急性心肌梗死后电风暴诊治二例  

Therapeutic Strategy for Electrical Storm After Acute Myocardial Infarction:Two Cases Report

作　　者：施姣姣[1] 吴楠 陈红武[1] 陈明龙[1] SHI Jiaojiao;WU Nan;CHEN Hongwu;CHEN Minglong(Department of Cardiology,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院心血管内科,南京210029

出　　处：《中国循环杂志》2023年第10期1075-1078,共4页Chinese Circulation Journal

摘　　要：电风暴是心肌梗死后最严重的临床危象之一,可加重心力衰竭、诱发精神疾病、增加死亡率。电风暴的流程性救治包括纠正血管闭塞和电解质紊乱等可逆因素、血液动力学支持、抗心律失常药物治疗、镇静麻醉、自主神经干预、程控除颤等,然而部分患者经上述治疗后仍不能解除危象。本病例报告报道2例急性心肌梗死合并电风暴病例,其中1例考虑希氏-浦肯野系统早搏触发多形性室性心动过速,经射频导管消融早搏后病情稳定,另1例考虑“R-on-T”早搏、“短-长-短”联律间期触发尖端扭转型室性心动过速,经高频起搏治疗后病情稳定。本病例报告旨在指导临床医师识别风暴发作的不同电学机制,采取更精准、积极的救治措施,避免不恰当用药和过度放电治疗。Electrical storm is a severe clinical crisis for patients with myocardial infarction,which is related with worsening cardiac function,mental disturbance and increased mortality.The standard therapies of electrical storm include the coronary artery reperfusion,hemodynamic support,antiarrhythic drugs(AAD)treatment,deep sedation,gangliolysis and shock.In this article,we reported two electrical storm cases secondary to myocardial infarction.One case was triggered by premature ventricular contraction(PVC)originated from Purkinje fibers and was well-controlled by radiofrequency catheter ablation and another case of Torsade de Pointes was caused by R-on-T phenomenon of PVC and short-long-short sequence and was relieved by cardiac pacing.This case report might help identify different electrical mechanisms of electrical storm to avoid inappropriate AAD treatment and excessive unnecessary shock and make more individualized treatment for patients with myocardial infarction combined with electrical storm.

关 键 词：电风暴 心肌梗死 导管消融 起搏 

分 类 号：R54[医药卫生—心血管疾病]