呼吸重症患者严重脓毒症合并急性心肌梗死的临床特点

目的:分析呼吸重症患者严重脓毒症合并急性心肌梗死的临床特点,提高临床医师对该疾病的诊治水平。方法:回顾性分析2016年1月至2021年2月在苏州大学附属第一医院呼吸与危重症医学科诊治的12例严重脓毒症合并急性心肌梗死患者的临床资料。结果:12例患者中,男10例,女2例,年龄63-89岁,中位年龄81岁。50%以上的患者存在高血压病或慢性呼吸系统基础疾病。所有患者在发生心肌梗死前存在明显缺氧。12例患者中发生心肌梗死当天出现热峰升高、氧合恶化、血压下降、胸闷气急比例分别为10、9、7以及6例。7例患者均出现血压下降及氧合恶化。出现心电图T波倒置、病理性Q波、ST段压低及ST段抬高的患者分别为6、4、4以及3例。前壁心尖段及中段梗死均为8例,下壁心尖段及中段梗死分别为7及6例。患者从发生严重脓毒症至急性心肌梗死的时间为1~2 d。12例患者均因病情危重采用保守治疗,其中9例患者死亡。结论:呼吸重症患者在发生严重脓毒症后短期内可并发急性心肌梗死,主要表现为热峰上升、血压下降及氧合恶化,此类患者病死率高。心电图主要表现为T波倒置、病理性Q波以及ST段压低,其心肌梗死部位以前壁及下壁多见。

Clinical characteristics of severe sepsis complicated with acute myocardial infarction in patients with severe respiratory diseases

Objective:To analyze the clinical characteristics of severe sepsis complicated with acute myocardial infarction(AMI)in patients with severe respiratory diseases.Methods:The clinical data of 12 patients with severe sepsis complicated with AMI admitted to the department of pulmonary and critical care medicine from January 2016 to February 2021 in our hospital was retrospectively analyzed.Results:Of the 12 patients,ten were males and two were females,with a median age of 81 years(ranging from 63 to 89 years).More than half of the patients had history of hypertension or chronic respiratory diseases and all patients developed significant hypoxia before AMI occurrence.On the day of AMI occurrence,the proportion of patients with symptoms of elevated heat peak,oxygenation deterioration,decreased blood pressure,and chest tightness and dyspnea were 10/12,9/12,7/12,and 6/12,respectively.The symptoms of decreased blood pressure and oxygenation deterioration simultaneously happened in seven patients.The proportion of T wave inversion,Q wave,ST-segment depression,and ST-segment elevation in electrocardiogram were 6/12,4/12,4/12,and 3/12,respectively.In all AMI sites,apical segment and middle segment of inferior AMI accounted for 8/12 respectively.Additionally,the apical segment and middle segment of anterior AMI accounted for 7/12 and 6/12,respectively.The interval in all patients from severe sepsis occurrence to AMI development was 1 to 2 days.All patients were treated conservatively because of their critical conditions,and nine of them died finally.Conclusion:AMI may develop in patients with severe respiratory diseases in a short interval after severe sepsis occurrence with symptoms of elevated fever peak,decreased blood pressure,and oxygenation deterioration.The prognosis of these patients was very poor.T wave inversion,Q wave,and ST segment depression were the main changes in electrocardiogram.Inferior and anterior myocardial infarction were common in this sepcial population.