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題名 | 擴張性心肌病變合併血栓性腦中風:一病例報告=Dilated Cardiomyopathy Complicated with Embolic Stroke--A Case Report |
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作者姓名(中文) | 林煊淮; 李昇駿; 邱建勳; 吳蓮山; | 書刊名 | 中華民國重症醫學雜誌 |
卷期 | 4:3 2002.07[民91.07] |
頁次 | 頁171-176 |
分類號 | 415.3165 |
關鍵詞 | 擴張性心肌病變; 心臟衰竭; 血栓性中風; 腎素血管收縮素系統; 腎上腺素性神經系統; Dilated cardiomyopathy; Heart failure; Embolic stroke; Renin-angiotensin system; RAS; Adrenergic nervous system; ANS; |
語文 | 中文(Chinese) |
中文摘要 | 我們提出一病例為擴張性心肌病變合併血栓性腦中風之病人,擴張性心肌病變的定義為心室舒張期和收縮期血量增加且心搏出率(ejection fraction)小於40%。病患於住院期間,心臟超音波顯示四個房室皆擴大,心搏出率小於40%且有巨大的血塊在左心室的内膜上,病人住院期間給予鬱血性心臟衰竭之標準療法同時加上抗凝血劑,而是否要常規使用抗凝血劑來預防心因性血栓塞目前雖無定論,不過一般相信warfarin可用於曾經有血栓性栓塞或心臟内有血栓的病人,而且心臟越是擴大收縮功能越是不良者都應建議使用warfarin。此病例於住院初期即使用抗凝血劑,半年後追蹤心臟超音波發現血塊有明顯變小,且期間並沒有再發生中風。在心律不整的治療方面,許多報告都指出使用抗心律不整藥物對病人長期的預後並沒有幫助,只有在緊急的時候才建議使用。 |
英文摘要 | We report one young solder of dilated cardiomyopathy complicated with embolic stroke. The definition of dilated cardiomyopathy is increased volume of ventricular diastolic and systolic phases and ejection fraction no more than 40%. During this admission, 2-D echocardiography revealed dilated four chambers and ejection fraction smaller than 40%. It also demonstrated a huge thrombus over left ventricle. Generally the treatment is just like heart failure. But "Dose whether use anticoagulant routinely to prevent cardiogenic embolism or not?" is not a final conclusion now. Most authors believe that warfarin could be administered to those patients who had episodes of embolism or had thrombi in the diseased heart. The more heart function is disadvantaged, the more the use of warfarin is advisable. In this case, we had prescribed the anticoagulant when he just admitted. After half a year, cardiography demonstrated the thrombus became smaller. On the concept of the treatment of arrhythmia, most of reports reveal that the long-term use of anti-arrhythmic agents did not have the benefit to overall prognosis. And it is just used in an emergency only. |
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