急性左下肢动脉栓塞并发肌病肾病代谢综合征的心力衰竭患者1例报告及文献复习
Heart failure patient with acute left lower limb arterial embolism complicated with myonephropathic metabolic syndrome:A case report and literature review
俞凯华 1尉昆 2张杰 1衣雪梅 3王刚 3庞磊1
作者信息
- 1. 吉林大学第一医院麻醉科,吉林 长春 130021
- 2. 山东中医药大学第二附属医院康复科,山东 济南 250001
- 3. 吉林大学第一医院第二手术室,吉林 长春 130021
- 折叠
摘要
目的:报道1例急性左下肢动脉栓塞并发肌病肾病代谢综合征(MNMS)的心力衰竭患者诊治过程,为此类患者诊断、麻醉和治疗提供参考.方法:回顾性分析1例急性左下肢动脉栓塞并发MNMS的心力衰竭患者的临床资料、麻醉方法和围术期管理,并进行相关文献复习.结果:患者,男性,56岁,于2017年3月25日因突发左下肢疼痛、麻木伴感觉运动障碍入院,入院35 min后血管超声检查提示左股浅动脉末段至腘动脉全段继发血栓.入院77 min后实验室检查显示肌红蛋白(MB)698.7 μg·L-1、肌钙蛋白I(TnI)0.092 μg·L-1 和肌酸激酶同工酶(CK-MB)4.78 μg·L-1.入院63 min后心电图检查结果显示心动过速、左心室肥大、心房颤动和房室传导阻滞.初诊为急性左下肢动脉栓塞,冠心病,陈旧性心肌梗死,心律失常,2型糖尿病.患者拟于入院3 h后在全麻下行急诊左下肢动脉栓塞取栓术,术中患者生命体征平稳,术后8 min患者突发室颤,考虑再发急性心肌梗死并发MNMS,经过积极的抢救处理,仍未能挽救患者生命.结论:对于急性肢体动脉栓塞并发心力衰竭的患者,及时恢复肢体的血液供应是治疗的关键,适当补液扩容,维持电解质平衡,保护心肾功能可以有效降低患者的病死率和截肢率.
Abstract
Objective:To report the diagnosis and treatment of one patient with acute left lower limb arterial embolism complicated with myonephropathic metabolic syndrome(MNMS)-associated heart failure,and to provide the reference for the diagnosis,anesthesia,and treatment of such patients.Methods:The retrospective analysis on the clinical data,anesthesia methods,and perioperative management of one patient with acute left lower limb arterial embolism complicated with MNMS-associated heart failure was conducted,and the related literatures were reviewed.Results:The patient,a 56-year-old male,was admitted to the hospital on March 25,2017,due to sudden pain and numbness in the left lower limb accompanied by sensory and motor disturbances.The vascular ultrasound performed 35 min after the admission suggested a secondary thrombus from the distal superficial femoral artery to the entire popliteal artery.The laboratory tests performed 77 min after admission showed the myoglobin(MB)level was 698.7 μg·L-1,cardiac troponin I(TnI)was 0.092 μg·L-1,and creatine kinase isoenzyme(CK-MB)was 4.78 μg·L-1.The electrocardiogram results taken 63 min after admission indicated tachycardia,left ventricular hypertrophy,atrial fibrillation,and atrioventricular block.The initial diagnosis was acute left lower limb arterial thrombosis,coronary artery disease,old myocardial infarction,arrhythmia,and type 2 diabetes.The patient was scheduled for an emergency thrombectomy of the left lower limb under general anesthesia 3 h after admission.During the surgery,the patient's vital signs were stable,but 8 min after operation,the patient suddenly developed ventricular fibrillation,which was considered to be a reinfarction of acute myocardial infarction complicated with MNMS.After active rescue treatment,the patient's life was still not saved.Conclusion:For the patients with acute limb arterial embolism complicated with heart failure,timely restoration of limb blood supply is crucial in treatment.Appropriate fluid resuscitation to expand blood volume,maintaining electrolyte balance,and protecting cardiac and renal functions can effectively reduce the mortality and amputation rate of the patients.
关键词
心力衰竭/急性动脉栓塞/肌病肾病代谢综合征/缺血再灌注损伤Key words
Heart failure/Acute arterial embolism/Myonephropathic metabolic syndrome/Ischemia-reperfusion injury引用本文复制引用
基金项目
国家自然科学基金项目(81970228)
国家自然科学基金项目(82102306)
吉林省科技厅社发基金项目(20210203091SF)
出版年
2024
国家科技期刊平台
NSTL
维普
万方数据