Case Study: Saving Severe Cardiovascular Patient 病案分析:从命悬一线到转危为安

患者病史

Case Study: Saving Severe Cardiovascular Patient 病案分析:从命悬一线到转危为安

2017-08-23 上海东方国际医院SEIMC

SEIMC successfully diagnosed and treated a cardiovascular surgical emergency of a patient. 上海东方联合医院成功抢救急诊重症心血管病病人。

At Shanghai East International Medical Center (SEIMC), we believe in the importance of education and knowledge sharing with communities and doctors. 

在上海东方联合医院(SEIMC),我们坚信与广大健康爱好者以及医生们分享健康知识和病例解析是非常重要的。

 

Today, we would like to share the case study of Mr. A so  that more people, regardless of age, gender, and current health condition, know that seemingly simple back pains can actually be serious complications; and how we at SEIMC handle life-threatening emergencies. Dr Beng Lin Liam, MD, FRCP Edin, who is chief consultant, family physician and medical director at SEIMC, wrote about Mr. A’s case as below, which not only demonstrated the medical professionalism of himself and SEIMC medical teams but also exemplified the essence of getting to the right hospitals at no waste of a single minute.   

今天我们通过分享A先生的医疗案例,大家不仅可以发现,貌似单纯的背部疼痛,其实隐藏夺命凶险; 也可以进一步了解上海东方联合医院24小时全天候接诊治疗急重症。我们的医疗总监、首席家庭医生、<英>皇家内科医师学会会员粘明仁医生记录了A先生的医疗案例,不仅显示了他本人和东方联合医院团队的高超医疗水准,还体现了病人选对医院并争分夺秒就医的重要性。

Mr. A is the senior executive at a famous international company. Based in Beijing, he came to Shanghai on a business trip in June 2017, when a critical health issue occurred. 

A先生是一位外籍人士,在一家著名的跨国公司担任高管,常驻北京。今年6月,他出差来沪时,突然大病来袭。 

 

One June night, Mr. A was admitted to SEIMC. His back pain started during a business meeting at around 7pm of the same day, lasting for 90 minutes before he was being seen at SEIMC. The pain was initially very severe over the entire upper back for 30 seconds, associated with tiredness, feeling of weakness over his lower body with sweating. There was no shortness of breath, anterior chest tightness or abdominal pain. The said patient’s medical history included Hypertension, Hyperlipidemia and Hyperuricemia, wherein he is on regular medications.

A先生被送到上海东方联合医院已是夜晚。当天晚上7点左右,他在开会时突然感到背部疼痛,疼痛持续了90分钟。最初的背部疼痛非常强烈,持续了30秒钟,伴随着疲劳,身体虚弱无力,大汗淋漓,没有呼吸急促,胸闷或腹部疼痛。病人的病史包括高血压、高脂血症和高尿酸血症,他在使用常规药物治疗这些疾病。

 

Upon admission, his breathing room air Oxygen Saturation level, blood pressure, and pulse rates,and ECG were normal.  The only blood test abnormality found was an elevated D-Dimer。

入院时,他的室内正常呼吸血氧饱和度、血压、脉率和心电图均为正常。只有血液检查异常,发现D-二聚体升高。 

 

Upon close review by the staff physicians, the patient was found to have flow murmur at the apex of his heart, lower blood pressure, and weaker peripheral pulses in his left upper limb and right lower limb.  A provisional diagnosis of suspected Aortic Dissection was made.  

我们的主治医生仔细检查后发现,病人的心脏心尖部有血流杂音,血压较低,左上肢和右下肢外周脉搏较低。当时诊断有主动脉壁夹层形成的可能性。

The aorta is the main blood vessel delivering oxygenated blood from the heart to the rest of the body. Aortic dissection occurs with a tear in the inner surface wall of the aorta resulting in bleeding into the wall which separates, narrowing the lumen and obstructing the openings of branch arteries as it extends along the aorta away from the heart.  

主动脉是主要的血管,把含氧的血液从心脏输送到身体的其他部位。主动脉夹层是指主动脉腔内的血液从主动脉内膜撕裂口进入主动脉壁内,使主动脉壁中层形成夹层血肿,并沿主动脉纵轴扩展的一种心血管系统的灾难性疾病。由于内膜局部撕裂,受到强有力的血液冲击,内膜逐步剥离、扩展,在动脉内形成真、假两腔,从而导致一系列包括撕裂样疼痛的表现。主动脉是身体的主干血管,承受直接来自心脏跳动的压力,血流量巨大,一旦出现内膜层撕裂,破裂的机会非常大,死亡率也非常高。

Our patient had high blood pressure which is a very important acquired predisposing factor for this disease condition. (Aortic dissection is more common in those people with a history of high blood pressure).  Stanford Type A Aortic Dissection is a cardiovascular surgical emergency with very high mortality. Urgent ultrasound and Thoracic-Abdominal CT Aortic Angiograms confirmed Stanford Type A Aortic Dissection with false lumen extending from aortic arch in the chest down to iliac artery in the lower abdomen. 

A先生有高血压,这是一个非常重要的诱发因素(主动脉夹层在高血压患者中更为常见)。Stanford A型主动脉夹层是一种死亡率极高的心血管外科急症。超声诊断和胸腹部CT主动脉造影亦证实Stanford A型主动脉夹层,并伴有假腔形成从胸主动脉弓延伸至髂动脉。

 

An immediate cardiovascular surgical referral was made and a surgical team was assembled.  Emergency Aortic Arch and Ascending Aortic Grafting Replacement, and Aortic Trunk Stent surgery was performed, in an operation lasting 7-8 hours with Heart-Arterial Bypass. The patient was expected to have postoperative complications of liver and kidney dysfunction and was treated in the intensive care before being transferred to the general ward where he recovered for 2 more weeks before repatriation to his home country. 

