冠状动脉旁路移植术后乙状结肠穿孔并感染性休克一例

One Case of Sigmoid Colon Perforation with Septic Shock after Coronary Artery Bypass Grafting

摘要: 消化道穿孔是冠状动脉旁路移植术(CABG)后一种罕见但致死率极高的非心脏并发症，由于症状隐匿早期影像学特征不典型，临床易误诊或延迟干预，导致病情迅速进展至脓毒症阶段。目前，针对冠状动脉旁路移植术(CABG)后非心脏并发症的预防及管理仍存在巨大挑战。本例患者因“胸痛半年，加重8天”入院，冠脉造影提示三支病变，完善心电图及心肌损伤标志物后行体外循环下冠状动脉旁路移植术，术后早期发生乙状结肠穿孔并感染性休克。该例患者的成功诊治体现了多学科协作诊疗的重要价值，本文回顾性分析该患者的诊疗过程，结合文献探讨其诊治难点病理机制与临床启示。

Abstract: Gastrointestinal perforation is a rare but highly lethal noncardiac complication after coronary artery bypass grafting (CABG), which is easy to be misdiagnosed or delayed in clinical intervention due to insidious symptoms and atypical early imaging features, leading to rapid progression to the sepsis stage. The prevention and management of non-cardiac complications after coronary artery bypass grafting (CABG) remains a great challenge. In this case, the patient was admitted to the hospital with “chest pain for six months, aggravated for eight days”, coronary angiography suggested three-branch lesions, and coronary artery bypass grafting was performed under extracorporeal circulation after improvement of electrocardiogram and markers of myocardial injury, and sigmoid colon perforation and infectious shock occurred in the early postoperative period. The successful diagnosis and treatment of this patient reflects the important value of multidisciplinary collaborative diagnosis and treatment. This article retrospectively analyzes the diagnosis and treatment process of this patient, and discusses its pathological mechanism and clinical revelation in the light of the literature.