吉林大学学报（医学版）2024，Vol.50Issue(2)：529-535,7.DOI:10.13481/j.1671-587X.20240228
急性左下肢动脉栓塞并发肌病肾病代谢综合征的心力衰竭患者1例报告及文献复习
Heart failure patient with acute left lower limb arterial embolism complicated with myonephropathic metabolic syndrome:A case report and literature review
摘要
Abstract
Objective:To report the diagnosis and treatment of one patient with acute left lower limb arterial embolism complicated with myonephropathic metabolic syndrome(MNMS)-associated heart failure,and to provide the reference for the diagnosis,anesthesia,and treatment of such patients.Methods:The retrospective analysis on the clinical data,anesthesia methods,and perioperative management of one patient with acute left lower limb arterial embolism complicated with MNMS-associated heart failure was conducted,and the related literatures were reviewed.Results:The patient,a 56-year-old male,was admitted to the hospital on March 25,2017,due to sudden pain and numbness in the left lower limb accompanied by sensory and motor disturbances.The vascular ultrasound performed 35 min after the admission suggested a secondary thrombus from the distal superficial femoral artery to the entire popliteal artery.The laboratory tests performed 77 min after admission showed the myoglobin(MB)level was 698.7 μg·L-1,cardiac troponin I(TnI)was 0.092 μg·L-1,and creatine kinase isoenzyme(CK-MB)was 4.78 μg·L-1.The electrocardiogram results taken 63 min after admission indicated tachycardia,left ventricular hypertrophy,atrial fibrillation,and atrioventricular block.The initial diagnosis was acute left lower limb arterial thrombosis,coronary artery disease,old myocardial infarction,arrhythmia,and type 2 diabetes.The patient was scheduled for an emergency thrombectomy of the left lower limb under general anesthesia 3 h after admission.During the surgery,the patient's vital signs were stable,but 8 min after operation,the patient suddenly developed ventricular fibrillation,which was considered to be a reinfarction of acute myocardial infarction complicated with MNMS.After active rescue treatment,the patient's life was still not saved.Conclusion:For the patients with acute limb arterial embolism complicated with heart failure,timely restoration of limb blood supply is crucial in treatment.Appropriate fluid resuscitation to expand blood volume,maintaining electrolyte balance,and protecting cardiac and renal functions can effectively reduce the mortality and amputation rate of the patients.关键词
心力衰竭/急性动脉栓塞/肌病肾病代谢综合征/缺血再灌注损伤Key words
Heart failure/Acute arterial embolism/Myonephropathic metabolic syndrome/Ischemia-reperfusion injury分类
医药卫生引用本文复制引用
俞凯华,尉昆,张杰,衣雪梅,王刚,庞磊..急性左下肢动脉栓塞并发肌病肾病代谢综合征的心力衰竭患者1例报告及文献复习[J].吉林大学学报（医学版）,2024,50(2):529-535,7.基金项目
国家自然科学基金项目(81970228,82102306) （81970228,82102306）
吉林省科技厅社发基金项目(20210203091SF) （20210203091SF）
