Gao Haolei, Wang Xiaodong, Yang Qingyue
Department of Anesthesiology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai City, Shandong Province, China.
Department of Critical Care Medicine, Laizhou People's Hospital, Yantai City, Shandong Province, China.
Medicine (Baltimore). 2025 Jan 31;104(5):e41454. doi: 10.1097/MD.0000000000041454.
Sepsis is one of the most prevalent and deadly diseases today. Sepsis involving the heart can progress to septic cardiomyopathy; however, there is a lack of uniform diagnostic criteria. A review of the literature reveals a paucity of literature on sepsis combined with acute myocardial infarction (AMI) and no reports on emergency surgical treatment.
A 52-year-old patient with trauma-induced sepsis leading to acute heart failure with elevated ST-segment on electrocardiogram and postoperative coronary angiography suggestive of AMI.
Small bowel rupture, infectious shock, AMI, hypertensive disease, old cerebral infarction.
The patient was admitted to the hospital and immediately underwent emergency surgery to remove the infected focus, with treatment with meropenem for anti-infection, ambroxol for sputum, parenteral nutritional support, sedation and analgesia, esmolol to control the ventricular rate, uradil to control blood pressure, and transfusion of red blood cells and plasma for correction of anemia and coagulation functions. Coronary angiography was performed 6 months later.
The patient was discharged after showing signs of improvement and was subsequently monitored in an outpatient clinic setting. At the time of writing, the patient is still alive and well.
In cases of acute heart failure resulting from trauma-induced sepsis, it is crucial to consider myocardial ischemia as a potential factor. Early surgical removal of infected foci may prove beneficial in improving the patient's prognosis. However, differentiating between septic cardiomyopathy and sepsis-combined myocardial infarction can be challenging, and the appropriateness of the diagnostic criteria for sepsis at this stage is debatable.
脓毒症是当今最常见且致命的疾病之一。累及心脏的脓毒症可进展为脓毒性心肌病；然而，目前缺乏统一的诊断标准。文献综述显示，关于脓毒症合并急性心肌梗死（AMI）的文献较少，且尚无急诊手术治疗的报道。
一名52岁患者因创伤性脓毒症导致急性心力衰竭，心电图显示ST段抬高，术后冠状动脉造影提示AMI。
小肠破裂、感染性休克、AMI、高血压病、陈旧性脑梗死。
患者入院后立即接受急诊手术以清除感染灶，给予美罗培南抗感染、氨溴索化痰、肠外营养支持、镇静镇痛，艾司洛尔控制心室率、乌拉地尔控制血压，并输注红细胞和血浆以纠正贫血及凝血功能。6个月后进行冠状动脉造影。
患者病情好转后出院，随后在门诊进行随访。在撰写本文时，患者仍然健在。
对于创伤性脓毒症导致的急性心力衰竭病例，将心肌缺血视为潜在因素至关重要。早期手术清除感染灶可能有利于改善患者预后。然而，区分脓毒性心肌病和脓毒症合并心肌梗死具有挑战性，现阶段脓毒症诊断标准的合理性存在争议。
