Novosti
Khirurgii

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Year 2018 Vol. 26 No 4

EXCHANGE OF EXPERIENCE

B.Î. ÌATVIYCHUK 1, YU.Y. HOLYK 1, Y.M. KNYSH 2, V.Ò. BOCHAR 1, Ò.Ì. FEDORYSHYN 2

RESULTS OF RENDERING MEDICAL AID TO VICTIMS WITH PENETRATING HEART IINJURIES AT THE GENERAL SURGERY DEPARTMENT

Danylo Halytsky Lviv National Medical University 1,
Communal City Clinical Emergency Hospital 2, Lviv,
Ukraine

Objective. To analyze the results of providing aid to the victims with the heart injuries at the general surgery department.
Methods. The retrospective analysis of the treatment results of 21 victims with penetrating injuries of the heart has been performed. There were 5 (23.8%) patients with stable hemodynamic parameters, 11 (52.4%) – with unstable parameters, 5 (23.8%) were delivered to the hospital in the preagony state. According to the criteria of American Association of Surgery Trauma (AAST), the class I of heart injury was diagnosed in 4 (19%) of the victims, III – in 1 (4.8%), IV – in 5 (23.8%), V – 10 (47.6%), VI – in 1 (4.8%) cases. According to the localization of cardiac trauma the left ventricle was most often damaged – in 10 (47.6%) cases, the left atrium – in 6 (28.6%) and the right ventricle – in 5 (23.8%) cases.
Results. For the access to the heart in 20 patients, the anterolateral thoracotomy in the IV-V intercostal space was applied, only in one case, the bilateral thoracosternotomy («clamshell») was used. 7 (33%) patients died, the cause of death in 4 (19%) was the hemorrhagic shock due to massive blood loss, in 2 (9.5%) - cardiac tamponade, 1 (4.7%) patient died of acute myocardial infarction on the second day after the surgery. Overall postoperative mortality made up 33%. As the analysis demonstrates, the condition of the patient’s hemodynamics determines a differentiated approach to the corresponding diagnostic algorithm. The main method of treatment of heart injuries is emergent thoracotomy, temporary bleeding stop with subsequent suturing the wound of the heart against the background of resuscitation measures.
Conclusions. Survival rate of patients with heart injuries depends on the appropriate evacuation and medical measures at the prehospital stage, compliance with the organizational algorithm of providing medical care and qualification of medical personnel.

Keywords: heart injuries, pericardial wound, cardiac tamponade, hemodynamic stability, hemodynamic instability
p. 502-508 of the original issue
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Address for correspondence:
79010, Ukraine,
Lviv, Pekarskaya Str., 69,
Danylo Halytsky Lviv
National Medical University,
Department of Surgery and Endoscopy
of the Faculty of Post-Graduate Training,
tel. +38 067 977-36-68,
e-mail: bovotar@ukr.net,
Volodymyr B. Bochar
Information about the authors:
Matviychuk Bohdan O., MD, Professor, Head of the Department of Surgery and Endoscopy of the Faculty of Post-Graduate Training, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/0000-0001-5749-0643
Holyk Yurij I., PhD, Assistant of the Department of Surgery and Endoscopy of the Faculty of Post-Graduate Training, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/0000-0002-2367-7204
Knysh Jaroslav M., PhD, Surgeon, the 1st Surgical Unit, Communal City Emergency Hospital, Lviv, Ukraine.
http://orcid.org/0000-0003-0106-3436
Bochar Volodymyr T., PhD, Associate Professor of the Department of Surgery and Endoscopy of the Faculty of Post-Graduate Training, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/0000-0002-5100-8657
Fedoryshyn Taras M., PhD, Surgeon, the 1st Surgical Unit, Communal City Emergency Hospital, Lviv, Ukraine.
http://orcid.org/0000-0002-8683-1221
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