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术后死亡丨急性心肌梗死3支血管闭塞,紧急开通右冠脉、前降支后3小时患者猝死

2024-01-09 DrKing道金医学 DrKing道金医学 发表于陕西省

患者男性,83岁,因胸痛3小时入院。心电图提示下壁导联ST段抬高。

病例资料

患者男性,83岁,因胸痛3小时入院。

心电图提示下壁导联ST段抬高。

急诊冠状动脉造影

粗大右冠脉近端闭塞。

回旋支近端局限性次全闭塞,远端血管隐约显影。

粗大前降支近端闭塞,远端血管隐约显影。

左、右冠状动脉造影时对侧血管远端没有逆向显影。

IABP全部占用。

图片

图片

治疗过程

先开通右冠脉,植入支架后造影,发现血流2级,近中段分支丢失。

图片

图片

然后开通前降支,血压低,用药回升血压,前降支放支架后近夹层,没有进一步处理。

回旋支未处理,血压平稳,IABP已撤出1台,然后用上,回病房3小时后,患者猝死。

图片

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  1. [GetPortalCommentsPageByObjectIdResponse(id=2186318, encodeId=0fe82186318e9, content=图没发全吗?LAD起始怎么处理的?, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210512/b39c8bc0ab334969ba4ccc08e7a6cd94/c4e41798ef27449aa31ad740c9b13062.jpg, createdBy=5ff35133022, createdName=forvalen, createdTime=Wed Feb 07 10:12:49 CST 2024, time=2024-02-07, status=1, ipAttribution=陕西省), GetPortalCommentsPageByObjectIdResponse(id=2183994, encodeId=d0bb218399402, content=我是显示不全吗?为什么看不完,云里雾里, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ae6f8811677, createdName=ms1000000799038861, createdTime=Fri Jan 26 00:00:32 CST 2024, time=2024-01-26, status=1, ipAttribution=湖南省), GetPortalCommentsPageByObjectIdResponse(id=2180349, encodeId=ac0d2180349d9, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Tue Jan 09 21:05:15 CST 2024, time=2024-01-09, status=1, ipAttribution=山西省), GetPortalCommentsPageByObjectIdResponse(id=2180342, encodeId=cb902180342a9, content=<a href='/topic/show?id=da48522840a' target=_blank style='color:#2F92EE;'>#急性心肌梗死#</a> <a href='/topic/show?id=1ca89e181b2' target=_blank style='color:#2F92EE;'>#闭塞#</a> <a href='/topic/show?id=c52010e888e7' target=_blank style='color:#2F92EE;'>#前降支#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=107888, encryptionId=c52010e888e7, topicName=前降支), TopicDto(id=52284, encryptionId=da48522840a, topicName=急性心肌梗死), TopicDto(id=97181, encryptionId=1ca89e181b2, topicName=闭塞)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cade5395722, createdName=梅斯管理员, createdTime=Tue Jan 09 20:44:16 CST 2024, time=2024-01-09, status=1, ipAttribution=陕西省)]
    2024-02-07 forvalen 来自陕西省

    图没发全吗?LAD起始怎么处理的?

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=2186318, encodeId=0fe82186318e9, content=图没发全吗?LAD起始怎么处理的?, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210512/b39c8bc0ab334969ba4ccc08e7a6cd94/c4e41798ef27449aa31ad740c9b13062.jpg, createdBy=5ff35133022, createdName=forvalen, createdTime=Wed Feb 07 10:12:49 CST 2024, time=2024-02-07, status=1, ipAttribution=陕西省), GetPortalCommentsPageByObjectIdResponse(id=2183994, encodeId=d0bb218399402, content=我是显示不全吗?为什么看不完,云里雾里, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ae6f8811677, createdName=ms1000000799038861, createdTime=Fri Jan 26 00:00:32 CST 2024, time=2024-01-26, status=1, ipAttribution=湖南省), GetPortalCommentsPageByObjectIdResponse(id=2180349, encodeId=ac0d2180349d9, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Tue Jan 09 21:05:15 CST 2024, time=2024-01-09, status=1, ipAttribution=山西省), GetPortalCommentsPageByObjectIdResponse(id=2180342, encodeId=cb902180342a9, content=<a href='/topic/show?id=da48522840a' target=_blank style='color:#2F92EE;'>#急性心肌梗死#</a> <a href='/topic/show?id=1ca89e181b2' target=_blank style='color:#2F92EE;'>#闭塞#</a> <a href='/topic/show?id=c52010e888e7' target=_blank style='color:#2F92EE;'>#前降支#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=107888, encryptionId=c52010e888e7, topicName=前降支), TopicDto(id=52284, encryptionId=da48522840a, topicName=急性心肌梗死), TopicDto(id=97181, encryptionId=1ca89e181b2, topicName=闭塞)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cade5395722, createdName=梅斯管理员, createdTime=Tue Jan 09 20:44:16 CST 2024, time=2024-01-09, status=1, ipAttribution=陕西省)]
    2024-01-26 ms1000000799038861 来自湖南省

