Kamil BOYACIOĞLU, Serkan KETENCİLER, Cihan YÜCEL, İlknur AKDEMİR, Nihan KAYALAR, Vedat ERENTUĞ

Kardiyak Travma Hastalarında Cerrahi Tedavi

Giriş: Penetran travmalar; ateşli silah yaralanması ve kesici alet dahil, kardiyak yaralanmaların esas sebeplerindendir. Bu çalışmanın amacı, kalp travması hastalarının tanı ve cerrahi tedavisini değerlendirmektir. Hastalar ve Yöntem: Kliniğimizde Şubat 2009-Mayıs 2017 tarihleri arasında penetran kardiyak yaralanma nedeniyle opere edilen 48 hasta retrospektif olarak incelendi. Hemodinamik olarak stabil olan hastalara ekokardiyografi, bilgisayarlı tomografi ve laboratuvar çalışmaları yapıldı. Bulgular: Penetran kardiyak yaralanma tanısı ile 48 hasta (45 erkek, 3 kadın; ortalama yaş 29.4 ± 11.1 yıl; dağılım 16-51 yıl) opere edildi. Olguların 46 (%95.8)'sında etyoloji delici kesici alet yaralanmasıydı. 29 (%60.4) hastada kardiyojenik şok mevcuttu. Kırk dört hastaya median sternotomi yapıldı. Hastaların 28 (%58.3)’inde sağ ventrikül yaralanması vardı ve burası en sık yaralanan bölgeydi. En çok yaralanan kalp dışı organ; 15 hasta ile akciğerlerdi. Çalışmamızda mortalite oranı 13 hasta ile %27.1 olarak tespit edildi. Hastaların hemodinamik durumlarının, preoperative CPR gereksinimi olmasının ve preoperative hematokrit değerlerinin mortalite üzerine anlamlı etkileri olduğu bulundu. Sonuç: Penetran kardiyak travmalarda erken tanı ve acil cerrahi girişim hayatta kalım oranlarını arttıracaktır. Hastaların hastaneye varış anındaki hemodinamik durumları prognoz üzerinde belirleyicidir.

Anahtar Kelimeler:

Kalp yaralanmaları, acil tedaviler, penetran yaralanmalar, cerrahi

Surgical Management of Penetrating Cardiac Trauma Patients

Introduction: Penetrating traumas, including gunshot and stab wounds, are the major causes of cardiac trauma. The aim of this study was to evaluate the diagnosis and surgical treatment in penetrating cardiac trauma patients. Patients and Methods: Forty-eight patients who underwent surgery for penetrating cardiac trauma between February 2009 and May 2017 were reviewed retrospectively. Transthoracic echocardiography, computed tomography angiography, and laboratory studies were performed if the patient was hemodynamically stable. Results: A total of 48 patients (45 males, 3 females; mean age 29.4 ± 11.1 years, range 16-51 years) were operated. Etiology was stab wound injury in 46 (95.8%) patients. Twenty-nine (60.4%) patients were in cardiogenic shock. In 44 cases, median sternotomy was performed. The most affected cardiac chamber was the right ventricle in 28 (58.3%) patients. The most common accompanying organ injury was the lungs with 15 patients. The mortality rate was 27.1% with 13 patients. Hemodynamic status of the patient, requirement of preoperative CPR, and preoperative hematocrit levels were found to have a significant effect on mortality. Conclusion: In penetrating cardiac trauma, early diagnosis and emergency surgery will improve overall survival rates. The hemodynamic status of patients on arrival have significant effect on prognosis.

Keywords:

Heart injuries, emergency treatment, penetrting wounds, surgery,

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ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi