950 (57.57%) patients with other cardiac trauma. Compared with other cardiac trauma patients, cardiac laceration patients were characterized with younger age, less White race, less comorbidities, more males, more uninsured, more admitted to level Ⅰ trauma designation and teaching hospitals, more firearm or explosive injury and cutting or piercing instrument injury, more penetrating injury of the cardiac cavity, more associated penetrating injury of the chest wall, traumatic hemothorax/pneumothorax and lung contusion, more surgery treatment, and more serious vital signs and higher trauma scores on admission (all P<0.01). Of the 1 437 patients, 467 were dead on arrival, 507 died in hospital, and the remaining 463 survived and discharged from hospital. Multivariate logistic regression analysis showed that age ≥ 50 years, uninsured, comorbidities, injury due to motor vehicle, injury severity score ≥ 25, severe arrhythmia, associated lung contusion, systolic blood pressure< 90 mmHg (1 mmHg=0.133 kPa), oxygen saturation< 90% and core temperature< 36℃ on admission, and exploratory thoracotomy were independent risk factors for in-hospital death of cardiac laceration patients (all P<0.01). Cutting or piercing instrument injury, respiratory rate on admission ≥ 20 min-1 and cardiac or pericardial repair were independent protective factors for in-hospital death in adult patients with cardiac laceration (all P<0.01). Conclusion The proportion of traumatic cardiac laceration is high and the survival rate is low in cardiac trauma patients. Cardiac laceration is more critical than other cardiac traumas. There are many influencing factors for its prognosis, and more attention should be given to cardiac laceration research. |
| Key words: cardiac trauma cardiac laceration clinical characteristics prognosis hospital mortality |
