颅内动脉瘤破裂并发急性心肌梗死 1 例报告及文献复习.

Objective: To discuss the diagnosis and treatment of one patient with ruptured intracranial aneurysm complicated with acute myocardial infarction (AMI), and to provide the reference for the clinical diagnosis, treatment, and anesthesia of the disease. Methods: The clinical data, imaging findings, and anesthesia methods of one patient with ruptured intracranial aneurysm complicated with AMI were retrospectively analyzed, and the analysis was performed combined with the relevant literatures. Results: The patient was admitted to hospital due to sudden severe headache with nausea and vomiting for 4 h. A total of 1 h and 10 min after admission, the multi-slice CT results showed subarachnoid hemorrhage (SAH). There was little bilateral ventricular effusion, and the intracranial angiography results showed a tumor in the posterior communicating segment of the right internal carotid artery. A total of 2 h 52 min after admission, the myoglobin was 483. 6 μ g·L-1, the troponin I was 4. 990 μg·L-1, the creatine kinase isoenzyme-MB (CK-MB) was 45. 70 μg·L-1. A total of 16 h 31 min after admission, the ECG results showed sinus bradycardia, left ventricular hypertrophy, and ST-T segment changes. The initial diagnosis of the patient was SAH, AMI, and hypertension grade 3 (very high risk). After early comprehensive treatment, the patient underwent emergency clipping of cerebral aneurysm after 3 d. The anesthesia method was tracheal intubation ansthesia, and the anesthetic drugs were carefully selected to achieve the best blood flow and anesthesia effect. The vital signs of the patient were stable during the operation, and the condition of the patient was improved and discharged after 7 d. Conclusion: For the patients with intracranial aneurysm rupture complicated with AMI, CT, intracranial angiography, and myocardial markers are the important examinations for the diagnosis and differential diagnosis; controlling the blood pressure is the key point for the treatment and anesthesia. [ABSTRACT FROM AUTHOR]