急性下壁心肌梗死合并乳头肌断裂1例  

Acute inferior myocardial infarction combined with papillary muscle rupture:A case report

作　　者：赵械雄 曹宇[1] 伍炯星[2] ZHAO Xiexiong;CAO Yu;WU Jiongxing(Department of Cardiology,Third Xiangya Hospital,Central South University,Changsha 410013;Department of Emergency,Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院心内科,长沙410013 [2]中南大学湘雅三医院急诊科,长沙410013

出　　处：《中南大学学报（医学版）》2023年第4期628-632,共5页Journal of Central South University ：Medical Science

基　　金：中南大学中央高校基本科研业务费专项资金(2019zzts1053)。

摘　　要：急性心肌梗死发病率逐年上升,急性乳头肌断裂是急性心肌梗死严重却少见的机械并发症之一,多见于下壁及正后壁心肌梗死。1例急性下壁心肌梗死患者出现肺水肿及难治性休克,继之心脏停搏,予心肺复苏(cardiopulmonaryresuscitation,CPR)后在主动脉球囊反搏(intra-aorticballoonpump,IABP)及体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)支持下行急诊经皮冠状动脉腔内血管成形术(percutaneous transluminal coronary angioplasty,PTCA),开通了犯罪血管,虽为患者争取了外科手术的机会,但因脑复苏未成功,家属放弃治疗。因此,急性下壁心肌梗死出现难以纠正的心源性肺水肿及心源性休克时,应高度怀疑急性乳头肌断裂、瓣膜功能障碍、心脏破裂穿孔等机械并发症,在开通犯罪血管的同时,床旁超声心动图检查及外科手术治疗更应前移。The incidence of acute myocardial infarction(AMI)is increasing.Acute papillary muscle rupture is one of the serious and rare mechanical complications of AMI,which occurs mostly in inferior and posterior myocardial infarction.A patient with acute inferior myocardial infarction developed pulmonary edema and refractory shock,followed by cardiac arrest.After cardiopulmonary resuscitation(CPR),revascularization of criminal vessels was carried out by emergency percutaneous transluminal coronary angioplasty(PTCA)under the support of intra-aortic balloon pump(IABP)and extra corporeal membrane oxygenation(ECMO).Although the patient was given a chance for surgery,his family gave up treatment due to unsuccessful brain resuscitation.It reminds that mechanical complications such as acute papillary muscle rupture,valvular dysfunction and rupture of the heart should be highly suspected when cardiogenic pulmonary edema and cardiogenic shock are difficult to correct in acute inferior myocardial infarction.Echocardiogram and surgery should be put forward when revascularization of criminal vessels is available.

关 键 词：急性下壁心肌梗死 乳头肌断裂 二尖瓣脱垂 二尖瓣关闭不全 心源性休克 

分 类 号：R542.22[医药卫生—心血管疾病]