摘要
目的分析急性心肌梗死(AMI)并发室间隔穿孔(VSR)的临床特点、诊治措施及短期预后影响因素。方法回顾性研究2005年12月至2012年12月中国医科大学附属盛京医院收治的AMI并发VSR病例的临床资料,按30 d生存情况分为死亡组与存活组,对其临床特点及短期预后影响因素进行统计分析。结果 3 881例AMI患者中出现VSR的20例(0.5%)。平均年龄65.3岁,60%伴高血压,75%为前壁心肌梗死,心力衰竭发生率100%。8例行冠状动脉造影检查者显示梗死相关血管完全闭塞,无侧支循环形成。死亡9例(45%),平均死亡时间在入院后10.6 d,其中,接受介入治疗患者6例中5例存活,外科手术患者5例中4例存活,介入封堵患者2例均存活。死亡组与存活组在年龄、合并疾病、急性期左室舒张末期内径、心功能等方面无统计学差异。但死亡组女性患者相对较多、VSR直径较大。再灌注治疗、缺损修复患者的死亡率(14.3%)较未进行再灌注、未修复者(61.5%)有降低趋势(P=0.070)。结论老年、罪犯血管完全闭塞且无侧枝循环、急性前壁心肌梗死患者易于发生VSR。再灌注治疗、介入封堵及外科手术修复缺损可能降低AMI并发VSR患者短期病死率。
Objective To analyze the clinical charactefistks and determine the risk fhetots which intluence the short-term prognosis in patients with ventricular septal rupture （ VSR ） following acute myocardial itffarction （ AMI ）. Methods A total of 20 patients with consecutive VSR Mlowing AMI, hospitalized in our ilospital between Decenfi）er 2005 and December 2012, were enrolled in this study. The subjects were divided into dead group （ n = 9 ） and survived group （ n = 11 ） according to the survival situation at the 30th day post AMI. The clinical characteristics of patients were compared between the two groups .The risk factors affecting the short-tern1 progqlosis was explored by statistical analysis. Results Among 3 881 patients with AMI, 20 （ 0.5% ） patients were found with VSR. The average age was 65.3 years. 12 （ 60% ） patients had hypertension, 75% patients were diagnosed as acute anterior infeu＇ction. All patients suffered with hearl failure. Tntal occlusion of inthrct-related ＇arteries was found in all 8 patients with coronary arteriagraphy, and there was no collateral circulation establishment. the average survival period of＂ patients in dead group was 10.6 days after hospitalization. 5 patients smwived in 6 cases that received percutaneous coronary＇ intervention. 4 of the 5 patients survived after surgical repair. All the 2 patients who received transcatheter VSR closure smwived. There were no significant statistics differences between the two grnups in age, comparing diseases, LVED and INEF. The trend wets there were more female patients and lager diameter of the rupture dei;ect in the dead group. There was descending trend for the mortality of patients who receiving reperfusion strategies or VSR repair （ 14.3% ） than those receiving conserva- tive management （ 61.5% ） （ P = 0.070 ）. Conclusion Advarn ed age, total occlusion of infarct-related ＇arteries and no collateral eirculation estahlishment, anterior AMI are the risk fhctors of VSR following AMI. Reperfusion
出处
《中国医科大学学报》
CAS
CSCD
北大核心
2013年第11期1028-1031,共4页
Journal of China Medical University
基金
辽宁省教育厅高校科研计划(L2010688
2009A741)
关键词
急性心肌梗死
室间隔破裂
预后
myocardial infarction
ventricular septal rupture
prognosis
