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实用!急性心肌梗死合并急性心脏压塞的常见原因与处理

2017-10-13 Ivy.K 医学界心血管频道

急性心包压塞是极严重的并发症,急性心梗(AMI)的心脏压塞是AMI除心源性休克外第二大死因,占AMI死亡率的15-20%,一旦发生后果极其危重,甚至危及患者生命。

急性心包压塞是极严重的并发症,急性心梗(AMI)的心脏压塞是AMI除心源性休克外第二大死因,占AMI死亡率的15-20%,一旦发生后果极其危重,甚至危及患者生命。10月12号,在第二十八届长城国际心脏病学会议中“急诊危重症”的分论坛中,来自沈阳军区总医院的荆全民教授带来了《急性心肌梗死合并急性心脏压塞的常见原因与处理》的精彩讲课,以下是小编整理的重要内容,分享给大家。荆全民教授现场演讲1.AMI合并急性心脏压塞的常见原因■ 冠脉血管原因AMI时操作不当造成冠脉破裂使心包积血,主要病变因素有:①较大号球囊进行高压扩张;②球囊那个在过高充盈压下破裂,可对局部血管壁造成喷射性损伤;③高度膨胀的球囊将支架金属结构强力外推至血管壁造成管壁损伤;④导丝及球囊误入血管外损伤或错误扩张;⑤AMI掩盖了远端的心肌肌桥。■ 心肌因素AMI后梗死的心肌变薄,易破裂,是引起AMI合并急性心脏压塞的常见原因,总发生率难估计,临床与尸检结果差别较大。■ 外源性因素AMI合并系统性红斑狼疮、尿毒症、粘液性水肿。2.AMI合并急性心脏压的表现与征象■ 破裂发生前患者往往有较剧烈的胸痛反复发作,对镇痛药反应不佳。■ 破

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objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20231215/ac08b4d4cecf4bd3b9af86e00dcbca38/f6b6a60efd854ff191eb5c611ec7dd12.jpg, createdBy=8afb2071832, createdName=15938038573红旗飘飘, createdTime=Fri Oct 13 09:31:02 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252509, encodeId=bae725250914, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=2dcd2089597, createdName=尉志鹏, createdTime=Fri Oct 13 09:30:05 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252490, encodeId=3bcb2524906b, content=谢谢分享学习了, beContent=null, objectType=article, channel=null, level=null, 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    2017-10-23 虈亣靌

    谢谢分享知识

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  3. 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    2017-10-18 三生有幸9135

    学习一下谢谢分享

    0

  4. 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createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Mon Oct 23 21:30:00 CST 2017, time=2017-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=253965, encodeId=a28925396530, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Wed Oct 18 09:00:29 CST 2017, time=2017-10-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=253757, encodeId=6c45253e57db, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Tue Oct 17 18:14:45 CST 2017, time=2017-10-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=253106, encodeId=747925310655, content=术后第二天给双抗.不得出血吗?, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0e92157486, createdName=梭边边的大夫, createdTime=Sun Oct 15 10:54:46 CST 2017, time=2017-10-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252949, encodeId=7ffa2529497c, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Sat Oct 14 23:57:09 CST 2017, time=2017-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252623, encodeId=106c252623d7, content=学习了谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Fri Oct 13 18:35:04 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252510, encodeId=2fd225251008, content=已学习并已分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20231215/ac08b4d4cecf4bd3b9af86e00dcbca38/f6b6a60efd854ff191eb5c611ec7dd12.jpg, createdBy=8afb2071832, createdName=15938038573红旗飘飘, createdTime=Fri Oct 13 09:31:02 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252509, encodeId=bae725250914, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=2dcd2089597, createdName=尉志鹏, createdTime=Fri Oct 13 09:30:05 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252490, encodeId=3bcb2524906b, content=谢谢分享学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Fri Oct 13 09:02:14 CST 2017, time=2017-10-13, status=1, ipAttribution=)]
    2017-10-17 三生有幸9135

    学习一下谢谢分享

    0

  5. 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objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20231215/ac08b4d4cecf4bd3b9af86e00dcbca38/f6b6a60efd854ff191eb5c611ec7dd12.jpg, createdBy=8afb2071832, createdName=15938038573红旗飘飘, createdTime=Fri Oct 13 09:31:02 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252509, encodeId=bae725250914, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=2dcd2089597, createdName=尉志鹏, createdTime=Fri Oct 13 09:30:05 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252490, encodeId=3bcb2524906b, content=谢谢分享学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Fri Oct 13 09:02:14 CST 2017, time=2017-10-13, status=1, ipAttribution=)]
    2017-10-15 梭边边的大夫

    术后第二天给双抗.不得出血吗?

