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目的探讨心房颤动(房颤)继发冠状动脉(冠脉)栓塞致急性心肌梗死的诊治方法。方法老年男性患者1例,既往有“风湿性心脏病二尖瓣狭窄、阵发性房颤”病史。突发急性下壁心肌梗死,急诊冠脉造影显示:左心室后支近段完全闭塞,可见血栓影。结果行急诊冠脉造影术治疗,将导丝送至左心室后支远端,先用抽吸导管抽吸血栓,冠脉内注入替罗非班10ml,再用球囊扩张,造影显示血流恢复。因术中出现急性肺水肿,血压、脉搏及PaO_2均较低,予以主动脉内球囊反搏术。术后恢复良好,长期口服华法林抗凝治疗。结论房颤继发冠脉栓塞致急性心肌梗死发生率相对较低,行急诊冠脉造影术非常必要。抗凝治疗在后续治疗中有重要地位。
Objective To investigate the diagnosis and treatment of acute myocardial infarction caused by secondary coronary artery (coronary artery) embolization in atrial fibrillation (AF). Methods One elderly male patient had a history of “rheumatic mitral stenosis, paroxysmal atrial fibrillation”. Sudden acute inferior myocardial infarction, emergency coronary angiography showed: near complete occlusion of the left ventricular posterior branch, showing thrombosis. Results of emergency coronary angiography, the guide wire to the distal left ventricular posterior, the first suction catheter thrombus, intracoronary injection of tirofiban 10ml, and then balloon dilation, angiography showed that blood flow restore. Due to acute pulmonary edema occurred during surgery, blood pressure, pulse and PaO_2 were lower, to be intra-aortic balloon counter-stroke. Postoperative recovery is good, long-term oral warfarin anticoagulant therapy. Conclusion The incidence of acute myocardial infarction secondary to coronary artery embolization in atrial fibrillation is relatively low. Coronary angiography is very necessary. Anticoagulant therapy in the follow-up treatment has an important place.