急性心肌梗死行PCI术发生反复电风暴的救治

Acute Myocardial Infarction Treated by Percutaneous Coronary Intervention with Repeated Electrical Storms: Medical Experience and Reflection

目的探讨急性心肌梗死(AMI)行经皮冠状动脉介入(percutaneous coronary intervention,PCI)术发生电风暴的临床表现,分析其原因并提出防范对策及处理方法。方法回顾分析我院成功救治的1例AMI行PCI术反复电风暴、护理操作失误导致咽后壁出血患者的临床资料。结果本例因突发胸闷5 h到我院就诊,诊断为下壁AMI,急诊行PCI术,术中及术后反复发生电风暴(室颤),予心肺复苏、电除颤等抢救后转复。但患者电风暴发作过程中因意识障碍,咬碎口中的体温计,随后出现口咽部、下呼吸道及胃管内流出大量血性液体,急行胃镜、纤维支气管镜等检查明确为咽后壁出血,予保护胃黏膜、抑酸、抗凝等处理后,出血停止,住院21 d病情好转出院。此后多次门诊随访,病情稳定。结论对于AMI患者要警惕电风暴,及时、谨慎处理救治过程中出现的问题,方能避免不良事件的发生。

Objective To explore the clinical manifestations of acute myocardial infarction with electrical storms in the process of percutaneous coronary intervention（PCI） treatment, analyze the causes and put forward preventive countermeas-ures and solutions. Methods Retrospective analysis of the clinical data of an acute myocardial infarction case undergoing PCI surgery, and suffering repeated electrical storms and pharynx posterior wall hemorrhage because of nursing error was made. Results The patient had sudden chest tightness for five hours, and was diagnosed with acute inferior myocardial infarction. During the emergency PCI surgery, electrical storms （ventricular fibrillation） occurred repeatedly. After cardio-pulmonary re-suscitation, and electric defibrillation, the patient regained normal heart rhythm and survived. But in the process of rescue, the patient bit a clinical thermometer in his mouth when unconscious. Subsequently, a large amount of blood flowed into air-way, oropharynx and the stomach tube. The bleeding was found from pharynx posterior wall through emergency endoscope and fiberoptic bronchoscopy examinations. After treatment of protecting the gastric mucosa, acid suppression, and anticoagulant, the patient was discharged with recovery on the 21st day. Since then the patient has been in a stable condition as the follow up showed. Conclusion Clinicians must be alert for the electrical storm which may occur in AMI patients, and timely and pru-dent measures can prevent adverse events.