摘要
目的分析急性心肌梗死(AMI)后发生游离壁破裂和室间隔穿孔患者的临床特征,识别发生心脏破裂(CR)的危险因素。方法回顾性纳入南京鼓楼医院于2013年10月至2020年3月收治的AMI患者,选取28例合并CR的AMI患者为CR组,按照1∶2选择年龄、性别、心肌梗死部位和入院GRACE评分匹配的56例未合并CR的AMI患者为非CR组。收集两组患者的基本资料、临床资料及用药情况。应用单因素及多因素logistic回归分析评估CR的相关危险因素。结果共纳入84例患者,其中女性44例(52.4%),平均年龄为(74.32±11.54)岁。CR组中,游离壁破裂16例,室间隔穿孔11例,游离壁破裂合并室间隔穿孔1例。住院期间,CR组21例死亡(75.0%),而非CR组无死亡病例。CR组和非CR组的基线资料基本相似,但较非CR组相比,CR组的脑梗死比例多(39.3%比8.3%),白细胞计数高[(12.30±3.63)×10^9/L比(10.87±2.35)×10^9/L],入院时外周收缩压水平低[(116.54±24.84)mmHg比(127.33±22.59)mmHg],室壁瘤的比例高(35.7%比8.3%)。此外,CR组的β受体阻滞剂和肾素-血管紧张素-醛固酮系统抑制剂使用率均明显低于非CR组(均为P<0.01)。多因素logistic回归分析提示,CR的独立危险因素有既往脑梗死(OR=6.00,95%CI:1.43~25.26,P=0.01)和室壁瘤(OR=7.45,95%CI:1.75~31.71,P<0.01),β受体阻滞剂为独立的保护因素(OR=0.07,95%CI:0.02~0.25,P<0.01)。结论合并CR的AMI患者短期死亡率高,常伴有脑梗死病史、血白细胞升高、室壁瘤和低血压。既往脑梗死和室壁瘤为CR的独立危险因素,而β受体阻滞剂为其独立保护因素。
Objective To analyze the clinical characteristics in patients with free wall rupture and ventricular septal perforation after acute myocardial infarction(AMI),and to identify risk factors for cardiac rupture(CR).Methods AMI patients admitted to Nanjing Drum Tower Hospital from October 2013 to March 2020 were enrolled retrospectively,and 28 AMI patients with CR were selected as the CR group,and 56 patients without CR and with comparable age,gender,myocardial infarction site and GRACE score were selected as the control group according to a 1∶2 ratio.We collected the basic data,clinical features and medication used of the two groups.Univariate and multivariate logistic regression analysis was used to assess the risk factors for CR.Results A total of 84 patients were enrolled,including 44 women(52.4%),with an average age of(74.32±11.54)years.In the CR group,there were 16 cases of free wall rupture,11 cases of ventricular septal perforation,1 case of free wall rupture combined with ventricular septal perforation.Among the patients in the CR group,21 cases(75.0%)died during hospitalization.The baseline data were comparable,but the CR group had a higher rate of cerebral infarction history(39.3%vs.8.3%),an elevated level of white blood cell count[(12.30±3.63)×10^9/L vs.(10.87±2.35)×10^9/L],a lower level of peripheral systolic blood pressure at admission[(116.54±24.84)mmHg vs.(127.33±22.59)mmHg],and an increased rate of ventricular aneurysm(35.7%vs.8.3%)(all P<0.05).In addition,the rates ofβ-blockers and renin-angiotensin-aldosterone system inhibitors used in the CR group were significantly lower than those in the non-CR group(all P<0.001).Multivariate logistic regression analysis indicated that the independent risk factors for CR were a history of cerebral infarction(OR=6.00,95%CI:1.43-25.26,P=0.01)and ventricular aneurysm(OR=7.45,95%CI:1.75-31.71,P<0.01),andβ-blocker was an independent protective factor for CR(OR=0.07,95%CI:0.02-0.25,P<0.01).Conclusions The short-term mortality of AMI patients with CR is high
作者
郑红艳
魏钟海
宋杰
马冬辉
Zheng Hongyan;Wei Zhonghai;Song Jie;Ma Donghui(Department of Cardiology,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)
出处
《中国心血管杂志》
2020年第6期520-524,共5页
Chinese Journal of Cardiovascular Medicine
关键词
急性心肌梗死
心脏破裂
危险因素
Acute myocardial infarction
Cardiac rupture
Risk factors
