[Abstract] OBJECTIVE: To explore the principles of early diagnosis and treatment of cardiac penetrating injuries. METHODS: To retrospectively analyze the clinical data of 29 cases of cardiac penetrating injuries admitted to our hospital from 1995 to 2010, 22 cases in men and 7 cases in women. The age ranged from 17 to 50 years old, with an average of 31 years old. Results: There was one case of death in the whole group, and the rest were successfully rescued. Conclusion: Pay attention to pre-hospital emergency and transport, and shorten the time from injury to surgery as much as possible. The diagnosis of cardiac trauma should be determined as soon as possible and immediate surgery should be performed to improve the success rate of resuscitation. Cardiac penetrating injury is an acute and critical condition in chest trauma, which can lead to pericardial tamponade and hemorrhagic shock, and the mortality rate is extremely high. Prompt diagnosis and correct treatment are the fundamental guarantee of successful resuscitation. Rapid preoperative preparation, correct surgical approach, intraoperative operation, effective cardiopulmonary resuscitation, and avoidance of missed combined injuries can improve the treatment outcome. From 1995 to 2010, 29 cases of penetrating cardiac injuries were treated in our hospital, and they are reported as follows. 1 Clinical data 1.1 General information There were 22 male cases and 7 female cases in this group. The age ranged from 17 to 50 years old, with an average of 31 years old. Causes of injury: 25 cases of sharp-edged injuries, 2 cases of wire collapse injuries, 2 cases of heart rupture due to fall injuries, 11 cases of wounds located in the left anterior chest wall, 5 cases in the left chest wall, 9 cases in the subsquamous and right chest wall. The time from injury to consultation was 30 min~4 h, and the time from injury to surgery was 1~6 h. 22 cases had obvious pericardial effusion suggested by cardiac ultrasonography, 8 cases had obvious widening of heart shadow suggested by chest radiography, and 6 cases had pericardial cavity effusion shown by chest CT. 1.2 Clinical manifestations The main manifestations of penetrating cardiac injury were pericardial tamponade and hemorrhagic shock. All patients had chest pain, chest tightness, shortness of breath, irritability, pallor, and decreased blood pressure. 6 cases were clear, 4 cases were confused, and 5 cases had indifferent expression. 1.3 Intraoperative observations All cases in this group were confirmed to have different degrees of pericardial blood accumulation after chest opening, with the volume of blood accumulation ranging from 100 to 600 ml, with 16 cases in the right ventricle, 2 cases in the left ventricle, and 11 cases in the right atrium as the site of heart injury. There were 10 cases of combined hemopneumothorax, 2 cases of liver laceration, and 7 cases of lung laceration. 1.4 Treatment All the patients in the group were given oxygen immediately after arriving at the emergency room, and blood and fluids were quickly established through intravenous infusion. 7 cases were treated with closed chest drainage in the emergency room, and the surface of the heart was carefully probed for fibrillation after successful repair of the heart rupture, and attention was paid to analyzing whether there was a combined intracardiac injury, and repair was performed under extracorporeal circulation if necessary. 2 Results One case of death in this group was a high school student who died of respiratory and cardiac arrest when he was stabbed in the emergency room, and died after chest compressions and electric defibrillation. The remaining 28 patients were successfully resuscitated. Patients with wire disintegration injuries were identified by chest X-ray and cardiac ultrasonography as having wire disintegration into the right atrium, and the wire was successfully found by incision of the right atrium after routine establishment of extracorporeal circulation. All cured patients were discharged without serious complications. They were able to participate in normal physical work. 3 Discussion Cardiac penetrating injury is a serious and fast developing disease, with the risk of cardiac arrest, which makes it difficult to save. The pre-hospital mortality rate of cardiac penetrating injuries is as high as 62% to 84%, and most of the patients died before admission to the hospital. Prompt and correct diagnosis and surgical treatment on admission is the key to successful treatment. Arikan et al. suggest that early presentation of wounds in the cardiac projection should be performed in the operating