上海东方联合医院立即安排心脏外科专家团队,为A 先生实施心脏外科手术。在长达8个小时紧急手术中,完成了全主动脉弓替换术、 支架象鼻术和心脏搭桥。病人预计会发生肝肾功能不全的术后并发症。A先生在重症监护室接受治疗两周后,转移至普通病房。 现在A 先生已出院并回国休养。 

 

This case illustrates the successful acute diagnosis and treatment of a Cardiovascular Surgical emergency with very high mortality exceeding 30% even after surgery. His supportive post-operative care during the first 2 weeks after surgery had been really critical to getting him better and out of danger! 

A先生曾经命悬一线,因为他的急症手术风险极高,死亡率超过30%。 但由于他及时就医于具有高水准的综合性医院,他的手术获得极大的成功。在术后两周的重症监护室里的治疗,为A先生转危为安起到了非常重要的作用!

SEIMC is well-staffed and equipped to manage this condition if patients come in time, in addition to the more common instances of heart attacks and pulmonary embolism that we encounter.If you are apprehensive about you or your family’s possibility of having heart problems, here are some advices on how you can prevent or earlier detect heart disease symptoms.

上海东方联合医院拥用专业医疗团队和先进设备,能处理急症急诊包括心脏病和肺栓塞。如果你担心你或你的家人有心脏病的可能性,以下是一些关于如何预防或更早发现心脏病症状的建议。

 

  • Take a tour of hospitals, particularly those with qualified brain imaging facilities and those which can handle and perform high-risk surgeries, to get a feel of the medical environment. 

    参观熟悉医院,特别是有合格脑成像设备的医院和能够处理和进行高风险手术的医院。

  • See a cardiological specialist to check your risk factors and talk about heart problems prevention. Keep a record of key personal information including family history, current medications or supplements taken, diet and exercise habits.

    请心脏病专家检查您的风险因素和了解如何预防心脏问题。记录建立关键的个人信息档案,包括家族史、目前的药物或补充剂、饮食和锻炼习惯。

  • Whether or not you have concerns over heart problems, it is always recommended to have annual health checkups to know your general health condition. Call us at 5879-9999 ext. 2662 to know more about our different Health Screening Packages.

    无论是否有心脏问题的担忧,我们建议每年作一次健康筛查。请致电5879-9999分机2662了解多种健康体检套餐。

  • Do some tests which can detect heart problems: 

    做一些可以检测出心脏问题的测试:

  • Electrocardiogram (ECG)   心电图测试 (ECG)

  • Blood Tests  血液检查

  • Holter Monitor  动态监护仪

  • Echocardiogram  超声心动图

  • Cardiac Stress Test  心脏负荷试验

  • Nuclear Scan  核素扫描

  • Coronary Catheterization (Angiogram) 冠状动脉导管插入术(血管造影)

  • Cardiac Computerized Tomography (CT) or Magnetic Resonance Imaging (MRI) 心脏计算机断层扫描(CT)或磁共振成像(MRI)

 

SEIMC is committed to provide our patients with high level of surgical and post-surgical care. Our surgeons and doctors are supported by a team of internationally trained medical professionals with experience in in-patient and critical care medicine to effectively manage chronic medical conditions or post-operative pain. 

上海东方联合医院(SEIMC)致力于为广大患者提供高质量的手术和术后护理。我们的外科医生和主治医生拥有受过国际训练的医疗专家的医疗支持,他们在住院和危重病方面的临床经验丰富,能够有效地改善慢性疾病和手术后疼痛。

Cardiology  心脏科

The Cardiology Department at Shanghai East International Medical Center offers excellent care for numerous cardiovascular conditions and disorders. Our cardiologists are experts in their field and fluent in both English and Chinese. Many of Shanghai’s cardiology specialists also provide support to our medical center.

上海东方联合医院(SEIMC)的心脏科为众多心血管疾病患者提供高水准的医疗治疗及医疗护理。我们拥有很多合作医院及上海诸多心脏科专家的医疗支持,他们都是该领域的权威人士,用流利的英语、德语、中文等语言与病人交流。  

 

Our experienced cardiologists not only provide emergency care for serious cardiovascular conditions, but also provide consultations on cardiovascular disease prevention and routine health checks.

我们经验丰富的心脏病专家不仅为严重的心血管疾病提供急诊服务,并且还提供心血管疾病预防和日常健康检查的咨询。

 

Our team are able to treat the following conditions:  我们的团队提供以下医疗服务 

• 24-hour Cardiac Emergencies 24小时心脏急诊

• Lipid Disorder血脂异常

• Pregnancy-related Issues妊娠相关问题

• Coronary Atherosclerotic Disease冠状动脉粥样硬化病

• Valvular Heart Disease瓣膜性心脏病

• Diabetic Heart Disease糖尿病性心脏病

• Refractory Hypertension难治性高血压

• Adult Congenital Heart Disease成人先天性心脏病 

• Heart Failure心脏衰竭

• Palpitation and Arrhythmias心悸和心律不齐

• Heart Attack心脏病发作

• Pediatric Heart Issues 儿科心脏问题   

Contact us

联系我们

150 Jimo Road Shanghai 上海市即墨路150号

Tel 电话(24hrs): (86 21) 5879-9999

Alternative: (86)150-0019-0899

Email 邮箱:  care@seimc.com.cn

Website 网址:  www.seimc.com.cn