钝性心脏损伤伴闪烁显像灌注-代谢不匹配
Blunt cardiac injury with scintigraphic perfusion-metabolism mismatch.
作者信息
Morikawa Miki, Hagiwara Akiyoshi, Sakamoto Taigo, Kimura Akio
机构信息
Department of Emergency and Critical Care Medicine Juntendo University Urayasu Hospital Urayasu Chiba Japan.
Department of Emergency Medicine and Critical Care National Center for Global Health and Medicine Hospital Tokyo Ibaraki Japan.
出版信息
Acute Med Surg. 2013 Dec 17;1(1):58-60. doi: 10.1002/ams2.8. eCollection 2014 Jan.
PATIENT
A healthy 37-year-old man who bruised his chest with a steel frame developed ventricular fibrillation, pulseless ventricular tachycardia, and temporary torsade de pointes, and was resuscitated with emergency medical treatment. Thallium 201 scintigraphy 7 days later revealed a defect only in a small area of the apex, whereas I-beta-methyl iodophenyl pentadecanoic acid scintigraphy showed defects in a larger area of the apex, ventricular septum, and inferior wall, indicating perfusion-metabolism mismatch. Follow-up dual myocardial scintigraphy on day 49 showed that the scintigraphic defects persisted only at a small area of the apex.
CONCLUSION
Blunt external force appeared to have caused perfusion-metabolism mismatch and subsequent life-threatening arrhythmias in this patient.
患者
一名37岁健康男性，胸部被钢架撞伤后出现心室颤动、无脉性室性心动过速和暂时性尖端扭转型室性心动过速，经紧急治疗后复苏。7天后的铊201闪烁扫描显示仅心尖小区域有缺损，而I-β-甲基碘苯基十五烷酸闪烁扫描显示心尖、室间隔和下壁较大区域有缺损，提示灌注-代谢不匹配。第49天的随访心肌双核素闪烁扫描显示，闪烁扫描缺损仅持续存在于心尖小区域。
结论
钝性外力似乎导致了该患者的灌注-代谢不匹配及随后危及生命的心律失常。
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