nmpЖурнал им. Н.В. Склифосовского «Неотложная медицинская помощь»Russian Sklifosovsky Journal "Emergency Medical Care"2223-90222541-8017“N.V. Sklifosovsky Research Institute for Emergency Medicine”nmp-12Research ArticleВ ПОМОЩЬ ПРАКТИКУЮЩЕМУ ВРАЧУFOR PRACTICING PHYSICIANSАЛГОРИТМ ВЕДЕНИЯ БОЛЬНЫХ С ПРЕДПОЛАГАЕМЫМ ЗАКРЫТЫМ ПОВРЕЖДЕНИЕМ СЕРДЦАALGORITHM OF MANAGEMENT OF PATIENTS WITH SUSPECTED BLUNT CARDIAC TRAUMAГиляревскийС. Р.GilarevskyS. R.

д.м.н., профессор старший научный сотрудник отделения неотложной кардиологии для больных инфарктом миокарда

sgilarevsky@rambler.ruКосолаповД. А.KosolapovD. A.ИвановП. А.IvanovP. A.КузьминаИ. М.KuzminaI. M.ЛопотовскийП. Ю.LopotovskiyP. Yu.ШабановА. К.ShabanovA. K.БатуринаО. В.BaturinaO. V.НИИ скорой помощи им. Н.В. Склифосовского ДЗ г. Москвы, МоскваРоссияSklifosovsky Research Institute for Emergency Medicine of Health Department of Moscow, MoscowRussian Federation201320022016015561Copyright © Гиляревский С.Р., Косолапов Д.А., Иванов П.А., Кузьмина И.М., Лопотовский П.Ю., Шабанов А.К., Батурина О.В., 20162016Гиляревский С.Р., Косолапов Д.А., Иванов П.А., Кузьмина И.М., Лопотовский П.Ю., Шабанов А.К., Батурина О.В.Gilarevsky S.R., Kosolapov D.A., Ivanov P.A., Kuzmina I.M., Lopotovskiy P.Y., Shabanov A.K., Baturina O.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jnmp.ru/jour/article/view/12

Резюме. В статье рассмотрен современный алгоритм обследования пострадавших, у которых предполагается закрытое повреждение сердца. Освещены также общие подходы к наблюдению и лечению пострадавших с закрытым повреждением сердца. 

Abstract. Contemporary algorithm of diagnostic examination of patients with suspected blunt cardiac trauma is presented. General aspects of monitoring and treatment of such patients are also discussed. 

закрытое повреждение сердцаалгоритм веденияblunt cardiac traumaalgorithm of managementReferencesEl-Menyar A., Al Thani H., Zarour A., Latifi R. Understanding traumatic blunt cardiac injury // Ann Card Anaesth. – 2012. – Vol. 15, N. 4. – P. 287–295.El-Menyar A., Al Thani H., Zarour A., Latifi R. Understanding traumatic blunt cardiac injury // Ann Card Anaesth. – 2012. – Vol. 15, N. 4. – P. 287–295.Elie M.C. Blunt cardiac injury // Mt Sinai J. Med. – 2006. – Vol. 73, N. 2. – P. 542–552.Elie M.C. Blunt cardiac injury // Mt Sinai J. Med. – 2006. – Vol. 73, N. 2. – P. 542–552.Schultz J.M., Trunkey D.D. Blunt cardiac injury // Crit Care Clin. – 2004. – Vol. 20, N. 1. – P. 57–70.Schultz J.M., Trunkey D.D. Blunt cardiac injury // Crit Care Clin. – 2004. – Vol. 20, N. 1. – P. 57–70.Ismailov R.M., Weiss H.B., Ness R.B., et al. Blunt cardiac injury associated with cardiac valve insufficiency: Trauma links to chronic disease? // Injury. – 2005. – Vol. 36, N. 9. – P. 1022–1028.Ismailov R.M., Weiss H.B., Ness R.B., et al. Blunt cardiac injury associated with cardiac valve insufficiency: Trauma links to chronic disease? // Injury. – 2005. – Vol. 36, N. 9. – P. 1022–1028.Kutsukata N., Sakamoto Y., Mashiko K., Ochi M. Morphological evaluation of areas of damage in blunt cardiac injury and investigation of traffic accident research // Gen.Thorac. Cardiovasc. Surg. – 2012. – Vol. 60, N. 1. – P. 31–35.Kutsukata N., Sakamoto Y., Mashiko K., Ochi M. Morphological evaluation of areas of damage in blunt cardiac injury and investigation of traffic accident research // Gen.Thorac. Cardiovasc. Surg. – 2012. – Vol. 60, N. 1. – P. 31–35.Maron B.J., Estes N.A. 3rd. Commotio cordis // N. Engl. J. Med. – 2010. – Vol. 362, N. 10. – P. 917–927.Maron B.J., Estes N.A. 3rd. Commotio cordis // N. Engl. J. Med. – 2010. – Vol. 362, N. 10. – P. 917–927.Marshall D.T. Gilbert J.D., Byard R.W. The spectrum of findings in cases of sudden death due to blunt cardiac trauma-’commotio cordis // Am. J. Forensic. Med. Pathol. – 2008. – Vol. 29, N. 1. – P. 1–4.Marshall D.T. Gilbert J.D., Byard R.W. The spectrum of findings in cases of sudden death due to blunt cardiac trauma-’commotio cordis // Am. J. Forensic. Med. Pathol. – 2008. – Vol. 29, N. 1. – P. 1–4.Kato K., Kushimoto S., Mashiko K., et al. Blunt traumatic rupture of the heart: An experience in Tokyo // J. Trauma. – 1994. – Vol. 36, N. 6. – P. 859–863.Kato K., Kushimoto S., Mashiko K., et al. Blunt traumatic rupture of the heart: An experience in Tokyo // J. Trauma. – 1994. – Vol. 36, N. 6. – P. 859–863.Nan Y.Y., Lu M.S., Liu K.S., et al. Blunt traumatic cardiac rupture: Therapeutic options and outcomes // Injury. – 2009. – Vol. 40. – P. 938–945.Nan Y.Y., Lu M.S., Liu K.S., et al. Blunt traumatic cardiac rupture: Therapeutic options and outcomes // Injury. – 2009. – Vol. 40. – P. 938–945.Fegheli N.T., Prisant L.M. Blunt myocardial injury // Chest. – 1995. – Vol. 108, N. 6. – P. 1673–1677.Fegheli N.T., Prisant L.M. Blunt myocardial injury // Chest. – 1995. – Vol. 108, N. 6. – P. 1673–1677.Bansal M.K., Maraj S., Chewaproug D., Amanullah A. Myocardial contusion injury: Redefining the diagnostic algorithm // Em. Med. J. – 2005. – Vol. 22, N. 7. – P. 465–469.Bansal M.K., Maraj S., Chewaproug D., Amanullah A. Myocardial contusion injury: Redefining the diagnostic algorithm // Em. Med. J. – 2005. – Vol. 22, N. 7. – P. 465–469.Brathwaite C.E., Rodriguez A., Turney S.Z., et al. Blunt traumatic cardiac rupture. A 5-year experience // Ann. Surg. – 1990. – Vol. 212, N. 6. – P. 701–704.Brathwaite C.E., Rodriguez A., Turney S.Z., et al. Blunt traumatic cardiac rupture. A 5-year experience // Ann. Surg. – 1990. – Vol. 212, N. 6. – P. 701–704.Nagy K., Fabian T., Rodman G., et al. Guidelines for the diagnosis and management of blunt aortic injury: An EAST Practice Management Guidelines Work Group // J. Trauma. – 2000. – Vol. 48, N. 6. – P. 1128– 1143.Nagy K., Fabian T., Rodman G., et al. Guidelines for the diagnosis and management of blunt aortic injury: An EAST Practice Management Guidelines Work Group // J. Trauma. – 2000. – Vol. 48, N. 6. – P. 1128– 1143.Fabian T.C., Richardson J.D., Croce M.A., et al. Prospective study of blunt aortic injury: Multicenter Trial of the American Association for the Surgery ofTrauma // J. Trauma. – 1997. – Vol. 42, N. 3. – P. 374–380.Fabian T.C., Richardson J.D., Croce M.A., et al. Prospective study of blunt aortic injury: Multicenter Trial of the American Association for the Surgery ofTrauma // J. Trauma. – 1997. – Vol. 42, N. 3. – P. 374–380.Cameron P.A., Dziukas L., Hadj A., et al. Aortic Transection // Aust. NZJ Surg. – 1998. – Vol. 68, N. 4. – P. 264–267.Cameron P.A., Dziukas L., Hadj A., et al. Aortic Transection // Aust. NZJ Surg. – 1998. – Vol. 68, N. 4. – P. 264–267.Katyal D., McLellan B.A., Brenneman F.D., et al. Lateral impact motorvehicle collisions: Significant cause of blunt traumatic rupture of the thoracic aorta // J. Trauma. – 1997. – Vol. 42, N. 5. – P. 769–772.Katyal D., McLellan B.A., Brenneman F.D., et al. Lateral impact motorvehicle collisions: Significant cause of blunt traumatic rupture of the thoracic aorta // J. Trauma. – 1997. – Vol. 42, N. 5. – P. 769–772.Sherren P.B., Galloway R., Healy M. Blunt traumatic pericardial rupture and cardiac herniation with a penetrating twist: Two case reports // Scand. J. Trauma Resusc. Emerg. Med. – 2009. – Vol. 17. – P. 64.Sherren P.B., Galloway R., Healy M. Blunt traumatic pericardial rupture and cardiac herniation with a penetrating twist: Two case reports // Scand. J. Trauma Resusc. Emerg. Med. – 2009. – Vol. 17. – P. 64.Fulda G., Brathwaite C.E., Rodriguez A., et al. Blunt traumatic rupture of the heart and the pericardium: A ten-year experience (1979–1989) // J. Trauma. – 1991. – Vol. 31, N. 2. – P. 167–73.Fulda G., Brathwaite C.E., Rodriguez A., et al. Blunt traumatic rupture of the heart and the pericardium: A ten-year experience (1979–1989) // J. Trauma. – 1991. – Vol. 31, N. 2. – P. 167–73.Farhataziz N., Landay M. Pericardial rupture after blunt chest trauma // J. Thorac. Imaging. – 2005. – Vol. 20, N. 1. – P. 50–52.Farhataziz N., Landay M. Pericardial rupture after blunt chest trauma // J. Thorac. Imaging. – 2005. – Vol. 20, N. 1. – P. 50–52.Sohn J.H., Sohn J.W., Seo J.B., et al. Case report: pericardial rupture and cardiac herniation after blunt trauma: A case diagnosed using cardiac MRI // Br. J. Radiol. – 2005. – Vol. 78, N. 929. – P. 447–449.Sohn J.H., Sohn J.W., Seo J.B., et al. Case report: pericardial rupture and cardiac herniation after blunt trauma: A case diagnosed using cardiac MRI // Br. J. Radiol. – 2005. – Vol. 78, N. 929. – P. 447–449.Huang Y.K., Lu M.S., Liu K.S., et al. Traumatic pericardial effusion: Impact of diagnostic and surgical approaches // Resuscitation. – 2010. – Vol. 81, N. 12. – P. 1682–1686.Huang Y.K., Lu M.S., Liu K.S., et al. Traumatic pericardial effusion: Impact of diagnostic and surgical approaches // Resuscitation. – 2010. – Vol. 81, N. 12. – P. 1682–1686.Degiannis E., Loogna P., Doll D., et al. Penetrating cardiac injuries: Recent experience in South Africa // World J. Surg. – 2006. – Vol. 30, N. 7. – P. 1258–1264.Degiannis E., Loogna P., Doll D., et al. Penetrating cardiac injuries: Recent experience in South Africa // World J. Surg. – 2006. – Vol. 30, N. 7. – P. 1258–1264.El-Menyar A., Shaikh N. Necrotizing fasciitis causing severe myocardial dysfunction with ST-segment elevation in a young man // Am. J. Emerg. Med. – 2010. – Vol. 28, N. 2. – P. 260.e3–260.e5.El-Menyar A., Shaikh N. Necrotizing fasciitis causing severe myocardial dysfunction with ST-segment elevation in a young man // Am. J. Emerg. Med. – 2010. – Vol. 28, N. 2. – P. 260.e3–260.e5.Prasad A., Lerman A., Rihal C.S. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): A mimic of acute myocardial Infarction // Am. Heart J. – 2008. – Vol. 155, N. 3. – P. 408–417.Prasad A., Lerman A., Rihal C.S. