Penatrating cardiac injuries

Mehmet ÖZKAN,Haldun ÖZBERRAK,Sadık ERYILMAZ,Mustafa ŞIRLAK,Tayyar MENGÜBAŞ,Neyyir Tuncay EREN,Refik TAŞÖZ,Atilla ARAL,Tümer ÇORAPÇIOĞLU,Hakkı AKALIN

Abstract

Twelve patients who have been suffered from gunshot wounds and 21 patients who have been suffered from stab wounds, (totally 33 patients) were reviewed. They were classified into 4 groups: In the first group 7 patients (without vital signs ), in the second group 6 patients (agonal) and there were totally 20 patients whose clinics were stable in the third and fourth group. Meanwhile thoracotomy was applied to the 5 of 7 patients (71.43%) in group 1, in emergency operating room, it was done 4 of 15 patients (26.6%) in group 3. While median sternotomy was applied to only 1 patient (143%) in group 1, it was applied to 11 .patients (73.3%) in the third group. Seven of 14 patients (50%) undergoing emergency room thoracotomy survived whereas 16 of 19 patients (84.2%) to whom median sternotomy was applied, survived. Two of 7 patients (28.57%) in group 1,4 of 6 patients (66.6%) in group 2, 12 of 15 patients (80%) in group 3 and 5 of 5 patients (100%) in the fourth group survived. Twentythree of 33 patients (69.7%) was the totally survivors. Gunshot wounds of the heart portend a worse prognosis than stab wounds. Survival of gunshot wound was 41.16% (5 of 12 patients); whereas the same rate was 85.7% (18 of 21 patients) in stab wounds. It is possible to cure the patients who are suffering from penetrating cardiac injury and who are in the first and second group, with the help of the aggressive resuscitation and treatment including emergency room thoracotomy

Özet

Onikisi kurşun ve 21 'i bıçakla olmak üzere 33 penetran kalp yaralanması vakası tedavi edildi. Bu hastalar 4 gruba ayrıldı: l.grup, 7 hasta (vital bulgu yok); 2. grup, 6 hasta (şok tablosunda); 3. ve 4. grupta toplam 20 hasta vardı ve klinik durumları kısmen stabildi. 1. gruptaki 7 hastanın 5'ine (%71,43) acil ameliyathanesinde torakotomi yapılırken, 3. grupta 15 hastanın 4'üne (%26,6) bu işlem uygulanmıştır. 1. grupta sadece tek hastaya mediyan sternotoıni uygulanabilir iken (%14,3), 3. grupta 11 hastaya (%73,3) mediyan sternotomi uygulanmıştır. Acilde torakotomi yapılan 14 hastanın tsi (%50) ölürken, mediyan sternotomi yapılan 19 hastanın 16'sı (%84,2)yaşamıştır. 1. grupta 7 hastanın 2'si (%28,57), 2. grupta 6 hastanın 4'ü (%66,6), 3. grupta 15 hastanın 12'si (%80) ve 4. grupta 5 hastanın 5'i de (%100) yaşamıştır. Toplam yaşayan hasta sayısı ise; 33 hastada 23 (%69,7) 'dür. Kurşun yaralanmalarının prognozu bıçaklanmalardan kötüydü. Kurşunla yaralananlarda yaşam oranı 12'de 5 (%41,6), hasta iken; bıçaklanmalarda bu oran 21'de 18 (%85,7), olarak bulunmuştur. Acil ameliyathanesinde yapılan torakotomi de dahil olmak üzere, agresif bir resüsitasyon ve tedavi yaklaşımıyla, penetran kardiyak yaralanmak grup l ve 2 'deki hastaların daha fazlasını kurtarmak mümkün görünmektedir.