room under local anesthesia and with a local anaesthetic exploration. local anesthesia in the operating room for dilation and exploration. The diagnosis is easier in patients with a clear history of trauma and a distinct clinical presentation. The clinical manifestations of penetrating cardiac injuries may include pericardial tamponade and shock. Pericardial tamponade is mainly due to the accumulation of blood in the pericardium resulting in increased intrapericardial pressure, which manifests as Beck’s triad, i.e. hypotension, jugular venous irritation, and low heart sounds. Typical Beck’s triad is seen in only 35% to 45% of patients. If a patient with a compound injury has severe hypotension that is not compatible with the degree of injury, the possibility of cardiac rupture should be thought of. Shock is mainly caused by excessive blood loss and can be clinically associated with palpitations, shortness of breath, decreased blood pressure, and rapid heart rate. Rozycki et al. reported that cardiac ultrasonography can rapidly, accurately, and specifically detect cardiac compression, intrapericardial hematoma, hemopneumothorax, and cardiac macrovascular injury. However, for patients with cardiac trauma who are critically ill, a large number of tests should never be done to clarify the diagnosis and delay resuscitation. The subclinical type lacks clinical manifestations of circulatory disorders, which can easily delay resuscitation or even lead to death, and the chest wall wound is the only clue to the diagnosis; the cardiac compression type often requires emergency chest opening to relieve pressure; the hemorrhagic shock type must ensure rapid blood volume replenishment while emergency chest opening. We have learned that patients with cardiac compression type and hemorrhagic shock type of cardiac penetrating injury, such as in a state of frequent death, should also be actively resuscitated, do not easily give up. Once the diagnosis is clear, decisive open-heart surgery must be performed to lift the pericardial compression and suture the heart rupture, the surgical incision depends on the chest wound and the estimated site of heart injury, in order to approach and fully expose the heart rupture as soon as possible, generally choose the left or right side of the 4th and 5th intercostal incision into the chest, if it is estimated that the condition is serious or estimated that the heart rupture is difficult to expose can choose the middle sternal incision, cut the pericardium should be gentle movements, The pericardium should be incised gently, avoiding the original wound as much as possible, and optional in its vicinity, in order to avoid incomplete incision of the pericardium and uncontrollable hemorrhage of the heart again. Avoid damaging the phrenic nerve when cutting the pericardium. If cardiac arrest occurs during pericardiotomy, cardiac compressions and other resuscitation measures should be performed immediately. When repairing a heart rupture, first press the rupture with your finger to stop bleeding, and if the rupture is small, use non-traumatic thread with spacers to close it directly. If it is difficult to suture directly, a heart patch can be added. For the rupture near the coronary artery, try to avoid injuring the coronary vessels when repairing, and submerged mattress sutures can be used to stop bleeding in the deep coronary vessels. In case of combined coronary artery injury, small branches can be directly ligated to stop bleeding, while large trunk bleeding requires coronary artery bypass grafting or fracture repair under extracorporeal circulation. After successful repair of the ruptured heart, the heart surface is carefully probed for tremor, and attention is paid to analyze whether there is combined intracardiac injury, such as ventricular septal rupture and heart valve injury, which can be repaired under extracorporeal circulation if necessary. For larger ruptured ventricular septal defects, if the patient develops left heart failure, repair should be performed under extracorporeal circulation. If the ruptured septal defect is small or if the patient does not have severe heart failure, the defect can be temporarily left unrepaired and repaired by elective surgery 2-3 months later, and small septal defects may close on their own. Cardiac rupture injuries are often associated with varying degrees of myocardial contusion, and intraoperative and postoperative arrhythmias and cardiac insufficiency often occur. This requires close observation, maintenance of acid-base and electrolyte balance, and protection of heart, lung, liver, kidney, and brain functions.