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): A mimic of acute myocardial Infarction // Am. Heart J. – 2008. – Vol. 155, N. 3. – P. 408–417.Parry G.W., Wilkinson G.A. Traumatic aortic regurgitation // Injury. – 1997. – Vol. 28, N. 9–10. – P. 679–680.Parry G.W., Wilkinson G.A. Traumatic aortic regurgitation // Injury. – 1997. – Vol. 28, N. 9–10. – P. 679–680.Khurana S., Puri R., Wong D., et al. Latent tricuspid valve rupture after motor vehicle accident and routine echocardiography in all chest-wall traumas //Tex Heart Inst J. – 2009. – Vol. 36, N. 6. – P. 615–617.Khurana S., Puri R., Wong D., et al. Latent tricuspid valve rupture after motor vehicle accident and routine echocardiography in all chest-wall traumas //Tex Heart Inst J. – 2009. – Vol. 36, N. 6. – P. 615–617.Hermens J.A., Wajon E.M., GrandjeanJ.G., et al. Delayed cardiac tamponade in a patient with previous minor blunt chest trauma // Int. J. Cardiol. – 2009. – Vol. 131, N. 3. – P. e124–e126.Hermens J.A., Wajon E.M., GrandjeanJ.G., et al. Delayed cardiac tamponade in a patient with previous minor blunt chest trauma // Int. J. Cardiol. – 2009. – Vol. 131, N. 3. – P. e124–e126.Dunsire M.R., Field J., Valentine S. Delayed diagnosis ofcardiac tamponade following isolated blunt abdominal trauma // Br J Anaesth. – 2001. – Vol. 87, N. 2. – P. 309–312.Dunsire M.R., Field J., Valentine S. Delayed diagnosis ofcardiac tamponade following isolated blunt abdominal trauma // Br J Anaesth. – 2001. – Vol. 87, N. 2. – P. 309–312.Pasquale N.K., Clarke J., Nagy K. Practice management guidelines for screening of blunt cardiac injury. – EAST, 1998. – 22 c.Pasquale N.K., Clarke J., Nagy K. Practice management guidelines for screening of blunt cardiac injury. – EAST, 1998. – 22 c.Paone R.R., Peacock J.B., Smith D.L. Diagnosis of myocardial contusion // South Med. J. – 1993. – Vol. 86, N. 8. – P. 867–870.Paone R.R., Peacock J.B., Smith D.L. Diagnosis of myocardial contusion // South Med. J. – 1993. – Vol. 86, N. 8. – P. 867–870.Salim A., Velmahos G.C., Jindal A., et al. Clinically significant blunt cardiac trauma: Role of serum troponin levels combined with electrocardiographic findings // J. Trauma. – 2001. – Vol. 50, N. 2. – P. 237–243.Salim A., Velmahos G.C., Jindal A., et al. Clinically significant blunt cardiac trauma: Role of serum troponin levels combined with electrocardiographic findings // J. Trauma. – 2001. – Vol. 50, N. 2. – P. 237–243.Illig K.A., Swierzewski M.J., Feliciano D.V., Morton J.H. A rational screening and treatment strategy based on the electrocardiogram alone for suspected cardiac contusion // Am. J. Surg. – 1991. – Vol. 162, N. 2. – P. 537–543.Illig K.A., Swierzewski M.J., Feliciano D.V., Morton J.H. A rational screening and treatment strategy based on the electrocardiogram alone for suspected cardiac contusion // Am. J. Surg. – 1991. – Vol. 162, N. 2. – P. 537–543.Nagy K.K., Krosner S.M., Roberts R.R., et al. Determining which patients require evaluation for blunt cardiac injury following blunt chest trauma // World J. Surg. – 2001. – Vol. 25, N. 1. – P. 108–111.Nagy K.K., Krosner S.M., Roberts R.R., et al. Determining which patients require evaluation for blunt cardiac injury following blunt chest trauma // World J. Surg. – 2001. – Vol. 25, N. 1. – P. 108–111.Labovitz A.J., Noble V.E., Bierig M., et al. Focused cardiac ultrasound in the emergent setting: A consensus statement of the American Society of Echocardiography and American College of Emergency Physicians // J. Am. Soc. Echocardiogr. – 2010. – Vol. 23, N. 12. – P. 1225–1230.Labovitz A.J., Noble V.E., Bierig M., et al. Focused cardiac ultrasound in the emergent setting: A consensus statement of the American Society of Echocardiography and American