Ulus Travma Acil Cerrahi Derg. 2009; 15(4): 362-366

Penetran Kalp Yaralanmalarý; Mortalite Belirleyicilerinin Analizi

Mustafa GÖZ, Ömer Çakýr, Mehmet Nesimi Eren
Dicle Üniversitesi Týp Fakültesi Kalp Ve Damar Cerrahi Ana Bilim Dalý, Diyarbakýr

AMAÇ
Penetran kalp yaralanmalarý, dramatik ve ölümcül travmalardýr. Bu hastalarýn birçoðu, hastaneye ciddi þok veya ölü olarak ulaþýrlar. Erken taný ve ameliyat prognozu belirler. Bu çalýþmada, kliniðimizde tedavi edilen penetran kalp yaralanmalý olgulardaki yaralanma biçimi, acil servise geliþ tablosu, geliþ süresi ile tedavi yaklaþýmlarýnýn morbidite ve mortalite üzerine olan etkileri deðerlendirildi.
GEREÇ VE YÖNTEM
Penetran kalp yaralanmalý 52 hasta retrospektif olarak incelendi. Hastalarýn demografik karekterleri, yaralanmanýn sebepleri, hastaneye geliþ zamaný, acil servis inceleme bulgularý, kullanýlan taný yöntemleri ve uygulanan cerrahi yöntemlerin sonuçlar üzerine etkisi incelendi.
BULGULAR
Erkek-kadýn oraný 48: 4 olup yaþ ortalamasý 27,86±13,73 idi. Kýrk altý hastada (%88,5) delici alet, dört hastada ateþli silah ve iki hastada iyatrojenik yaralanma etyolojide rol oynamaktaydý. Tüm hastalara acil cerrahi giriþim uygulandý. Kardiyak yaralanmalar primer dikiþle tamir edildi. Sekiz olgu ile hastane mortalitesi %15,4 olarak saptandý.
SONUÇ
Penetran kardiyak yaralanmalarda kanama ve/veya tamponad nedeniyle çok kýsa sürede þok geliþebilir. Erken taný ve acil torakotomi penetran kardiyak yaralanma sonrasý hastalarýn yaþamasýnda temel faktörlerdir.

Anahtar Kelimeler: Acil torakotomi, kardiyak tamponad; mortalite belirleyicileri; penetran kalp yaralanmalarý.

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Penetrating Cardiac Injuries; Analysis of The Mortality Predictors.

Mustafa GÖZ, Ömer Çakýr, Mehmet Nesimi Eren
Dicle University School Of Medicine Departement Of Cardiovascular Surgery, Diyarbakýr, Turkey

BACKGROUND
Penetrating cardiac injuries are a dramatic and lethal form of trauma. Most of these patients reach the hospital already dead or in severe shock. The prognosis is determined by early diagnosis and operation. In this study, we discuss the effects of the etiology of trauma, the state of presentation in the emergency department, and the treatment approaches on the morbidity and mortality in penetrating cardiac trauma treated in our clinic.
METHODS
Fifty-two patients treated due to penetrating cardiac injury were investigated retrospectively. Demographic characteristics, etiology of the injury, arrival time at the hospital, physical examination findings in the emergency room, diagnostic methods used, and surgical methods applied were determined along with the results.
RESULTS
The male to female ratio was 48: 4, and mean age was 27.86±13.73. The etiology was stab injury in 46, gun shot injury in four and iatrogenic trauma in two patients. Surgery was applied in emergency condition for all cases. Cardiac injury was repaired using primary repair technique. Hospital mortality was determined as 15.4% (8 patients).
CONCLUSION
Penetrating cardiac injuries lead to shock in a very short period of time because of bleeding and/or pericardial tamponade. Early diagnosis and prompt thoracotomy are the fundamental factors affecting patient outcome after penetrating cardiac injury.

Keywords: Emergency thoracotomy, cardiac tamponade; predictors of mortality; penetrating cardiac injury.

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