体外心肺复苏成功救治顽固性心室电风暴——附1例报告  

Successful treatment of intractable electrical storm with extracorporeal cardiopulmonary resuscitation:one case report

作　　者：方可 孙瑞祥 张鹏 汪君 李阳 江海娇 姜小敢 鲁卫华 Fang Ke;Sun Ruixiang;Zhang Peng;Wang Jun;Li Yang;Jiang Haijiao;Jiang Xiaogan;Lu Weihua(Department of Critical Care Medicine,the First Affiliated Hospital of Wannan Medical College(Yijishan Hospital),Anhui Provincial Clinical Research Center for Critical Respiratory Disease,Wuhu 241000,Anhui,China)

机构地区：[1]皖南医学院第一附属医院(弋矶山医院)重症医学科,安徽省危重症呼吸疾病临床医学研究中心,安徽芜湖241000

出　　处：《实用检验医师杂志》2023年第1期107-109,共3页Chinese Journal of Clinical Pathologist

基　　金：安徽省医疗卫生重点专科建设项目(2021-273)。

摘　　要：目的 报告1例急性心肌梗死(AMI)患者暴发顽固性心室电风暴期间的血清钾变化,分析电风暴与血清钾水平的相关性。方法 皖南医学院第一附属医院(弋矶山医院)重症医学科于2022年5月5日收治1例43岁男性AMI患者,冠状动脉造影(CAG)显示三支血管病变,行经皮冠状动脉介入治疗(PCI),随后患者频繁暴发顽固性心室电风暴,以体外心肺复苏(ECPR)为血流动力学基础,经90次电除颤以及超过9 h的间断胸外心脏按压成功救治患者,转归良好。总结并分析该患者在电风暴及非电风暴期间的血清钾水平。结果 电风暴期间患者的血清钾水平处于正常或异常低值,未发生电风暴时,患者血清钾呈正常高值水平,绘制受试者工作特征曲线并计算曲线下面积,结果显示将该患者血清钾水平维持在4.35 mmol/L以上的正常高值范围,可避免心室电风暴的发生。结论 对于AMI患者,正常血清钾浓度范围内的低值水平即可诱发电风暴的发生,血清钾水平应控制在正常高值范围,另一方面,AMI患者补钾后的血清钾水平并不能反映其钾储存的恢复。Objective To report the changes of serum potassium level during the outbreak of intractable ventricular electrical storm in a patient with acute myocardial infarction(AMI),and analyze the correlation between electrical storm and serum potassium level.Methods On May 5,2022,a 43-year-old male patient with AMI was admitted to the Department of Critical Care Medicine of the First Affiliated Hospital of Wannan Medical College(Yijishan Hospital).Coronary angiography(CAG)showed three-vessel lesions,and percutaneous coronary intervention(PCI)was performed.Subsequently,the patient broke out frequently with intractable ventricular electrical storms.Extracorporeal cardiopulmonary resuscitation(ECPR)was used as a hemodynamic basis,after 90 times of electrical defibrillation and more than 9 hours of intermittent cardiac compression,the patient was successfully treated with good results.The serum potassium levels of the patient during electrical storm and non-electrical storm were summarized and analyzed.Results During the electrical storm,the serum potassium level of patient was at the normal or abnormally low level,while when non-electrical storm occurred,the serum potassium level was usually at the normal high value level.Through receiver operator charicteristic curve analysis,the serum potassium concentration of patient was controlled within the normal high value range of>4.35 mmol/L,which could avoid the occurrence of ventricular electrical storm.Conclusions For AMI patients,the low level within the normal range of serum potassium concentration could induce the occurrence of electrical storm,and the serum potassium level should be controlled within the normal range of high value.On the other hand,the serum potassium level of AMI patients after potassium supplementation cannot indicate the recovery of potassium storage.

关 键 词：电风暴 电解质 血清钾 体外心肺复苏 

分 类 号：R542.22[医药卫生—心血管疾病]