查詢結果分析
來源資料
相關文獻
- A Case of ST Elevation Myocardial Infarction with Concurrent Ischemic Stroke: Etiology and Therapy
- 缺血性腦梗塞的影像診斷
- Risk Factors for Ischemic Stroke: Electrocardiographic Findings
- Risk Factors for Seizures after First-Time Ischemic Stroke by Magnetic Resonance Imaging
- Strokes in Children: A Medical Center-Based Study
- 急性腦梗塞治療新進展
- 擴散影像在腦缺血及梗塞診斷上的應用價值
- 因橋腦梗塞造成之單純垂直方向眼球運動痲痺
- 開顱減壓術應用於大範圍腦梗塞病人之療效
- Noninvasive Evaluation of Vertebral Arteries in Lateral Medullary Infarction
頁籤選單縮合
| 題 名 | A Case of ST Elevation Myocardial Infarction with Concurrent Ischemic Stroke: Etiology and Therapy=個案討論:ST段上升心肌梗塞後缺血性腦梗塞之成因與治療 |
|---|---|
| 作 者 | 簡韶甫; 張釗監; | 書刊名 | 輔仁醫學期刊 |
| 卷 期 | 22:3 2024.09[民113.09] |
| 頁 次 | 頁33-37 |
| 分類號 | 415.923 |
| 關鍵詞 | ST段上升心肌梗塞; 缺血性腦梗塞; 腦梗塞; STEMI; Myocardial infarction; Stroke; |
| 語 文 | 英文(English) |
| DOI | 10.53106/181020932024092203004 |
| 中文摘要 | 急性心肌梗塞後之缺血性腦梗塞發生率低,但同時合併急性心肌梗塞和缺血 性腦梗塞,患者的死亡率會明顯上升。常見的原因包括心肌梗塞後新發生的心房 顫動、左心室前壁梗塞引起的心室內血栓或病患本身有凝血異常的疾病。一位 64 歲男性患有ST 上升型心肌梗塞合併心因性休克而住院,心導管檢查顯示左 主冠狀動脈至左前降支和左迴旋支阻塞,接受緊急心導管介入治療,由於生命徵 象不穩定,使用強心劑、主動脈氣球幫浦和呼吸器以維持血流動力學,按照現行 治療指引使用雙重抗血小板藥物和抗凝劑治療,而後病況逐漸穩定。然而,移除 主動脈氣球幫浦後,發生缺血性腦梗塞併有左側偏癱和失語症。病人接受顱內動 脈取栓術後恢復良好,美國國家衛生院腦中風評估表(NIHSS)從14 分下降到2 分。我們詳細回顧了心肌梗塞後缺血性腦梗塞的病生理機轉,包含左心室功能下 降造成血液鬱積、心內膜缺血壞死造成發炎反應、新發生的心房顫動或本身凝血 功能異常容易產生血栓。若是和心房顫動相關,按照現行治療指引使用抗血小板 藥物和非維他命K 拮抗劑類口服抗凝血劑治療為主,若為左心室內血栓可以抗 凝血劑治療三到六個月後再追蹤,但目前無隨機對照試驗顯示哪一種抗凝血劑效 果較好。 |
| 英文摘要 | Post-myocardial infarction (MI) ischemic stroke is rare but increases mortality than those not complicated with stroke. Here, we present a 64-year-old man suffered from ST segment elevation myocardial infarction and complicated with cardiogenic shock. Primary percutaneous coronary intervention was done for left main to left anterior descending. Inotropic agent, intra-arterial balloon pump (IABP) and mechanical ventilator support were used for unstable hemodynamics. Dual anti-platelet and anticoagulation were used as guideline recommendation. However, ischemic stroke happened with left side hemiplegia and aphasia after removing IABP. Intra-arterial thrombectomy was done for right middle cerebral infarct. National Institutes of Health Stroke Scale improved from 14 to 2 after thrombectomy. The pathogenesis of post-MI stroke includes extensive anterior wall akinesia leading to blood stasis, inflammatory changes by subendocardial injury, new onset atrial fibrillation (AF), and hypercoagulable status. Preexisting AF with acute coronary syndrome has clear recommendation with antithrombotic therapy with anti-platelet and non-vitamin K antagonist oral anticoagulant (NOAC) use. However, stroke prevention after acute MI is limited for those without AF. Guidelines suggest considering anticoagulation for 3 to 6 months once LV thrombus observed, but there was no randomized controlled trial to confirm which anticoagulant is better. |
本系統中英文摘要資訊取自各篇刊載內容。