胸部钝性外伤性急性心肌梗塞2例报告及文献复习

Acute Myocardial Infarction Caused by Blunt Chest Trauma Report of Two Cases and Literature Review

本文报告2例青年于胸部钝性外伤后出现心肌异常Q波和损伤性ST段抬高，其心电图和心肌酶学的演变与典型的急性心肌梗塞（AMI）相同。胸部钝性外伤致AMI的主要机理为冠状动脉内膜扯裂、内膜下出血、血栓形成以及粥样斑块扯裂而导致冠状动脉阻塞，受累最多的是左前降支。由于常伴体表、心脏或其它脏器的挫伤或损伤，全身抗凝或静脉溶栓治疗通常为禁忌。如病人条件允许，可施行冠脉搭桥、PTCA或冠状动脉内溶栓等治疗。

This paper reported two young men suffering from pathologic Q wave and ST segment elevations secondary to blunt chest trauma because of motor vehicle accident. The dynamic changes of the electrocardiography (EKG) and the myocardial enzyme are simillar to those of typical acute myocardial infarction. The mechanismes of the coronary artery occlusion that cause acute myocardial infarction after blunt chest trauma are intimal tear, subintimal hemorrhage, thrombosis and disruption of atheromatous plaques. The left anterior descending artery has a higher incidence. As myocardial contusion and Other injures may accompany acute myocardial infarction secondary to the blunt chest trauma, the intravenous thrombolytic therapy and systemic anticoagulant therapy are usually contraindicated. If pateints have no evidence of contraindications, intracoronary thrombolysis,coronary artery bypass graft surgery and percutaneous transluminal coronary angioplasty (PTCA) may be recommended.