中华医学会第7次全国重症医学大会论文汇编1.pdf

CM Y CM MY CY CMY K 未标.pdf 2011-6-7 22:52:09 C-01 Successful Extracorporeal Membrane Oxygenation for Cardiogenic Shock Due to Left Main Coronary Artery Myocardial Infarction ZhongTao Du 1 , Jia-Lin Xing 1 , Xiao-Fang Yang 1 , Jing Hou 2 , Ming Jia 2 , Ran Dong 3 , Xiao-Tong Hou 1 1. Department of Extracorporeal Circulation, Beijing Anzhen Hospital, Capital Medical University, Beijing, China 2. Department of Intensive Care Unit, Beijing Anzhen Hospital, Capital Medical University, Beijing, China 3. Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China Abstract A 59-year-old man was admitted to the emergency department with an acute myocardial infarctio n (AMI) due to left main coronary artery (LMCA) occlusion. An emergent percutaneous coronary angiogram was performed and showed total occlusion of the mid-shaft of the LMCA, which resulted in insufficient perfusion and the patient’s condition worsened. Because an intra-aortic balloon pump (IABP) could not provide adequate organ perfusion pressure, veno-arterial extracorporeal membrane oxygenation (ECMO) and percutaneous transluminal coronary angioplasty (PTCA) were performed. The patient was transferred to the Cardiac Surgical Department for surgical revascularization and coronary artery flow was re-established, successfully weaned from ECMO after 86 hours of support, and discharged to home with recovered left ventricular function 12 days later. C-02 恶病质合并低血容量休克患者的围手术期管理 陈松 中国医科大学附属第一医院 ICU 110001 患者赵某 性别 女 年龄 72岁 主诉：“腹胀 6个月，发现盆腔包块 1个月” 患者绝经 21年，无绝经后阴道流血及排液，6个月前无明显诱因出现腹胀，无腹痛及恶心呕吐， 无二便改变，就诊于外院，发现“盆腔包块”，未治疗。6 月来患者自觉上诉症状逐渐加重，为求 手术治疗于 2012 年 12 月 5 日收入我院妇科。妇检：双附件区软，可触及超新生儿头大囊性中午， 表面光滑，不活动，无压痛。我院全腹增强 CT提示病变为卵巢源性恶性病变可能性大，腹水，肠系 膜及大网膜转移改变。入院时存在消瘦（体重 36Kg）贫血（血红蛋白 85g/L）低蛋白血症（白蛋白 24g/L）患者术前未行肺功能检查一秒率 82%，通气储备百分比 88.5%，术前心彩超提示结构基本正 常，但因胸廓畸形，射血分数（EF 值）未测出。患者完善术前准备后，于 2012 年 12 月 12 日行手 术治疗，术中病理回报卵巢恶性肿瘤，腹腔游离血性腹水 2000毫升，行全子宫、双附件、大网膜、 阑尾切除术，