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中华重症医学电子杂志 ›› 2023, Vol. 09 ›› Issue (03) : 311 -315. doi: 10.3877/cma.j.issn.2096-1537.2023.03.014

病例报告

钝性胸部外伤引起冠状动脉斑块脱落导致心肌梗死一例
郝怿隆, 叶慧, 白金霞, 宋威, 秦龙, 张黔, 万健()   
  1. 201299 上海,上海市浦东新区人民医院重症医学科
    200137 上海,上海市第七人民医院重症医学科
  • 收稿日期:2022-07-07 出版日期:2023-08-28
  • 通信作者: 万健
  • 基金资助:
    上海市浦东新区临床医学高原学科建设项目(PWYgy2021-09)

A case of myocardial infarction caused by coronary plaque shedding due to blunt chest trauma

Yilong Hao, Hui Ye, Jinxia Bai, Wei Song, Long Qin, Qian Zhang, Jian Wan()   

  1. Department of Intensive Care Unit, Shanghai Pudong New Area People's Hospital, Shanghai 201299, China
    Department of Intensive Care Unit, Shanghai Seventh People's Hospital, Shanghai 200137, China
  • Received:2022-07-07 Published:2023-08-28
  • Corresponding author: Jian Wan
引用本文:

郝怿隆, 叶慧, 白金霞, 宋威, 秦龙, 张黔, 万健. 钝性胸部外伤引起冠状动脉斑块脱落导致心肌梗死一例[J]. 中华重症医学电子杂志, 2023, 09(03): 311-315.

Yilong Hao, Hui Ye, Jinxia Bai, Wei Song, Long Qin, Qian Zhang, Jian Wan. A case of myocardial infarction caused by coronary plaque shedding due to blunt chest trauma[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(03): 311-315.

胸部外伤继发的心肌梗死比较罕见,文献报道的相关病例屈指可数。当心电图上的ST段抬高与心肌标志物阳性时,是外伤所致的心肌挫伤还是外伤导致的心肌梗死很难鉴别。本文报道1例高空坠落,被高空着地后反弹的钢板打中胸部,导致多发伤的患者,并讨论创伤导致的心肌梗死与创伤性心肌挫伤之间的异同,强调在评估胸部钝性损伤时须考虑冠状动脉病变可能性;探讨在胸部外伤情况下出现心肌梗死时,血栓与出血风险之间如何获得较好的平衡,并强调多学科协同的重要性,以使这类患者获得更好的治疗和护理。

Myocardial infarction secondary to chest trauma is rare, and few cases have been reported in the literature. When both ST segment and myocardial biomarkers are positive, it is difficult to distinguish whether it is a trauma-induced myocardial contusion or a trauma-induced myocardial infarction. We report a case of multiple trauma patient caused by falling and chest hitting with a steel plate rebounding after landing. To discuss the similarities and differences between traumatic myocardial infarction and traumatic myocardial contusion, possibility of coronary artery disease must be considered when evaluating blunt chest injury. To explore how to achieve balance between thrombosis and hemorrhage risk when myocardial infarction occurs in case of chest trauma, multidisciplinary cooperation can deliver better treatment and care.

图1 钝性胸部外伤患者心电图。图a为初入院时心电图,窦性心律,基本正常心电图;图b为入院第2天晨心电图,窦性心律,V2-V5导联ST段弓背向上抬高
图2 钝性胸部外伤患者冠状动脉CTA检查。图a为三维重建表面成像;图b为冠状动脉成像,均显示冠状动脉左前降支中段血栓、管腔闭塞(图中绿/红箭头所示处) 注:CTA为CT血管造影
图3 钝性胸部外伤患者心脏血管内超声。图a为LAD左前降支近中段横截面斑块负荷68%;图b为左前降支中段病变处狭窄最重处的横截面斑块负荷73% 注:LAD为左前降支冠状动脉
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