总结7例多发性骨髓瘤伴心肌淀粉样变患者突发意识丧失的高风险因素有效识别和急救护理经验。针对该类患者起病隐匿、临床表现缺乏特异性、病情变化快、病死率高等临床特点,采取早期识别高风险因素、快速识别恶性心律失常、有效抢救配合、正确实施经皮体外起搏等措施,成功抢救6例患者,化疗后出院,随访恢复良好。
To summarize the effective identification of high risk factors and emergency care experience for sudden loss of consciousness in 7 patients with multiple myeloma with myocardial amyloidosis. For the onset concealment,clinical specificity,rapid changes,high fatality characteristics of these patients,early identification of high risk factors,rapid identification of malignant arrhythmia,effective rescue cooperation,correct implementation of percutaneous in vitro pacing were implemented. Six patients were successful rescued and discharged after chemotherapy,and recovery were good during follow-up.
[1] Michels TC,Petersen KE.Multiple myeloma:diagnosis and treatment[J]. Am Fam Physician,2017,95(6):373-383.
[2] 中国医师协会血液科医师分会,中华医学会血液学分会,中国医师协会多发性骨髓瘤专业委员会. 中国多发性骨髓瘤诊治指南(2017年修订)[J]. 中华内科杂志,2017,56(11):866-870.
Hematologist Branch of Chinese Medical Doctor Association,Hematology Committee of Chinese Medical Association,Multiple Myeloma Professional Committee of Chinese Medical Doctor Association. The guidelines for the diagnosis and management of multiple myeloma in China(2017 revision)[J]. Chin J Intern Med,2017,56(11):866-870.
[3] Plummer C,Driessen C,Szabo Z,et al.Management of cardiovascular risk in patients with multiple myeloma[J]. Blood Cancer J,2019,9(3):26.
[4] 冀晋,方理刚,方全,等. 心肌淀粉样变104例临床分析[J]. 中华心力衰竭和心肌病杂志(中英文),2017(2):98-103.
Ji J,Fang LG,Fang Q,et al.Clinical analysis of 104 cases with cardiac amyloidosis[J]. Chin J Heart Fall & Cardiomyopathy,2017(2):98-103.
[5] 邱惠,沈爱东,孙志军,等. 8例多发性骨髓瘤致心肌淀粉样变性临床特点分析[J]. 中国心血管杂志,2018,23(3):219-223.
Qiu H,Shen AD,Sun ZJ,et al.Clinical characteristics of 8 patients with cardiac amyloidosis caused by multiple myeloma[J]. Chin J Cardiovasc Med,2018,23(3):219-223.
[6] 吴茂源,许传芬,许岩,ICU心脏淀粉样变性患者的临床特征和预后因素研究[J]. 中国急救医学,2019,39(5):446-451.
Wu MY,Xu CF,Xu Y,Study on clinical characteristics and prognostic factors of ICU patients with cardiac amyloidosis[J]. Chin J Emerg Med,2019,39(5):446-451.
[7] 李光照,姜正明,户富栋,等. 多发性骨髓瘤致心脏淀粉样变的临床特点分析[J]. 中国实用医刊,2020,6(12):22-25.
Li GZ,Jiang ZM,Hu FD,et al.Clinical analysis of cardiac amyloidosis caused by multiple myeloma[J]. Chin J Clin Med,2020,6(12):22-25.
[8] 申曼,黄仲夏,李新,等. 硼替佐米治疗新诊断多发性骨髓瘤期间心脏不良事件的影响因素及其对生存时间影响的真实世界研究[J]. 中国全科医学,2021,24(2):210-218.
Shen M,Huang ZX,Li X,et al.Associated factors and outcome of cardiac adverse events in newly diagnosed multiple myeloma patients with bortezomib:a real-world study[J]. Chin Gen Pract,2021,24(2):210-218.
[9] 李诗文,刘卓刚,胡荣. 多发性骨髓瘤相关心血管事件研究进展[J]. 中国实验血液学杂志,2019,27(6):2035-2038.
Li SW,Liu ZG,Hu R.Research progress of multiple myeloma related cardiovascular events[J]. Chin J Experi Hematol,2019,27(6):2035-2038.
[10] 刘平,李晚泉,黄雪兰,等. 胸外按压联合应用经皮体外起搏的应用研究[J]. 中国医药导报,2010,7(15):33-34.
Liu P,Li WQ,Huang XL,et al.Application of external chest compression combined with percutaneous application of pacing in vitro[J]. China Med Her,2010,7(15);33-34.
[11] 中国研究型医院学会护理分会项目组. 中等长度静脉导管临床应用专家共识[J]. 中华护理杂志,2020,55(S2):43-50.
Project Team of Nursing Branch of Chinese Research Hospital Association. Expert consensus on the clinical application of medium length intravenous catheter[J]. Chin J Nurs,2020,55(S2):43-50.
