查詢結果分析
相關文獻
- Early Detection of Myocardial Contusion in Patients with Blunt Chest Trauma
- Tracheobronchial and Esophageal Rupture after Blunt Chest Trauma--A Case Report
- Blunt Chest Trauma with Cardiac Ruptures in Eastern Taiwan
- Aortic Regurgitation Due to Aortic Root Intimal Tear as a Result of Blunt Chest Trauma
- Isolated Left Diaphragmatic Rupture Following Blunt Chest Trauma
- Blunt Traumatic Rupture of the Aorta
- Post-Traumatic Right Ventricular Pseudoaneurysm as the Result of a Motorcycle Accident--Report of a Case
- Traumatic Pseudoaneurysm of the Superior Mesenteric Artery in a Patient with Blunt Chest Injury
- Overlooked Radiographic Signs of Traumatic Great Vessel Injury: A Diagnostic Pitfall
- 以胸腔鏡手術治療胸部鈍傷之血胸
頁籤選單縮合
題 名 | Early Detection of Myocardial Contusion in Patients with Blunt Chest Trauma=胸部鈍傷病人如何早期預知心肌挫傷 |
---|---|
作 者 | 林廷燦; 姜洪霆; 林少琳; 余國和; 郭獻文; | 書刊名 | Acta Cardiologica Sinica |
卷 期 | 13:3 民86.07-09 |
頁 次 | 頁129-137 |
分類號 | 416.14 |
關鍵詞 | 胸部鈍傷; 心肌挫傷; 創傷嚴重度指數; 明顯心律不整; Blunt chest trauma; Myocardial contusion; Injury severity score; ISS; Significant cardiac arrhythmia; SCA; |
語 文 | 英文(English) |
中文摘要 | 背景:胸部鈍傷會引起心肌挫傷,有時不易引人注意,但其併發症諸如致命性心律不整、心因性休克、心包填塞、心肌梗塞、瓣膜裂損均有所聞,如何早期診療,預防重大心血管事件仍是必需。本篇研究旨在尋找高危險群病人合併有心肌挫傷之病患並分析其在急診之表徵,並且分析心電圖、心肌□(MB)、超音波心圖診斷之敏感度,特異度以及試驗之正確度,提供臨床參考。 方法:本篇為回溯性之分析。總計收集98例胸部鈍傷之病患。包含病史、身體檢查、急診心電圖初始表現,受傷嚴重度評估(ISS),心肌□,以及相關之非侵襲性檢查。診斷心肌挫傷之要是依據心電圖之連續變化,心肌□(CK-MB)之高低。以及必要時心臟超音波之檢查。A組為心肌挫傷組,B組為非心肌挫傷組。另外住院期間發生"明顯"之心律不整為一組,另一組為“無”發作組。提供相關之比較以供參考。另外我們將3種檢查之敏感度、特異度,以及試驗正確度做一評估比較。 結果:其中(A)組32例伴有心肌挫傷,(B)組66例則無心肌挫傷。A組具明顯的心電圖異常而且創傷嚴重指數高達10以上。A組呈現明顯之重大心血管事作有15次急需治療。B組僅有一件心律不整乃非心因性所引起。以上所述對照於B組皆呈現顯著之統計意義。此外住院發生明顯心律不整者,其年齡以及受傷嚴重程度相數皆較高。而且住院日數及接受手術頻數亦較高。統計皆見明顯意義。尤有進者,心電圖、心肌□(MB)以及超音波檢查,其敏感度為76%,78%/100%;其特異度為67%,48%/58%,63%。若以不正常評估而論,則超音波檢查排行第一高達85%。整體而言心電圖、心肌□╱MB及超音波檢查其診斷正確率大數如下:69%,58%/90%,88%。以MB為最高,超音波居次。 結論:急診心電圖異常、創傷指數高達10以上,伴有陽性MB反應以及明顯心律異常者, 是診斷伴有心肌挫傷之重大線索。因此,急診常用之心電圖、OK/MB等可充分判定出高危險之病人進一步接受超音波心圖檢查。而心肌□(MB)以及超音波心圖將是診斷心肌挫傷之二大器。至於三種檢查之正確度仍需大型前瞻性研究來證實。 |
英文摘要 | Background. Blunt chest trauma may involve myocardial injury Early diagnosis and monitoring of these patients are necessary to prevent potentially lethal complications from progressing. This study attempts to define a group of patients at high risk who can be identified from the data available during Emergency Room. Methods. All patients admitted with suspicion of a myocardial contusion over a three-year period were collectively reviewed. Their records were examined for history, physical findings, electrocardiographic (ECG) results, creatine kinase levels, Injury Severity Score (ISS), Diagnosis of a myocardial contusion was made if patients had an ECG consistent with acute injury, or increased creatine kinase MB. Echocardiogram was done selectively based on clinical judgements. The sensitivity and specifity as well as predictive value and test accuracy of three diagnostic tools will be evaluated. Results. A total of 98 patients were evaluated; 32 of these were found to have a myocardial contusion (Group A), with 66 patients placed in Group B (no myocardial contusion, N-MC). Group A patients had an abnormal ECG (P<0.001), and an ISS greater than or equal to 10 (P<0.001). During their subsequent hospital courses, patients with significant cardiac arrhythmia (SCA) episodes were older and had higher ISS scores than those without SCA. The efficacy of laboratory tests (ECG, CPK/MB(±), and Echo) in evaluation of MC was as follows: sensitivity(76%, 78%/100%, and 100%), specificity(67%, 48%/85%, and 63%),and test accuracy(69%, 58%/90%, and 88%). The highest abnormal likelihood ratio of three tests was MB-positive. Next to it was echo exam. As to abnormal predictive value, echo examination stood in first place(85%). Overall, MB-positive and echo examination were the two best tools for diagnosis of MC. Conclusions. Abnormal initial ECG manifestations, higher ISS score(≧10), together with positive MB fraction and subsequent SCA, are the clues to the presence myocardial contusion in emergency practice. These data suggest that a combination of easily obtained variables, in the Emergency Department, could be used to select a population at high risk for myocardial contusion in patients with blunt chest trauma. |
本系統中英文摘要資訊取自各篇刊載內容。