急性胰腺炎合并早期复极致恶性心律失常及其机理

Acute pancreatitis complicated with early repolarization-induced malignant arrhythmia and its mechanism

目的探讨急性胰腺炎、早期复极与恶性心律失常三者可能存在的联系及相关机理。方法回顾性分析2017年4月4日就诊于自贡市第三人民医院的1例急性胰腺炎合并早期复极致恶性心律失常患者的临床资料。结果患者男,51岁,因'左上腹痛、呕吐9 h'入院,经问诊和查体后以'急性胰腺炎'为诊断收入消化内科。入院后查白细胞、超敏C反应蛋白、血淀粉酶、尿淀粉酶等均升高,腹部CT考虑急性胰腺炎。心电图示:窦性心动过速,心率120次/分,心律齐,V2见Q波形成,早期复极。经抗感染、抑制胰腺分泌、补液等治疗,患者腹痛、呕吐缓解。入院后第7天,患者休息时突发左侧胸痛、背痛,疼痛剧烈,血压75/39 mmHg,脉搏50次/分,持续数分钟后缓解,3 h后休息时再次发作,发作时伴三度房室传导阻滞,ST段抬高,短阵室性心动过速,最慢心率约27次/分。急查D-二聚体为0.38 mg/L,心肌损伤标志物:CK-MB为1.4 ng/mL,肌钙蛋白为0.01 ng/mL,肌红蛋白为41.8 ng/mL。心肌酶谱:CK为32 U/L,CK-MB为6.1 U/L,肌钙蛋白阴性。急诊冠状动脉造影提示:冠状动脉左优势型,左前降支近段管壁不规则。立即安装临时起搏器,术后未再发作,临时起搏器于术后7 d拆除,入院20 d后痊愈出院。随访至今未再出现类似症状。结论急性胰腺炎合并早期复极患者有发生恶性心律失常的可能,医务人员应重视。

Objective To investigate the possible links and related mechanisms of acute pancreatitis,early repolarization and malignant arrhythmia.Methods The clinical data of a patient with acute pancreatitis complicated with early repolarization-induced malignant arrhythmia who was admitted to the Third People’s Hospital of Zigong on April 4,2017 were retrospectively analyzed.Results The patient,male,51 years old,was admitted to the hospital because of'left upper abdominal pain and vomiting for 9 h'.After consultation and physical examination,the patient was diagnosed as'acute pancreatitis'and admitted to the department of gastroenterology.White blood cells,high-sensitivity C-reactive protein,blood amylase,and urinary amylase were all elevated.Abdominal CT considered acute pancreatitis.Electrocardiograph:sinus tachycardia,heart rate 120 beats/m,Q wave formation(V2),early repolarization.After anti-infection,inhibition of pancreatic secretion,rehydration and other treatments,abdominal pain and vomiting were relieved.On the 7 th day after admission,the patient had a sudden left chest and back pain at rest.The pain was severe,and the blood pressure of patient dropped to 75/39 mmHg.The pain lasted for a few minutes and re-emerged after 3 h when the patient was at rest.There were three-degree atrioventricular block,ST-segment elevation,short-term ventricular tachycardia,and the slowest heart rate was about 27 beats/m.The D-dimer was 0.38 mg/L.The myocardial injury markers:CK-MB was 1.4 ng/mL,troponin was 0.01,and myoglobin was 41.8 ng/mL.Myocardial zymogram:CK was 32 U/L,CK-MB was 6.1 U/L,and troponin was negative.Emergency coronary angiography showed that the left coronary artery was dominant and the wall of the left anterior descending artery was irregular.The temporary pacemaker was installed immediately and the patient did not relapse after surgery.The temporary pacemaker was removed 7 days after surgery.The patient was discharged from hospital after 20 days of admission.No similar symptoms have occurred since the follow-up.Conclusion Patients with acute pancreatitis complicated with early repolarization may have malignant arrhythmia,and medical staff should pay attention to it.