中枢神经系统疾病相关Takotsubo综合征的临床分析

发布时间：2018-04-17 23:23

本文选题：Takotsubo综合征 + 应激性心肌病　；参考：《山东大学》2017年硕士论文

【摘要】：研究背景Takotsubo综合征(Takotsubosyndrome,TTS),又称应激性心肌病、心尖球形综合征,是一种由心理或躯体应激等因素诱发的急性可逆性心脏衰竭综合征,其特征是室壁短暂可逆性的运动减弱或消失,导致心脏收缩功能障碍,临床表现于类似急性心肌梗死的胸痛、呼吸困难,同时伴心电图、心肌酶谱改变,而冠状动脉无病理性狭窄病变。已知多种中枢神经系统(Central nervous system,CNS)的疾病可能会引起一系列心功能异常,其中可能包括TTS。及时诊断CNS疾病引起的TTS并给予适当治疗,有助于提高患者预后,改善患者生活质量。目的本文报告1例罕见的颅内肿瘤患者围术期间突发TTS,术中给予积极有效的抢救,术后给予血流动力学的支持治疗,患者预后较好,并无其他并发症。在此基础上收集国内外CNS疾病诱发TTS的相关报道,总结其一般临床特点,并进一步分析了该病的病因、发生机制及诊断治疗,旨在加强临床医师对TTS的重视,避免误诊误治。临床资料和方法1.一位65岁男性患者于颅内肿瘤切除术中突发室颤后被成功抢救,随后超声心动图表现出经典型TTS病变模式,1周内患者左室收缩功能恢复正常。我们分析了该患者发病诱因及发病机制,根据其围术期病情变化、辅助检查及预后结果,最终诊断为TTS。2.利用中国知网、万方医学网和Pubmed、Elsevier等数据库进行文献检索,挑选TTS与CNS疾病相关的文献,统计分析每篇文献中的病例特点,包括患者年龄、性别、神经系统诊断、TTS病变类型及临床结局。结果我们回顾国内外相关病例报道,共筛选出120篇文献所报道的284例病例在遭遇CNS疾病时并发TTS,最常见于蛛网膜下腔出血(n=174),其次是癫痫(n=44),第三是脑卒中(n=27)。女性234例,男性47例,3例没有提供性别信息,平均年龄为57.11±15.67岁。绝大多数病例为心尖部典型病变类型(经典型=183;反向型=24;其他类型=12;未提及=65)。心电图显示ST段异常(抬高或压低)占42%,T波倒置占39%。6%的患者冠状动脉存在不同程度的狭窄。279例有预后结果,其中220例(77%)心功能可完全恢复,59例(20%)死亡。死亡病例中有5例是反向型TTS,28例是经典型TTS。结论TTS是CNS疾病的常见并发症之一,好发于绝经后女性,心尖部典型病变类型最常见,一般预后良好。主要发病机制可能是交感神经兴奋导致的儿茶酚胺风暴。其中下丘脑以及岛叶附近区域损伤引起的交感神经过度激活,是心功能损伤的最可能原因。
[Abstract]:Background: Takotsubo syndrome (Takotsubosyndrome, TTS), also known as stress cardiomyopathy, apical ballooning syndrome, is a psychological or physical stress and other factors induced by acute reversible heart failure syndrome, which is characterized by a transient and reversible ventricular wall movement weakened or disappeared, leading to cardiac systolic dysfunction, clinical manifestations in similar to acute myocardial infarction accompanied with chest pain, dyspnea, electrocardiogram, myocardial enzyme change, and coronary artery stenosis. No pathological known variety of central nervous system (Central nervous system, CNS) of the disease may cause a series of abnormal heart function, which may include the timely diagnosis of TTS. CNS disease caused by TTS and proper treatment can help to improve the prognosis of patients, improve the quality of life of patients. The purpose of this report of 1 cases of postoperative intracranial tumor were rare during the emergency operation have given positive TTS The effect of the rescue, support treatment after giving hemodynamics, patients with good prognosis, no other complications. On the basis of collecting relevant reports at home and abroad CNS disease induced by TTS, summarize its clinical characteristics, and further analyzes the causes of the disease, pathogenesis and diagnosis and treatment, to strengthen the clinician to TTS attention. To avoid misdiagnosis. Methods 1. clinical data and a 65 year old male patient with intracranial tumor resection in sudden ventricular fibrillation after operation were successfully rescued, then echocardiography showed classical TTS lesion patterns within 1 weeks in patients with left ventricular systolic function returned to normal. We analyzed the predisposing causes and pathogenesis. According to the perioperative changes of disease and prognosis, auxiliary examination results, the final diagnosis was TTS.2. by China CNKI, Wanfang and Pubmed, Elsevier database and CNS document retrieval, choose TTS. Disease related literature, statistical analysis of the different characteristics of each cases in the literature, including age, gender, neurological diagnosis, and clinical outcome in type TTS lesions. The results of our review of the domestic and foreign related cases, 284 cases were screened out of 120 articles reported in the CNS TTS concurrency suffered disease, most commonly in the spider subarachnoid hemorrhage (n=174), followed by epilepsy (n=44), third stroke (n=27). 234 cases were female, 47 were male, 3 cases did not provide information on gender, the average age was 57.11 + 15.67 years. Most of the cases were typical apical lesion types (classical =183; reverse type =24; other type =12; =65 not mentioned). ECG showed ST Duan Yichang (higher or lower) accounted for 42%, accounting for T wave inversion in the presence of 39%.6% in patients with coronary artery stenosis of.279 patients with different degree of the outcome, of which 220 cases (77%) heart function can be completely restored in 59 cases (20%) died of death. 5 cases are the reverse type TTS, 28 cases of classic TTS. conclusion TTS is one of the common complications of CNS disease, occurs in postmenopausal women, the most common type of typical apical lesions, generally good prognosis. The main pathogenesis is sympathetic to catecholamine storm. The hypothalamus and the insula near the damage of excessive sympathetic activation, is the most likely reason for heart function damage.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.41;R541.7

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