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心脏“停摆”10天后康复

2017-09-07 08:32:15   中国青年网

25天前,一位从昆山前往盐城探亲的年轻妈妈暴发致命性心肌炎,突发心脏停跳以及肝脏、子宫大出血等一系列危急重症,东南大学附属中大医院紧急驰援,多学科联动先后三次冒险手术治疗。6日,中大医院传来消息,目前,患者生命体征平稳,过两天即可出院。心脏停跳10天还能完全康复,这样的救治案例极为罕见。

31岁的年轻妈妈小张在盐城市第一人民医院被确诊为急性病毒性心肌炎,病情发展迅猛,8月12日夜,该院立即向中大医院求援。

接到求援消息后,重症医学专家、中大医院副院长邱海波教授和中大医院重症医学科主任杨毅教授立即抽调精干医护团队,携带监护仪、呼吸机、ECMO(叶克膜技术即体外膜肺氧合)等,组成“移动ICU”,紧急赶赴盐城会诊。深夜赶到盐城时,小张已经心脏停跳、呼吸衰竭、反复室颤。危急时刻,抢救团队立即接上体外生命支持设备及监护设备,用“人工心脏”进行生命支持,稳住心率、血压和呼吸,暂时挽留住这个年轻的生命,并一路护送至中大医院重症医学科接受继续抢救。

在这个国内一流的体外生命支持救治中心曾经挽救的众多重症心肌炎患者中,一般5-7天心脏功能开始恢复,最晚也不超过10天。但是,小张转入中大医院重症医学科后,心脏一直处于“停摆”状态。

终于在第10天,小张的心脏“活”过来了,心脏超声发现微弱搏动。在医护人员24小时的密切监护下,小张此后的情况一天比一天好,在第15天成功脱离ECMO,心脏恢复自主功能!

心脏不跳还能做手术吗?医生的回答是必须的。胆胰疾病专家郑国灿博士和医护团队勇上手术台,腹腔镜下清理腹腔积血,切除出血的肝外叶。

心脏不跳的人做手术怎么麻醉?麻醉科王瑾主治医师在用药品种和剂量上都格外小心。凭借出色的经验,王瑾为小张选用了安全有效的药物,在剂量上力求恰到好处,以免用少了麻醉浅手术会刺激心脏引起应激反应,用多了麻醉深血压低,恐生命体征波动。

病情复杂多变,一波未平一波又起。入院第三天,小张又突发子宫大出血,前后出血量达700-800毫升。心脏停跳多天,又突发子宫大出血,为病情如此危重的患者行止血术,对妇产科而言也是头一回。妇产科于红、赵维英、史悦华等医师先后会诊,反复斟酌治疗方案,最终由史悦华主治医师在床边为患者清理宫腔积血,行水囊压迫止血术。幸好,术后24小时取出水囊后,患者子宫不再出血,情况稳定。

中大医院重症医学科主任杨毅教授在重症医学一线多年看惯生死时速,听到这个奇迹依然十分激动,感慨不已:“对于年轻的重症心肌炎患者,家属和医生都不能轻易放弃,在这种情况下,家属的充分信任至关重要,只有这样,才给了医生‘冒险’的机会,才可能创造医学和生命奇迹!”

本报记者 沈峥嵘

通讯员 钱钰玲 程守勤

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