败血症诱发心室电风暴一例

发布时间：2018-06-13 17:50

本文选题：电风暴 + 心肌梗死　；参考：《浙江大学》2014年硕士论文

【摘要】：患者,男性,71岁,既往前壁心肌梗死,左前降支支架植入术后,1年半前因阵发性室速植入单腔ICD。本次因突发寒战高热心前区刺痛(ICD放电)5-6次,入院后胺碘酮等控制心律,血培养提示大肠埃希菌,肺部CT示肺部感染,依据药敏结果予美罗培南抗感染,入院3天后再发高热寒战时并发心室电风暴,对症降温、静推胺碘酮、硫酸镁、地塞米松及异丙嗪后缓解,复查肺部CT提示肺实变,美罗培南继续治疗3周,血常规,CRP,胸部CT以及血培养均恢复正常后改静滴头孢西丁治疗2周出院。患者出院后4年内未再发室速或室颤(ICD未报警)。患者心室电风暴均在败血症蔓延并发寒战高热时发生,考虑为败血症高热引发全身交感兴奋引发心室电风暴可能性大。
[Abstract]:The patient, male, 71 years old, had anterior myocardial infarction, left anterior descending branch stent implantation, one and a half years ago because of paroxysmal ventricular tachycardia implanted single lumen ICD. The ICD discharge was 5-6 times due to sudden shivering and high enthusiasm. After admission, amiodarone was used to control cardiac rhythm, blood culture suggested Escherichia coli, lung CT showed pulmonary infection, and meropenem was given anti-infection according to the drug sensitivity results. After 3 days of hospitalization, ventricular electrical storm occurred during hyperthermia and shivering after admission. The symptoms were cooled down, amiodarone, magnesium sulfate, dexamethasone and promethazine were relieved. Pulmonary CT examination indicated pulmonary consolidation, and meropenem continued to be treated for 3 weeks. CRP, chest CT and blood culture were restored to normal and then were treated with cefoxitin intravenously for 2 weeks. No recurrent ventricular tachycardia or ventricular fibrillation was reported within 4 years after discharge. Ventricular electrical storms occurred when septicemia spread and chills and hyperthermia occurred. It was considered that systemic sympathetic excitation caused by septicemia and hyperthermia was more likely to cause ventricular electrical storms.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R515.3

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