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急性心肌梗死是冠状动脉急性、持续性缺血缺氧所引起的心肌坏死。临床主要表现为剧烈而持久的胸骨后疼痛,休息及服用硝酸酯类药物不能完全缓解,伴有血清心肌酶活性增高及进行性心电图变化,可并发心律失常、休克或心力衰竭,常可危及生命。本文报告了心肌梗死频发心室颤动抢救成功1例。患者因上腹不适3h,剧烈胸疼、大汗1h就诊。查体:神志清楚,急病痛苦面容,血压110/75mmHg,心率80/min,心音低钝,律不齐。心电图显示,频发室性期前收缩,ST段弓背抬高,Ⅱ、Ⅲ导联ST段压低,T波倒置。诊断为急性广泛前壁心肌梗死。立即给予面罩吸氧、心电监护、硝酸甘油5mg静脉滴注,嚼服阿司匹林、硫酸氯吡格雷,吗啡静脉注射等治疗;处置过程中患者突发全身抽搐,小便失禁,意识丧失,触大动脉无搏动,立即胸外按压,360J非同步直流电除颤2次后,意识恢复,几分钟后又出现上述症状,再次胸外按压、除颤,以及静脉给予胺碘酮及利多卡因,恢复窦性心律,心室率110/min,血压90/60mmHg。后送医院行冠状动脉造影示左前降支闭塞,球囊扩张病变血管后植入支架,预后良好。
Acute myocardial infarction is acute myocardial infarction caused by persistent ischemia and hypoxia. The main clinical manifestations of severe and lasting post-sternal pain, rest and taking nitrates can not be completely relieved, accompanied by increased serum myocardial enzyme activity and progressive ECG changes can be complicated by arrhythmia, shock or heart failure, often life-threatening . This article reports a successful case of successful rescue of ventricular fibrillation in myocardial infarction. Patients due to abdominal discomfort 3h, severe chest pain, sweating 1h treatment. Physical examination: conscious, acute painful face, blood pressure 110 / 75mmHg, heart rate 80 / min, low heart sound blunt, irregularity. Electrocardiogram showed frequent ventricular contraction, ST segment dorsal raised, ST segment depression of lead II, III, T wave inversion. Diagnosis of acute extensive anterior myocardial infarction. Immediately give masks oxygen, ECG monitoring, nitroglycerin 5mg intravenous infusion, chewing aspirin, clopidogrel sulfate, morphine intravenous injection and other treatment; the process of sudden systemic twitch, incontinence, loss of consciousness, touch the aorta Beats, immediately chest compressions, 360J asynchronous DC defibrillation after 2 times, consciousness recovery, a few minutes after the above symptoms, again chest compressions, defibrillation, and intravenous amiodarone and lidocaine to restore sinus Heart rate, ventricular rate 110 / min, blood pressure 90 / 60mmHg. Evacuation hospital line coronary angiography showed left anterior descending artery occlusion, balloon dilatation vessel implanted stent, the prognosis is good.