摘要
目的 探讨急性胰腺炎后发生急性心肌梗死(acute myocardial intarction,AMI)的发病机制、危险因素、临床特点和治疗预后,以提高临床对此病的认识.方法 回顾性分析1例南京医科大学第一附属医院胰腺中心收治的重症急性胰腺炎合并AMI病人的临床资料及文献复习,对该并发症的发病机制、危险因素、临床表现、诊断、防治策略以及预后进行分析.结果 该例病人,男性,76岁,因重症急性胰腺炎入院,病人住院期间因胰腺坏死感染行经皮置管引流以及外科手术清创.病人经外科清创后感染明显改善,但在术后5周时出现出现胸闷症状,心电图提示前壁V1-V3 导联ST段抬高,并伴有肌钙蛋白T以及肌酸激酶同工酶升高.冠状动脉造影显示左前降支中段明显狭窄,诊断为AMI.对罪犯血管行经皮冠状动脉腔内血管成形术以及药物球囊处理,复查造影未见明显残余狭窄,术后恢复良好.结论 AMI是急性胰腺炎的罕见并发症,临床医师应该提高这一潜在并发症的认识和重视,并探索更有效的预防和治疗策略.
Abstract
Objective To explore the pathogenesis,risk factors,clinical manifestations and treatment outcomes of acute myocardial infarction(AMI)after severe acute pancreatitis(SAP)to enhance the clinical awareness of this condition.Methods A retrospective analysis of clinical data and literature review was conducted for one hospitalized case of SAP complicated by AMI.The mechanisms,risk factors,clinical manifestations,diagnosis,preventive measures and outcomes were examined.Results A 76-year-old male was admitted for SAP.During hospitalization,percutaneous catheter drainage(PCD)and surgical debridement were performed for infected pancreatic necrosis.Infection improved markedly after surgical debridement.Chest discomfort appears at Week 5 post-operation.Electrocardiography revealed ST-segment elevation in leads V1-V3 of anterior wall,accompanied by elevated levels of troponin T and creatine kinase-MB(CK-MB).Coronary angiography hinted at marked stenosis in mid-left anterior descending artery.A diagnosis of AMI was made.Percutaneous transluminal coronary angioplasty(PTCA)and drug balloon angioplasty were performed,resulting in successful revascularization without residual stenosis.Postoperative recovery was favorable.Conclusion AMI as a complication of AP is rare and yet significant.Clinicians should heighten attention to this potential complication and explore more effective strategies for prevention and treatment.
维普
万方数据