College of Emergency Physicians // J. Am. Soc. Echocardiogr. – 2010. – Vol. 23, N. 12. – P. 1225–1230.Moore E.E., Malangoni M.A., Cogbill T.H., et al. Organ injury scaling. IV: Thoracic vascular, lung, cardiac, and diaphragm // J. Trauma. – 1994. – Vol. 36, N. 3. – P. 299–300.Moore E.E., Malangoni M.A., Cogbill T.H., et al. Organ injury scaling. IV: Thoracic vascular, lung, cardiac, and diaphragm // J. Trauma. – 1994. – Vol. 36, N. 3. – P. 299–300.Karalis D.G., Victor M.F., Davis G.A., et al. The role of echocardiography in blunt chest trauma: A transthoracic and transesophageal echocardiographic study // J. Trauma. – 1994. – Vol. 36, N. 1. – P. 53–58.Karalis D.G., Victor M.F., Davis G.A., et al. The role of echocardiography in blunt chest trauma: A transthoracic and transesophageal echocardiographic study // J. Trauma. – 1994. – Vol. 36, N. 1. – P. 53–58.Wisner D.H., Reed W.H., Riddick R.S. Suspected myocardial contusion. Triage and indications for monitoring // Ann. Surg. – 1990. – Vol. 212, N. 1. – P. 82–86.Wisner D.H., Reed W.H., Riddick R.S. Suspected myocardial contusion. Triage and indications for monitoring // Ann. Surg. – 1990. – Vol. 212, N. 1. – P. 82–86.Mori R., Zuppiroli A., Ognibene A., et al. Cardiac contusion in blunt chest trauma: A combined study oftransesophageal echocardiography and cardiac tropinin I determination // Ital. Heart J. – 2001. – Vol. 2, N. 3 – P. 222–227.Mori R., Zuppiroli A., Ognibene A., et al. Cardiac contusion in blunt chest trauma: A combined study oftransesophageal echocardiography and cardiac tropinin I determination // Ital. Heart J. – 2001. – Vol. 2, N. 3 – P. 222–227.Collins J.N., Cole P.J., Weireter L.J., et al. The usefulness of serum Troponin levels in evaluating cardiac injury // Am. Surg. – 2001. – Vol. 67, N. 9. – P. 821–825.Collins J.N., Cole P.J., Weireter L.J., et al. The usefulness of serum Troponin levels in evaluating cardiac injury // Am. Surg. – 2001. – Vol. 67, N. 9. – P. 821–825.Lancey R.A., Monahan T.S. Correlation of clinical characteristics and outcomes with injury scoring in blunt cardiac trauma // J. Trauma. – 2003. – Vol. 54, N. 3. – P. 509–515.Lancey R.A., Monahan T.S. Correlation of clinical characteristics and outcomes with injury scoring in blunt cardiac trauma // J. Trauma. – 2003. – Vol. 54, N. 3. – P. 509–515.Brown J., Grover P.L. Trauma to the heart // Chest. Surg. Clin. N. Am. – 1997. – Vol. 7, N. 2. – P. 325–341.Brown J., Grover P.L. Trauma to the heart // Chest. Surg. Clin. N. Am. – 1997. – Vol. 7, N. 2. – P. 325–341.Ismailov R.M., Ness R.B., Weiss H.B., et al. Trauma associated with acute myocardial infarction in a multi-state hospitalized population // Int. J. Cardiol. – 2005. – Vol. 105. – P. 141–146.Ismailov R.M., Ness R.B., Weiss H.B., et al. Trauma associated with acute myocardial infarction in a multi-state hospitalized population // Int. J. Cardiol. – 2005. – Vol. 105. – P. 141–146.Sturaitis M., McCallum D., Sutherland G., et al. Lack of significant longterm sequelae following traumatic myocardial contusion // Arch. Intern. Med. – 1986. – Vol. 146, N. 9. – P. 1765–1769.Sturaitis M., McCallum D., Sutherland G., et al. Lack of significant longterm sequelae following traumatic myocardial contusion // Arch. Intern. Med. – 1986. – Vol. 146, N. 9. – P. 1765–1769.

The authors declare that there are no conflicts of interest present.