Cardiac penetrating wound suture

Myocardial injury is an extremely serious injury, and it is rapidly dying due to massive bleeding. A small number of wounded people have a small myocardial rupture, and the ejected blood flows into the pericardial cavity, which can cause life-threatening pericardial occlusion. If it can be transported and rescued in time, it can save lives. Treating diseases: penetrating cardiac trauma Indication For wounded patients with myocardial penetrating wounds, surgery should be performed immediately to quickly save the necessary preoperative preparation to save lives. Preoperative preparation Preoperative preparation (including blood transfusion, infusion, rescue shock, preparation of a large number of blood sources, etc.) should be as short as possible, the movement should be agile, and the wounded immediately sent to the operating room, waiting for shock to correct the operation. If the symptoms of heart compression are too heavy, a part of the blood can be quickly removed from the pericardium before the induction of anesthesia to improve the severe compression of the heart. If a cardiac arrest occurs in the emergency room, the heart can be opened at the site, and the heart can be resuscitated while the heart is resuscitated. Surgical procedure 1. Position, incision: Select the anterior or posterolateral incision according to the wound site, and be ready to enlarge the incision. Generally, the lateral incision is the fastest in the chest, and the fifth intercostal incision is performed to cut the fifth costal cartilage. 32. Hole repair and suture: After carefully finding the small hole pierced by the pericardium, use the hemostatic forceps to lift the pericardium on both sides of the hole, prepare the aspirator, and then cut the happy bag longitudinally, pull it open on both sides, and suck out the blood in the pericardial cavity. Remove the blood clot, quickly find the crack on the myocardium, and use the left finger to gently stop the bleeding. The myocardium is sutured with a silk thread under the finger or a full-thickness suture. If the stenosis is located near the coronary artery, coronary artery sacral suture should be performed to avoid ligating the coronary artery and affecting myocardial blood supply. Sometimes, a needle can be used to suture a suture on each side of the split, and the two lines can be temporarily pulled to temporarily stop the bleeding, and then the myocardial cleft is interrupted. In the case of atrial penetrating injury, the atrial pliers or heart ear tongs can be used to clamp the atrial wall around the rupture and then repaired and sutured. Suture pericardium: Check the heart cleft suture satisfactorily, no longer bleed, rinse the pericardial cavity, and cut a small mouth after electrocoagulation in the posterior part of the phrenic nerve to facilitate drainage of blood and pericardial exudate, to avoid recurrence of pericardial occlusion symptoms And loosely suture the pericardial incision. 4. Close the chest cavity: Rinse the chest cavity, place the thoracic drainage tube through the 8th intercostal space on the left side, and suture the 5th costal cartilage with the 10th wire or fine steel wire, and suture the chest wall layer by layer.