心包开窗术在重度心肌钝挫伤中的治疗作用(1)
[摘要] 目的 研究心包开窗术在重度心肌钝挫伤中的治疗作用。 方法 回顾性分析8例重度的心肌钝挫伤患者救治的临床资料；建立大鼠重度心肌挫伤模型，记录撞伤前、撞伤后3 h及心包开窗术后2 h心率(HR)及左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)，射血分数(EF)、每搏输出量(SV)、左心室收缩压(LVSP)、左心室舒张末期压力(LVEDP)等指标。 结果 急诊心包开窗术8例，抢救成功6例；大鼠撞伤后射血分数(EF)、每搏输出量(SV)、左心室收缩压(LVSP)明显下降，而心率(HR)、左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、左心室舒张末期压力(LVEDP)较前上升(P<0.05)；心包开窗术后大鼠心率明显好转，射血分数(EF)、每搏输出量(SV)、左心室收缩压(LVSP)上升，而左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、左心室舒张末期压力(LVEDP)较撞伤后下降(P<0.05)。 结论 心包开窗术是治疗重度心肌钝挫伤的有效手段。
[关键词] 心包开窗术；心肌钝挫伤；大鼠；动物模型；心脏功能
[中图分类号] R654.2 [文献标识码] B [文章编号] 1673-9701(2017)13-0054-04
[Abstract] Objective To study the therapeutic effect of pericardial fenestration in severe contusion of myocardium. Methods The clinical data of 8 patients with severe myocardium contusion were retrospectively analyzed. The model of severe myocardial contusion in rats was established(LVESV). The indicators including heart rate(HR)， left ventricular end-systolic volume(LVESV)，left ventricular end-diastolic volume (LVEDV)， ejection fraction (EF)， stroke volume (SV)， left ventricular systolic pressure (LVSP) and left ventricular end diastolic pressure (LVEDP) before injury， at 3 h after bruising and at 2 h after pericardial fenestration were recorded. Results There were 8 cases of emergency pericardial fenestration and 6 cases of successful rescue.The ejection fraction (EF)， stroke volume (SV) and left ventricular systolic pressure(LVSP) were significantly decreased in rats after injury (P<0.05). While the heart rate(HR)， left ventricular end-systolic volume(LVESV)， left ventricular end diastolic volume(LVEDV) and left ventricular end diastolic pressure (LVEDP) were increased than those before injury(P<0.05). The heart rate of rats was significantly better，and the ejection fraction(EF)， stroke volume(SV)， left ventricular systolic pressure(LVSP) were increased after pericardial fenestration surgery. While the left ventricular end-systolic volume (LVESV)， left ventricular end diastolic volume (LVEDV)， left ventricular end diastolic pressure(LVEDP) decreased compared with those of the posterior injury(P<0.05). Conclusion Pericardial fenestration is an effective means to treat severe contusion of myocardium.
[Key words] Pericardial fenestration； Myocardial contusion； Rat； Animal model； Cardiac function
胸部创伤的发病率仅次于头部和肢体创伤，而居于第3位.且在严重胸部钝性损伤患者中普遍存在心肌挫伤[1]，严重的心肌挫伤可引起即刻死亡。传统的心肌挫伤治疗方法以保守治疗为主，即卧床休息吸氧、严密监护、营养心肌、对症处理[2-3]。但临床治疗过程中，我们发现重度心肌挫伤患者常合并严重的室壁活动受限，采用保守治疗往往不利于疾病转归。因此对于合并嚴重室壁活动受限的重度心肌钝挫伤患者而言，如何早期更有效的治疗就显得尤为重要。我科于2010年1月～2016年8月共收治合并重度心肌挫伤患者8例，经急诊心包开窗术及围手术期严密监护，取得较满意效果，并通过建立大鼠实验性心肌挫伤模型，观察心包开窗术前后心率变化及左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)，射血分数(EF)、每搏输出量(SV)、左心室收缩压(LVSP)、左心室舒张末期压力(LVEDP)等指标变化，为重度心肌钝挫伤的治疗提供实验依据。, http://www.100md.com(周鑫 潘朝阳 漆滨)
[关键词] 心包开窗术；心肌钝挫伤；大鼠；动物模型；心脏功能
[中图分类号] R654.2 [文献标识码] B [文章编号] 1673-9701(2017)13-0054-04
[Abstract] Objective To study the therapeutic effect of pericardial fenestration in severe contusion of myocardium. Methods The clinical data of 8 patients with severe myocardium contusion were retrospectively analyzed. The model of severe myocardial contusion in rats was established(LVESV). The indicators including heart rate(HR)， left ventricular end-systolic volume(LVESV)，left ventricular end-diastolic volume (LVEDV)， ejection fraction (EF)， stroke volume (SV)， left ventricular systolic pressure (LVSP) and left ventricular end diastolic pressure (LVEDP) before injury， at 3 h after bruising and at 2 h after pericardial fenestration were recorded. Results There were 8 cases of emergency pericardial fenestration and 6 cases of successful rescue.The ejection fraction (EF)， stroke volume (SV) and left ventricular systolic pressure(LVSP) were significantly decreased in rats after injury (P<0.05). While the heart rate(HR)， left ventricular end-systolic volume(LVESV)， left ventricular end diastolic volume(LVEDV) and left ventricular end diastolic pressure (LVEDP) were increased than those before injury(P<0.05). The heart rate of rats was significantly better，and the ejection fraction(EF)， stroke volume(SV)， left ventricular systolic pressure(LVSP) were increased after pericardial fenestration surgery. While the left ventricular end-systolic volume (LVESV)， left ventricular end diastolic volume (LVEDV)， left ventricular end diastolic pressure(LVEDP) decreased compared with those of the posterior injury(P<0.05). Conclusion Pericardial fenestration is an effective means to treat severe contusion of myocardium.
[Key words] Pericardial fenestration； Myocardial contusion； Rat； Animal model； Cardiac function
胸部创伤的发病率仅次于头部和肢体创伤，而居于第3位.且在严重胸部钝性损伤患者中普遍存在心肌挫伤[1]，严重的心肌挫伤可引起即刻死亡。传统的心肌挫伤治疗方法以保守治疗为主，即卧床休息吸氧、严密监护、营养心肌、对症处理[2-3]。但临床治疗过程中，我们发现重度心肌挫伤患者常合并严重的室壁活动受限，采用保守治疗往往不利于疾病转归。因此对于合并嚴重室壁活动受限的重度心肌钝挫伤患者而言，如何早期更有效的治疗就显得尤为重要。我科于2010年1月～2016年8月共收治合并重度心肌挫伤患者8例，经急诊心包开窗术及围手术期严密监护，取得较满意效果，并通过建立大鼠实验性心肌挫伤模型，观察心包开窗术前后心率变化及左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)，射血分数(EF)、每搏输出量(SV)、左心室收缩压(LVSP)、左心室舒张末期压力(LVEDP)等指标变化，为重度心肌钝挫伤的治疗提供实验依据。, http://www.100md.com(周鑫 潘朝阳 漆滨)