摘要
目的:分析急性心肌梗死(AMI)后发生室间隔穿孔(PI-VSR)患者的临床资料,探讨PI-VSR 60 d内的临床结局及相关因素。方法:回顾性分析2003年10月1日-2021年2月28日收治于大连医科大学附属第一医院52例PI-VSR患者的临床资料,其中男性24例(46.15%),年龄(73.83±8.92)岁,AMI后至VSR发生的时间为(2.29±1.88)d,穿孔大小(8.58±4.25)mm。其中4例患者行外科修补,8例行介入封堵术。结果:PI-VSR后随访60 d,共有38例患者死亡,病死率为73.08%。与生存组相比,死亡组女性比例较高(65.79%∶28.57%,P=0.017)、年龄较大[(76.13±8.61)岁∶(67.57±6.61)岁,P=0.001]、行外科修补或介入封堵术比例少(18.42%∶50%,P=0.005)、室间隔缺损直径较大[(10.3±3.92)mm∶(6.82±2.14)mm,P=0.009]、B型利钠肽(BNP)较高[(2402.2±1679.23)pg/mL∶(1146.79±789.07)pg/mL,P=0.018]。室间隔缺损直径是PI-VSR死亡的独立预测因素(OR=1.727,P=0.013)。手术修复组冠状动脉开通率(58.33%∶25%,P=0.031)和生存率(58.33%∶17.5%,P=0.005)均高于未手术组。对8例行介入封堵治疗的患者进行分析,所有患者均成功封堵,其中3例患者在手术成功后15 d内死亡,死因分别为感染、溶血和肾功能衰竭;介入封堵后死亡组室间隔缺损直径显著大于生存组[(10.67±3.06)mm∶(5.4±1.52)mm,P=0.015],BNP[(1654.86±403.82)pg/mL∶(416.99±150.89)pg/mL,P=0.001]、总胆固醇[TC:(4.8±0.62)mmol/L∶(3.64±0.44)mmol/L,P=0.02]和低密度脂蛋白胆固醇[LDL-C:(2.86±0.48)mmol/L∶(1.97±0.43)mmol/L,P=0.035]显著高于生存组。结论:VSR为AMI的严重机械并发症,女性、高龄、未行修复术、室间隔缺损直径大、心功能恶化是死亡率增加的危险因素。
Objective:To analyze the clinical data of patients with ventricular septal rupture(VSR)secondary to acute myocardial infarction(AMI)and explore the clinical outcomes and the related factors within 60 days.Methods:Fifty-two patients who were diagnosed with PI-VSR admitted to the First Affiliated Hospital of Dalian Medical University from October 1,2003 to February 28,2021 were included.There were 24 males(46.15%),aged(73.83±8.92)years old,and the time from AMI to VSR was(2.29±1.88)days,the diameter of VSR was(8.58±4.25)mm.Surgical repair was performed in 4 patients,and interventional closure was performed in 8 patients.Results:After 60 days of follow-up,38 patients died with a total mortality rate of 73.08%.Compared with the survival group,the death group had a higher proportion of women(65.79%vs.28.57%,P=0.017),an older age([76.13±8.61]years vs.[67.57±6.61]years,P=0.001),and a lower proportion of underwent surgical repair or interventional occlusion(18.42%vs.50%,P=0.005),a larger VSR diameter([10.3±3.92]mm vs.[6.82±2.14]mm,P=0.009),and higher B-type natriuretic peptide(BNP)([2402.2±1679.23]pg/mL vs.[1146.79±789.07]pg/mL,P=0.018).VSR diameter was an independent predictor of PI-VSR mortality(OR=1.727,P=0.013).The coronary opening rate(58.33%vs.25%,P=0.031)and survival rate(58.33%vs.17.5%,P=0.005)in the surgical repair group were higher than those in the non-surgical group.Eight patients who underwent interventional occlusion were successfully occluded,and 3 patients died within 15 days after successful operation.The causes of death were infection,hemolysis,and renal failure,respectively.VSR diameter in the death group was significantly larger than that in the survival group([10.67±3.06]mm vs.[5.4±1.52]mm,P=0.015);The levels of BNP([1654.86±403.82]pg/mL vs.[416.99±150.89]pg/mL,P=0.001),total cholesterol(TC,[4.8±0.62]mmol/L vs.[3.64±0.44]mmol/L,P=0.02),and low-density lipoprotein cholesterol(LDL-C,[2.86±0.48]mmol/L vs.[1.97±0.43]mmol/L,P=0.035)were significantly higher than those in the survival grou
作者
钟扬
陈菲菲
赵谊昶
ZHONG Yang;CHEN Feifei;ZHAO Yichang(Department of Cardiology,The Fifth People’s Hospital of Dalian,Dalian,Liaoning,116021;Department of Cardiology,The First Affiliated Hospital of Dalian Medical University)
出处
《临床心血管病杂志》
CAS
北大核心
2021年第10期920-924,共5页
Journal of Clinical Cardiology
基金
国家自然科学基金(No:81700301)
辽宁省教育厅科学研究经费项目(No:LZ2020058)。
关键词
急性心肌梗死
室间隔穿孔
外科修补术
介入封堵术
acute myocardial infarction
ventricular septal rupture
surgical repair
interventional occlusion
