并发严重热损伤和 STEV 心肌梗死的处理方法

IF 1 Q4 CRITICAL CARE MEDICINE
Julie Beveridge, Curtis Budden, Abelardo Medina, Kathryne Faccenda, Shawn X Dodd, Edward Tredget
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引用次数: 0

摘要

急性冠状动脉血栓是导致热损伤和电损伤患者发病和死亡的一个已知但罕见的因素。烧伤患者心肌梗死的总发病率为 1%,梗死后的院内死亡率约为 67%,而普通烧伤患者的总死亡率为 1.4% 至 18%。因此,早期发现和有效的围手术期管理对优化患者预后至关重要。在此,我们详细报告了一名体表总面积达 65% 的成年男性重度热损伤患者的救治情况,该患者在复苏期间发生了 STEV 心肌梗死(STEMI)。患者被发现左前降支冠状动脉100%闭塞,为此及时进行了药物洗脱支架(DES)冠状动脉支架置入术。植入支架后,患者需要接受双重抗血小板治疗。持续的双联抗血小板疗法要求制定详细的围手术期方案,其中包括集合血小板、包装红细胞、去氨加压素 (DDAVP™),以及术中通过血栓弹力图监测患者的凝血参数,进行三次分阶段手术干预,以实现烧伤创面的彻底清创和植皮。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Management of Concomitant Severe Thermal Injury and ST-Elevation Myocardial Infarction
Acute coronary thrombosis is a known, but rare, contributor to morbidity and mortality in patients with thermal and electrical injuries. The overall incidence of myocardial infarction among burn patients is 1%, with an in-hospital post-infarction mortality of approximately 67%, whereas the overall mortality rate of the general burn patient population is from 1.4% to 18%. As such, early detection and effective peri-operative management are essential to optimize patient outcomes. Here, we report the details of the management of an adult male patient with a 65% total body surface area severe thermal injury, who developed an ST-elevation myocardial infarction (STEMI) in the resuscitation period. The patient was found to have 100% occlusion of his left anterior descending coronary artery, for which prompt coronary artery stent placement with a drug-eluting stent (DES) was performed. Following stent placement, the patient required dual antiplatelet therapy. The ongoing dual antiplatelet therapy required the development of a detailed peri-operative protocol involving pooled platelets, packed red blood cells, desmopressin (DDAVP™) and intraoperative monitoring of the patient’s coagulation parameters with thromboelastography for three staged operative interventions to achieve complete debridement and skin grafting of his burn wounds.
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