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一氧化碳中毒诱发的变异型心绞痛:一份符合 CARE 标准的病例报告。

Variant angina induced by carbon monoxide poisoning: A CARE compliant case report.

作者信息

Song Lisha, Bian Ge, Yang Weimin, Li Hai-Feng

机构信息

Department of Emergency.

Department of Urology, The First Hospital of Jilin University, Changchun, Jilin, China.

出版信息

Medicine (Baltimore). 2019 Apr;98(16):e15056. doi: 10.1097/MD.0000000000015056.

Abstract

RATIONALE

Carbon monoxide (CO) poisoning can cause severe damage to the nervous system, and can also cause serious damage to organs, such as the heart, kidneys, and lungs. CO damage to myocardial cells has been previously reported. This can lead to serious complications, such as myocardial infarction.

PATIENT CONCERNS

A 47-year-old female patient complained of sudden chest pain for 30 minutes. Before admission, the patient had non-radiating burning chest pain after inhalation of soot.

DIAGNOSIS

An electrocardiogram showed that myocardial ischemia was progressively aggravated, manifested by progressive ST-segment elevation, and accompanied by T wave inversion and other changes. No obvious coronary stenosis was observed in a coronary angiographic examination. Therefore, the patient was considered to have developed variant angina resulting from CO poisoning-induced coronary artery spasm.

INTERVENTIONS

The patient was treated with drugs for improving blood circulation and preventing thrombosis, and underwent hyperbaric oxygen therapy.

OUTCOMES

Clinical symptoms relieved after the treatment.

LESSONS

Findings from this case suggest that CO can cause coronary artery spasm and it is one of the predisposing factors of variant angina. For these patients, hyperbaric oxygen therapy can improve blood circulation and prevent formation of thrombus and encephalopathy.

摘要

原理

一氧化碳(CO)中毒可导致神经系统严重损伤,也可对心脏、肾脏和肺等器官造成严重损害。此前已有关于CO对心肌细胞损伤的报道。这可能导致严重并发症,如心肌梗死。

患者情况

一名47岁女性患者主诉突发胸痛30分钟。入院前,患者吸入烟尘后出现非放射性灼痛。

诊断

心电图显示心肌缺血逐渐加重,表现为ST段逐渐抬高,并伴有T波倒置等变化。冠状动脉造影检查未观察到明显的冠状动脉狭窄。因此,该患者被认为是由CO中毒引起冠状动脉痉挛导致变异性心绞痛。

干预措施

患者接受改善血液循环和预防血栓形成的药物治疗,并接受高压氧治疗。

结果

治疗后临床症状缓解。

经验教训

该病例结果表明,CO可导致冠状动脉痉挛,是变异性心绞痛的诱发因素之一。对于这些患者,高压氧治疗可改善血液循环,预防血栓形成和脑病。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dac0/6494374/9f4de8ac82f6/medi-98-e15056-g001.jpg

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