心臓外傷に対する手術経験

Experience of Surgical Repair for Cardiac Trauma

心臓外傷は軽症から重症まで多様な病態を呈するが，重症例ではきわめて死亡率が高い．われわれは，過去18年間に7例の重症心臓外傷に対する手術を経験したので報告する．

Cardiac trauma is one of the most lethal injuries. We reported 7 patients with cardiac injuries who underwent surgical repair. They were 4 men and 3 women with a mean age of 64 years. The mechanisms of injuries were blunt trauma by traffic accident in 5 patients and penetrating trauma in 2 patients. The injured cardiac chambers were the right atrium in 2, the right ventricle in 2, the right ventricle and the ascending aorta in 1,the left atrium in 1 and the left ventricle in 1 patient.

The wounds of all patients were repaired by direct suture closure. Only 1 patient with injuries in the right ventricle and the ascending aorta was repaired under cardiopulmonary bypass （CPB）. The patient with right atrial rupture and concomitant pelvic bone fructure died of retroperitoneal hemorrhage. According to the analysis by Trauma and Injury Severity Score （TRISS）, probability of survival （Ps） values ranged from 0.002 to 0.978. A patient with a Ps value of 0.002 died of bleeding. Evaluation of the severity of trauma and injury by TRISS was considered generally reasonable.