Usefulness of transthoracic and transoesophageal echocardiography in recognition and management of cardiovascular injuries after blunt chest trauma
Usefulness of transthoracic and transoesophageal echocardiography in recognition and management of cardiovascular injuries after blunt chest trauma
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DOI：
10.1136/hrt.75.3.301
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发表时间：
1996-03-01
期刊：
影响因子：
5.7
通讯作者：
Stritoni, P
中科院分区：
文献类型：
--
作者：
Chirillo, F;Totis, O;Stritoni, P
目的：评估经胸和经食管超声心动图检测严重钝性胸部创伤患者创伤性心血管损伤的诊断潜力。设计：为期三年的前瞻性研究。地点：一个区域心胸中心。患者：134例连续患者（94例男性/40例女性;平均年龄38（SD 14）岁），患有重度钝性胸部创伤（损伤严重程度评分33.5（18.2））。大多数患者（89%）的受害者的机动车accidents. Evaluation，所有患者入院后8小时内进行经胸和经食管超声心动图。主动脉造影在第一个20例，并在进一步的5个模棱两可的cases.Results-transthoracic超声心动图提供了次优图像83例，检测三个主动脉破裂，28心包积液（心包填塞），35左胸腔积液，和15心肌挫伤。经食管超声心动图在131例患者中是可行的，并检测到14个主动脉破裂（13个在峡部），40个心包积液。51例左胸腔积液，34例主动脉周围血肿，45例心肌挫伤，1例右心房撕裂伴心包填塞，1例三尖瓣破裂，1例瓣环破裂导致重度二尖瓣返流。经食管超声心动图检测主动脉破裂的敏感性为93%，特异性为98%，准确性为98%。手术时间明显缩短（30（12）vs 71（21）min;结论经胸超声心动图对严重钝性胸部创伤的诊断率较低，而经食管超声心动图可在床旁短时间内提供准确的诊断，且价格低廉，创伤小，并且不干扰其它诊断或治疗过程。
Objective-To assess the diagnostic potential of transthoracic and transoesophageal echocardiography for the detection of traumatic cardiovascular injuries in patients suffering from severe blunt chest trauma.Design-Prospective study over a three year period.Setting-A regional cardiothoracic centre.Patients-134 consecutive patients (94 M/40 F; mean age 38 (SD 14) years) suffering from severe blunt chest trauma (injury severity score 33.5 (18.2)). Most patients (89%) were victims of motor vehicle accidents.Evaluation-All patients underwent transthoracic and transoesophageal echocardiography within 8 h of admission. Aortography was performed in the first 20 patients and in a further five equivocal cases.Results-Transthoracic echocardiography provided suboptimal images in 83 patients, detecting three aortic ruptures, 28 pericardial effusions (one cardiac tamponade), 35 left pleural effusions, and 15 myocardial contusions. Transoesophageal echocardiography was feasible in 131 patients and detected 14 aortic ruptures (13 at the isthmus), 40 pericardial effusions. 51 left pleural effusions, 34 periaortic haematomas, 45 myocardial contusions, right atrial laceration in one patient with cardiac tamponade, one tricuspid valve rupture, and one severe mitral regurgitation caused by annular disruption. For the detection of aortic rupture transoesophageal echocardiography showed 93% sensitivity, 98% specificity, and 98% accuracy. Time to surgery was significantly shorter (30 (12) v 71 (21) min; P < 0.05) for patients operated on only on the basis of transoesophageal echocardiographic findings.Conclusions-Transthoracic echocardiography has low diagnostic yield in severe blunt chest trauma, while transoesophageal echocardiography provides accurate diagnosis in a short time at the bedside, is inexpensive, minimally invasive, and does not interfere with other diagnostic or therapeutic procedures.