    0

  6. 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objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20231215/ac08b4d4cecf4bd3b9af86e00dcbca38/f6b6a60efd854ff191eb5c611ec7dd12.jpg, createdBy=8afb2071832, createdName=15938038573红旗飘飘, createdTime=Fri Oct 13 09:31:02 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252509, encodeId=bae725250914, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=2dcd2089597, createdName=尉志鹏, createdTime=Fri Oct 13 09:30:05 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252490, encodeId=3bcb2524906b, content=谢谢分享学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Fri Oct 13 09:02:14 CST 2017, time=2017-10-13, status=1, ipAttribution=)]
    2017-10-14 戒馋,懒,贪

    谢谢分享.学习了

    0

  7. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Sat Oct 14 23:57:09 CST 2017, time=2017-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252623, encodeId=106c252623d7, content=学习了谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Fri Oct 13 18:35:04 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252510, encodeId=2fd225251008, content=已学习并已分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20231215/ac08b4d4cecf4bd3b9af86e00dcbca38/f6b6a60efd854ff191eb5c611ec7dd12.jpg, createdBy=8afb2071832, createdName=15938038573红旗飘飘, createdTime=Fri Oct 13 09:31:02 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252509, encodeId=bae725250914, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=2dcd2089597, createdName=尉志鹏, createdTime=Fri Oct 13 09:30:05 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252490, encodeId=3bcb2524906b, content=谢谢分享学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Fri Oct 13 09:02:14 CST 2017, time=2017-10-13, status=1, ipAttribution=)]
    2017-10-13 虈亣靌

    学习了谢谢作者分享!

    0

  8. 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objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20231215/ac08b4d4cecf4bd3b9af86e00dcbca38/f6b6a60efd854ff191eb5c611ec7dd12.jpg, createdBy=8afb2071832, createdName=15938038573红旗飘飘, createdTime=Fri Oct 13 09:31:02 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252509, encodeId=bae725250914, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=2dcd2089597, createdName=尉志鹏, createdTime=Fri Oct 13 09:30:05 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252490, encodeId=3bcb2524906b, content=谢谢分享学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Fri Oct 13 09:02:14 CST 2017, time=2017-10-13, status=1, ipAttribution=)]
    2017-10-13 15938038573红旗飘飘

    已学习并已分享

    0

  9. 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objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20231215/ac08b4d4cecf4bd3b9af86e00dcbca38/f6b6a60efd854ff191eb5c611ec7dd12.jpg, createdBy=8afb2071832, createdName=15938038573红旗飘飘, createdTime=Fri Oct 13 09:31:02 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252509, encodeId=bae725250914, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=2dcd2089597, createdName=尉志鹏, createdTime=Fri Oct 13 09:30:05 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252490, encodeId=3bcb2524906b, content=谢谢分享学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Fri Oct 13 09:02:14 CST 2017, time=2017-10-13, status=1, ipAttribution=)]
    2017-10-13 尉志鹏

    学习了

    0

  10. 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objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20231215/ac08b4d4cecf4bd3b9af86e00dcbca38/f6b6a60efd854ff191eb5c611ec7dd12.jpg, createdBy=8afb2071832, createdName=15938038573红旗飘飘, createdTime=Fri Oct 13 09:31:02 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252509, encodeId=bae725250914, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=2dcd2089597, createdName=尉志鹏, createdTime=Fri Oct 13 09:30:05 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252490, encodeId=3bcb2524906b, content=谢谢分享学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Fri Oct 13 09:02:14 CST 2017, time=2017-10-13, status=1, ipAttribution=)]
    2017-10-13 戒馋,懒,贪

    谢谢分享学习了

    0

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