本文選題：Takotsubo綜合征 + 應激性心肌病��； 參考：《山東大學》2017年碩士論文

【摘要】：研究背景Takotsubo綜合征(Takotsubosyndrome,TTS),又稱應激性心肌病、心尖球形綜合征,是一種由心理或軀體應激等因素誘發(fā)的急性可逆性心臟衰竭綜合征,其特征是室壁短暫可逆性的運動減弱或消失,導致心臟收縮功能障礙,臨床表現(xiàn)于類似急性心肌梗死的胸痛、呼吸困難,同時伴心電圖、心肌酶譜改變,而冠狀動脈無病理性狹窄病變。已知多種中樞神經系統(tǒng)(Central nervous system,CNS)的疾病可能會引起一系列心功能異常,其中可能包括TTS。及時診斷CNS疾病引起的TTS并給予適當治療,有助于提高患者預后,改善患者生活質量。目的本文報告1例罕見的顱內腫瘤患者圍術期間突發(fā)TTS,術中給予積極有效的搶救,術后給予血流動力學的支持治療,患者預后較好,并無其他并發(fā)癥。在此基礎上收集國內外CNS疾病誘發(fā)TTS的相關報道,總結其一般臨床特點,并進一步分析了該病的病因、發(fā)生機制及診斷治療,旨在加強臨床醫(yī)師對TTS的重視,避免誤診誤治。臨床資料和方法1.一位65歲男性患者于顱內腫瘤切除術中突發(fā)室顫后被成功搶救,隨后超聲心動圖表現(xiàn)出經典型TTS病變模式,1周內患者左室收縮功能恢復正常。我們分析了該患者發(fā)病誘因及發(fā)病機制,根據(jù)其圍術期病情變化、輔助檢查及預后結果,最終診斷為TTS。2.利用中國知網、萬方醫(yī)學網和Pubmed、Elsevier等數(shù)據(jù)庫進行文獻檢索,挑選TTS與CNS疾病相關的文獻,統(tǒng)計分析每篇文獻中的病例特點,包括患者年齡、性別、神經系統(tǒng)診斷、TTS病變類型及臨床結局。結果我們回顧國內外相關病例報道,共篩選出120篇文獻所報道的284例病例在遭遇CNS疾病時并發(fā)TTS,最常見于蛛網膜下腔出血(n=174),其次是癲癇(n=44),第三是腦卒中(n=27)。女性234例,男性47例,3例沒有提供性別信息,平均年齡為57.11±15.67歲。絕大多數(shù)病例為心尖部典型病變類型(經典型=183;反向型=24;其他類型=12;未提及=65)。心電圖顯示ST段異常(抬高或壓低)占42%,T波倒置占39%。6%的患者冠狀動脈存在不同程度的狹窄。279例有預后結果,其中220例(77%)心功能可完全恢復,59例(20%)死亡。死亡病例中有5例是反向型TTS,28例是經典型TTS。結論TTS是CNS疾病的常見并發(fā)癥之一,好發(fā)于絕經后女性,心尖部典型病變類型最常見,一般預后良好。主要發(fā)病機制可能是交感神經興奮導致的兒茶酚胺風暴。其中下丘腦以及島葉附近區(qū)域損傷引起的交感神經過度激活,是心功能損傷的最可能原因。
[Abstract]:Background: Takotsubo syndrome (Takotsubosyndrome, TTS), also known as stress cardiomyopathy, apical ballooning syndrome, is a psychological or physical stress and other factors induced by acute reversible heart failure syndrome, which is characterized by a transient and reversible ventricular wall movement weakened or disappeared, leading to cardiac systolic dysfunction, clinical manifestations in similar to acute myocardial infarction accompanied with chest pain, dyspnea, electrocardiogram, myocardial enzyme change, and coronary artery stenosis. No pathological known variety of central nervous system (Central nervous system, CNS) of the disease may cause a series of abnormal heart function, which may include the timely diagnosis of TTS. CNS disease caused by TTS and proper treatment can help to improve the prognosis of patients, improve the quality of life of patients. The purpose of this report of 1 cases of postoperative intracranial tumor were rare during the emergency operation have given positive TTS The effect of the rescue, support treatment after giving hemodynamics, patients with good prognosis, no other complications. On the basis of collecting relevant reports at home and abroad CNS disease induced by TTS, summarize its clinical characteristics, and further analyzes the causes of the disease, pathogenesis and diagnosis and treatment, to strengthen the clinician to TTS attention. To avoid misdiagnosis. Methods 1. clinical data and a 65 year old male patient with intracranial tumor resection in sudden ventricular fibrillation after operation were successfully rescued, then echocardiography showed classical TTS lesion patterns within 1 weeks in patients with left ventricular systolic function returned to normal. We analyzed the predisposing causes and pathogenesis. According to the perioperative changes of disease and prognosis, auxiliary examination results, the final diagnosis was TTS.2. by China CNKI, Wanfang and Pubmed, Elsevier database and CNS document retrieval, choose TTS. Disease related literature, statistical analysis of the different characteristics of each cases in the literature, including age, gender, neurological diagnosis, and clinical outcome in type TTS lesions. The results of our review of the domestic and foreign related cases, 284 cases were screened out of 120 articles reported in the CNS TTS concurrency suffered disease, most commonly in the spider subarachnoid hemorrhage (n=174), followed by epilepsy (n=44), third stroke (n=27). 234 cases were female, 47 were male, 3 cases did not provide information on gender, the average age was 57.11 + 15.67 years. Most of the cases were typical apical lesion types (classical =183; reverse type =24; other type =12; =65 not mentioned). ECG showed ST Duan Yichang (higher or lower) accounted for 42%, accounting for T wave inversion in the presence of 39%.6% in patients with coronary artery stenosis of.279 patients with different degree of the outcome, of which 220 cases (77%) heart function can be completely restored in 59 cases (20%) died of death. 5 cases are the reverse type TTS, 28 cases of classic TTS. conclusion TTS is one of the common complications of CNS disease, occurs in postmenopausal women, the most common type of typical apical lesions, generally good prognosis. The main pathogenesis is sympathetic to catecholamine storm. The hypothalamus and the insula near the damage of excessive sympathetic activation, is the most likely reason for heart function damage.

【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R739.41;R541.7

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本文編號：1765770