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題 名 | Left Atrial Rupture Following Blunt Chest Trauma--A Case Report=胸鈍挫傷引致左心房破裂--一病例報告 |
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作 者 | 郭華基; 蔣臺舟; 周林興; 郝繼隆; 杜和祥; 毛士維; 左安順; 黃奕鐘; |
書刊名 | Acta Cardiologica Sinica |
卷 期 | 14:3 民87.07-09 |
頁 次 | 頁143-148 |
分類號 | 416.262 |
關鍵詞 | 心臟鈍挫傷; 左心耳破裂; 心臟破裂; Blunt cardiac trauma; Left atrial rupture; Rupture of heart; |
語 文 | 英文(English) |
中文摘要 | 背景:胸挫傷合併心臟破裂案例不多,僅有少數倖存者見諸報告,大多數在屍體解剖時才被發現,此類傷患都合併多重器官受傷;故此,臨床上診斷心臟破裂是相當困難。我們在此報告一例左心房破裂,在受傷六天後才發現和治療成功。 方法與治療:一位40歲的男性駕駛發生追撞車禍,致顏面多處嚴重外傷合併休克,胸腔X光檢查,僅發現左側肋骨幾根骨折和心臟稍呈增大,經體液復甦治療,其生命徵象回復穩定,六天後因有心臟衰竭現象,心臟超音波檢查發現左心房內側有裂縫和出血跡象,發生心包膜填塞,經左側開胸手術,無須借助心肺分流,直接成功修補。 結論:對於本例的病程發展,我們假設左心房早在撞擊時便破裂,因裂縫在心耳內側,可能因為裂縫細小和失血量不多,心包膜受創後壓力增加,心房產生壓迫現象,使裂傷處形成血栓,流血暫停;六天後,病患的血動力狀況漸趨穩定,心臟房室之壓力增大,裂傷處血栓又出現軟化,於是再度出血。在辨症上,除仔細推敲,排除各種致命外傷,心臟受傷後症候群亦不容忽略。本例能夠存活的關鍵,我們認為低壓的左心房失血和心包膜完整無缺,成功阻斷心臟的瞬間大量出血。同時,心臟受傷後症候群和穩定的生命象徵,會構成診斷假象,故此,臨床辨症醫者必須具高度警覺性,配合心臟超音波的檢查,可有效降低誤診的機率。 |
英文摘要 | Background. Clinically, it is rare for cardiac rupture to occur in patients with blunt chest trauma. Blunt traumatic rupture of the heart is usually lethal and mostly found at autopsy series. Our report describes a case of left atrial rupture after blunt chest trauma which was failed to be diagnosed in a timely fashion. Methods and Results. A 40 year-old male who was involved in a motor vehicle collision presented with multiple facial lacerations. He was in shock when he arrived at emergency room (ER). The initial chest x-ray (CXR) revealed mild cardiomegaly. The patient was resuscitated with volume challenge and vital signs were maintained stability for six days. The patient developed exertional dyspnea with increased jugular venous pressure. The follow-up CXR revealed that the 2□ to 5□ left ribs were fractured and the size of the heart was increased. The thoracic CT scan noted thickness of pericardium and bilateral pleural effusion. Transthoracic two-dimensional echocardiograms (2-D ECHO) were performed and revealed that patient had detachment of the left atrium from the posterior wall. The patient received left posterolateral thoracotomy to repair the left atrium successfully without cardiopulmonary bypass. Conclusions. Blunt traumatic cardiac rupture can occur in all patients with blunt chest injuries. 2-D ECHO was the effective diagnostic tool in the diagnosis of blunt traumatic left atrial rupture. While sometimes the clinical features of post-cardiac injury syndrome are present, stable hemodynamic and clinical condition of a patient may lead to late diagnosis and management. |