    我是显示不全吗?为什么看不完,云里雾里

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=2186318, encodeId=0fe82186318e9, content=图没发全吗?LAD起始怎么处理的?, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210512/b39c8bc0ab334969ba4ccc08e7a6cd94/c4e41798ef27449aa31ad740c9b13062.jpg, createdBy=5ff35133022, createdName=forvalen, createdTime=Wed Feb 07 10:12:49 CST 2024, time=2024-02-07, status=1, ipAttribution=陕西省), GetPortalCommentsPageByObjectIdResponse(id=2183994, encodeId=d0bb218399402, content=我是显示不全吗?为什么看不完,云里雾里, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ae6f8811677, createdName=ms1000000799038861, createdTime=Fri Jan 26 00:00:32 CST 2024, time=2024-01-26, status=1, ipAttribution=湖南省), GetPortalCommentsPageByObjectIdResponse(id=2180349, encodeId=ac0d2180349d9, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Tue Jan 09 21:05:15 CST 2024, time=2024-01-09, status=1, ipAttribution=山西省), GetPortalCommentsPageByObjectIdResponse(id=2180342, encodeId=cb902180342a9, content=<a href='/topic/show?id=da48522840a' target=_blank style='color:#2F92EE;'>#急性心肌梗死#</a> <a href='/topic/show?id=1ca89e181b2' target=_blank style='color:#2F92EE;'>#闭塞#</a> <a href='/topic/show?id=c52010e888e7' target=_blank style='color:#2F92EE;'>#前降支#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=107888, encryptionId=c52010e888e7, topicName=前降支), TopicDto(id=52284, encryptionId=da48522840a, topicName=急性心肌梗死), TopicDto(id=97181, encryptionId=1ca89e181b2, topicName=闭塞)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cade5395722, createdName=梅斯管理员, createdTime=Tue Jan 09 20:44:16 CST 2024, time=2024-01-09, status=1, ipAttribution=陕西省)]
    2024-01-09 医鸣惊人 来自山西省

    认真学习了

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=2186318, encodeId=0fe82186318e9, content=图没发全吗?LAD起始怎么处理的?, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210512/b39c8bc0ab334969ba4ccc08e7a6cd94/c4e41798ef27449aa31ad740c9b13062.jpg, createdBy=5ff35133022, createdName=forvalen, createdTime=Wed Feb 07 10:12:49 CST 2024, time=2024-02-07, status=1, ipAttribution=陕西省), GetPortalCommentsPageByObjectIdResponse(id=2183994, encodeId=d0bb218399402, content=我是显示不全吗?为什么看不完,云里雾里, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ae6f8811677, createdName=ms1000000799038861, createdTime=Fri Jan 26 00:00:32 CST 2024, time=2024-01-26, status=1, ipAttribution=湖南省), GetPortalCommentsPageByObjectIdResponse(id=2180349, encodeId=ac0d2180349d9, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Tue Jan 09 21:05:15 CST 2024, time=2024-01-09, status=1, ipAttribution=山西省), GetPortalCommentsPageByObjectIdResponse(id=2180342, encodeId=cb902180342a9, content=<a href='/topic/show?id=da48522840a' target=_blank style='color:#2F92EE;'>#急性心肌梗死#</a> <a href='/topic/show?id=1ca89e181b2' target=_blank style='color:#2F92EE;'>#闭塞#</a> <a href='/topic/show?id=c52010e888e7' target=_blank style='color:#2F92EE;'>#前降支#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=107888, encryptionId=c52010e888e7, topicName=前降支), TopicDto(id=52284, encryptionId=da48522840a, topicName=急性心肌梗死), TopicDto(id=97181, encryptionId=1ca89e181b2, topicName=闭塞)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cade5395722, createdName=梅斯管理员, createdTime=Tue Jan 09 20:44:16 CST 2024, time=2024-01-09, status=1, ipAttribution=陕西省)]

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