以电风暴为首发表现的急性心肌梗死患者一例

Electrical storm as the initial manifestation of a patient with acute myocardial infarction

目的探讨急性冠脉综合征(ACS)相关电风暴(ES)的临床特点及治疗方法。方法采用回顾性调查方法,对1例ES致心脏骤停为首发表现的急性心肌梗死患者的临床资料进行分析,并结合文献进行复习。结果患者男,73岁,院内突发意识丧失,心电活动呈顽固性室颤(VF)及室性心动过速(VT),经反复电除颤17次(双相波:200J,11次;300J,4次;360J,2次),联合抗室性心律失常药物,同时应用多项高级生命支持技术,抢救4 h后心肺脑复苏初步成功。结合心肌损伤标志物和心电图动态改变最终诊断急性ST段抬高型广泛前壁心肌梗死,择期行经皮冠状动脉介入治疗(PCI),于前降支和回旋支共植入支架4枚。随访5年,无不良心血管事件发生。结论 ES是临床急危重症,ACS相关ES有其独特的发病特点及救治原则;及时、正确的复苏方案能够提高患者的救治成功率,改善预后。

Objective To investigate the characteristics and therapeutic method of electrical storm（ES）associated with acute coronary syndrome（ACS）. Methods The clinical data of one patient with ES induced by ACS were collected and relevant literatures were reviewed. Results A 73-year-old man suffered a sudden loss of consciousness in hospital. Electric activities displayed repetitive episodes of ventricular fibrillation（VF）and ventricular tachycardia（VT）. The patient was treated with 17 defibrillations with the energy of biphasic wave form from 200 J to 360 J,combined with anti-arrhythmia drugs and advanced life support treatments. Successful cardiopulmonary-cerebral resuscitation was achieved after 4 hours. The patient was diagnosed with extensive anterior wall ST-segment elevation myocardial infarction based on the dynamic changes of myocardial injury markers and electrocardiogram（ECG）. The patient undergone selective percutaneous coronary intervention（PCI）on left anterior descending and the circumflex coronary artery,and received 4 stents in total. The patient had no major adverse cardiac event during 5-year follow-up. Conclusion Cardiac arrest caused by ES is a critical illness.ES associated with ACS has specific characteristics and principles of treatment. A prompt and proper resuscitation protocol can improve the survive rate and prognosis.