急性左主干闭塞病例报告庞文跃

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1、CaseReport病例报告ShengjingHospitalofChinaMedicalUniversity中国医科大学附属盛京医院WenyuePang庞文跃Patientname:PanXX,Sex:Male,Age:64years患者潘XX，男，64Washospitalizedwiththechiefcomplaint“remittentchestpainfor5yearswithattenuationfor1week”.因“间断胸痛5年，加重1周”为主诉入院ClinicData临床资料ClinicData临床资料Pasthistory:hypertensionfor7y

2、ears.Smoke20cigarettesperdayfor30years.既往有高血压病史7年。吸烟20支/天30年Physicalexamination:BP150/95mmHg，thecardiacboarderenlargedtotheleftandlower.HR72bpm,withoutcardiacmurmur.体检：BP150/95mmHg，心界左下扩大，HR72次/分，无杂音ClinicData临床资料ECG：LeadsV1-V5STsegmentsdepressedfor0.05mVECG：V1-V5导联ST段下移0.05mV；PDE：LV=57.4mm；E

3、F=61%ClinicData临床资料CoronaryarteryCT：Leftmajor-leftanteriordescending(LAD)branchproximalandmedialsegmentsseverestenosis;leftcircumflex(LCX)proximalsegmentmoderatestenosis.冠脉CT：左主干-前降支近中段重度狭窄；旋支近段中度狭窄。ClinicData临床资料临床诊断：1.冠心病：不稳定心绞痛2.高血压病3级Clinicaldiagnosis:1.coronaryheartdisease:unstableangina

4、pectoris2.HypertensionCoronaryAngiography影像CoronaryAngiography影像CoronaryAngiography影像CoronaryAngiographyInthepreparationofrightcoronaryangiography,beforeangiographiccatheterreachedtheorificeoftherightcoronaryartery,BPdepression,from135/85mmHgto80/40mmHgin30seconds.准备右冠造影过程中，造影导管未到达右冠开口时，患者血压下

5、降，30秒内由135/85下降到80/40NoobviouschangesofHR心率无明显减慢Noobviouschangeswasobservedintheleadsofelectrocardiography(ECG)monitoring.心电监测导联未见明显变化。Thepatientsaidchestskinitch,withoutchestpain.患者自述胸前皮肤搔痒，无胸痛Whathappened?发生什么了？Pressuremonitoringpathwayleakage?压力监测通道漏气？contrastmediahypersensitivity？造影剂过敏？Va

6、galreflex?迷走反射？Occlusionofleftcoronaryartery？左冠闭塞？Thepatient’sHRdroppedto35bpm患者心率下降至35次/分Chestpainonset开始出现胸痛acuteleftmajorocclusion！急性左主干闭塞！Whichfirst?首先做什么？IABP/Temporarycardiacpacing,thenPCIIABP/临时起搏器，然后PCIPCI首先PCIDrug药物抢救Other其他Management处理XB3.5GCCatheterwasemergentlysentin,approvingthe1

7、00%occlusionofleftmajor(LM)bodypart.紧急予XB3.5GC导管送入，证实左主干体部100%闭塞遗憾：没有留下影像Regret:novideomadeGC:XB3.5GW:BMWSTENT:3.5*18mmCypherIABP3.0*13Cypher3.0*18CypherPCI治疗四:LCX3.0*23CypherT支架技术afterKissballoon右冠造影Followup随访（14months）Ophthalmalgiawhenmovem