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心脏穿透伤快速诊断与救治15例

目的 探讨心脏穿透伤的快速诊断和救治方法，提高抢救成功率。 方法 深圳市第六人民医院1993年5月至2010年5月救治15例心脏穿透伤患者，男13例，女2例；年龄17～40岁，平均年龄25岁。均为锐器伤，伤后至就诊时间20~120 min。典型的临床表现为胸闷，不能平卧，低血压，脉压差小，心音遥远，颈静脉怒张，上腔静脉引流区域广泛瘀血。床旁B超示：心包积液5例；CT检查示：心包积液1例；其余患者均未做辅助检查。临床分型为亚临床型4例，心脏压塞型4例，失血性休克型5例，濒死型2例。除2例濒死型患者在急诊科开胸探查外，其余患者均送手术室。全身麻醉后经第4或第5肋间进胸探查，进胸后如发现心脏有破口或心包张力大呈紫蓝色，即可确定有心脏损伤，剪开心包，迅速找到破口，予以修补；如胸腔出血gt;1 000 ml 予以回输；术后给予抗生素预防感染，注意保护肾、脑功能。 结果 全组生存13例，1例为多发伤合并呼吸窘迫综合征（ARDS）；死亡2例， 1例为濒死型，另1例为失血性休克型。平均住院时间17 d(9～88 d)。随访11例，随访3个月～8年。13例生存患者心功能良好，无后遗症。 结论 根据伤口的部位，临床表现，快速作出诊断并及时手术，是提高心脏穿透伤抢救成功率的关键。

Correlation of Clinical Characteristics and Outcomes with Organ Injury Scaling in Penetrating Cardiac Trauma

Objective To evaluate the relationship of the organ injury scale （OIS） with clinical characteristics and survival in penetrating cardiac trauma patients. Methods A retrospective review identified 224 patients with penetrating cardiac trauma. A grade assigned on the basis of the American Association for the Surgery of Trauma OIS was assigned to each case studied. Clinical data, including Glasgow coma scale（GCS）, revised trauma score（RTS）, injury severity score （ISS）, penetrating thoracic trauma index （PTTI）, penetrating trauma index （PTI）, and outcomes were analyzed for association with OIS grade. Results The majority of patients were either grade Ⅳ/ or Ⅴ , with grade Ⅵ having the highest mortality. Patients of grade Ⅰ to Ⅲ were mostly Sub-clinical type patients, and grade Ⅳ to Ⅵ were mostly pericardial tamponade type and hemorrhagic shock type patients. The OIS grade was significantly negative correlated with postinjury duration and GCS （r=-0. 18, -0.16）, and positive correlated with transfusion, ISS, PTTI, PT1, and death（r=0. 17,0. 22,0. 40,0. 41,0. 29）. Conclusion The OIS appears to correlate with severity of injury and survival, and it may be useful in predicting outcomes in patients with penetrating cardiac injury.

左心室金属异物贯通伤一例

Surgical Emergency Treatment of Penetrating Heart and Great Vessels Trauma: Experience of 26 Patients

目的总结心脏大血管穿透伤的临床特点、早期诊断和救治经验，提高抢救成功率。 方法回顾性分析2007年7月至2014年6月我院26例心脏大血管穿透伤患者的临床资料，男23例、女3例，年龄16～71（22.0±8.4）岁。其中刀刺伤25例，钢锥刺伤1例；心脏穿透伤23例，升主动脉刀刺伤2例，主肺动脉刀刺伤1例；心脏压塞型7例，失血休克型8例，心脏压塞+失血休克型2例，亚临床型9例。26例就诊后30 min至3 h急诊在全身麻醉下行开胸手术治疗，侧开胸手术20例，前正中开胸手术6例，其中2例在体外循环下手术。 结果全组死亡2例，均为失血休克型，1例69岁右心室贯通伤和右冠状动脉主干损伤男性患者术中死于低心排血量综合征，1例38岁右心室前壁穿透伤男性患者术后死于纵隔感染导致的多器官功能衰竭，其余患者痊愈出院，救治成功率达92.3%。18例随访1个月至7年，无后遗症发生。 结论迅速明确伤情，及时诊断，急诊开胸探查是提高心脏大血管穿透伤抢救成功率的关键。

Protective effects of metformin on myocardial injury in patients with COVID-19 combined with coronary heart diseases and diabetes

ObjectiveTo investigate whether metformin has protective effect on myocardial injury in patients with coronavirus disease 2019 (COVID-19) combined with coronary heart diseases and diabetes.MethodsCOVID-19 patients with coronary heart disease and diabetes who were admitted to Tongji Hospital from January 18 to April 25 in 2020 were enrolled. They were divided into a metformin group and a none-metformin group according to whether the metformin was used. The demographic characteristics, clinical symptoms, laboratory parameters, treatment and clinical outcomes of the two groups were analyzed retrospectively.ResultsThere were 29 patients in the metformin group, 3 patients (12.0%, 3/25) suffered myocardial injury and 1 (3.4%) died of acute respiratory failure complicated by septic shock; 67 patients were in the non-metformin group and 24 (37.5%, 24/64) had myocardial injury but 15 died in hospital among whom 1 died of septic shock complicated by disseminated intravascular coagulation, 1 acute respiratory failure complicated by possible cerebral hemorrhage, 2 acute respiratory failure, 1 fulminant myocarditis, 3 acute myocardial infarction and 7 cardiac arrest. The incidence of myocardial injury (12.0% vs. 37.5%, P=0.019), hospital mortality (3.4% vs. 22.4%, P=0.034) and mortality of cardiovascular events (0.0% vs. 16.4%, P=0.049) in the metformin group were significantly lower than those in the non-metformin group. Multivariate analysis showed that the use of insulins (OR=11.235, P=0.003) was an influencing factor for in-hospital mortality of patients. The use of metformin (OR=0.154, P=0.013) was positively correlated with the myocardial injury.ConclusionWhen patients with coronary heart disease and diabetes are infected with COVID-19, metformin can effectively reduce myocardial damage and has a certain effect on reducing hospital mortality. Combined with clinical considerations, it is worthy of popularization.

Progress in the study of mechanisms of cardiac injury induced by infrasound

At present, the potential hazards of infrasound on heart health have been identified in previous studies, but a comprehensive review of its mechanisms is still lacking. Therefore, this paper reviews the direct and indirect effects of infrasound on cardiac function and explores the mechanisms by which it may induce cardiac abnormalities. Additionally, in order to further study infrasound waves and take effective preventive measures, this paper reviews the mechanisms of cardiac cell damage caused by infrasound exposure, including alterations in cell membrane structure, modulation of electrophysiological properties, and the biological effects triggered by neuroendocrine pathways, and assesses the impact of infrasound exposure on public health.