摘要
目的:分析心肌梗死后室间隔穿孔手术围术期死亡的危险因素,寻找室间隔穿孔手术的最佳手术时机。方法:回顾性分析中国医学科学院阜外医院2006年1月至2020年12月间连续收治的112例行手术治疗的室间隔穿孔患者的临床及随访资料。根据术后30 d死亡情况及心肌梗死位置进行分组,分别分析生存组与死亡组、前壁心肌梗死组与下壁或后壁心肌梗死组的差异,以及不同心肌梗死位置对手术效果的影响。并应用Logistic回归分析影响术后30 d死亡的危险因素。使用ROC曲线寻找心肌梗死发作至手术时间间隔对术后死亡预测的截断值,并根据截断值分组,依此寻找最佳手术时机。结果:总体术后30 d死亡率为7.14%,3年生存率91.20%,5年生存率87.80%,估算平均生存时间(147.25±5.94)个月。死亡组(n=8)较生存组(n=104)年龄大,女性患者比例高,心肌梗死发作至手术时间间隔更短(P均<0.05)。前壁心肌梗死组(n=86)较下壁或后壁心肌梗死组(n=26)术后30 d死亡率高(P>0.05),但差异无统计学意义。多因素分析发现较短心肌梗死发作至手术时间间隔、年龄、女性、既往脑血管意外病史是患者术后30 d内死亡的风险预测因素。ROC曲线截断值为37.04 d,相较于心肌梗死发作至手术时间间隔> 37 d的患者,间隔≤37 d的患者术后30 d死亡率更高(3.45%vs. 20.69%,P=0.044),中期随访平均生存时间更短[(156.56±4.69)个月vs.(120.53±14.10)个月,log-rank P=0.001],不过进行倾向性匹配后两者生存曲线差异未发现统计学意义[(138.59±13.01)个月vs.(124.96±13.91)个月,log-rank P=0.331]。结论:对积极治疗反应良好的室间隔穿孔患者应首选延期手术治疗。心肌梗死发作37 d后为延期手术的最佳手术时机。
Objectives:The aim of this study was to identify risk factors of postoperative mortality after surgical repair of ventricular septal rupture (VSR) post infarction and to explore the best timing of surgical repair for these patients.Methods:Clinical data from 112 patients,who underwent surgical repair of ventricular septal rupture post infarction from January 2006 to December 2020 in our center,were retrospectively analyzed.Obtained data included clinical,angiographic,and echocardiographic findings,operative procedures,early morbidity and total mortality and survival time.Univariable and multivariable analyses were performed to identify predictors of 30-day mortality.Patients were grouped according to the location of myocardial infarction to analyze their influence on the outcomes post surgical repair.ROC curve was used to identify the cut-off point for best surgical repair timing.Results:Thirty-day mortality post operation was 7.14%for the whole cohort.The mean survival time was (147.25±5.94)months,with a 3-year survival rate of 91.20%and a 5-year survival rate of 87.80%.Aging,female sex,shorter interval between infarction and surgery,as well as inferior infarction tended to be the risk factors of post-operative death (all P>0.05).Multivariable analysis showed that shorter infarction-surgery interval,elder ages,female gender,and previous cerebrovascular accidents were potential predictors of 30-day mortality.The ROC curve indicated that the best infarction-surgery interval was37.04 days.Conclusions:The priority choice for VSR patients who respond well to aggressive treatment should be the delayed surgical repair.The best timing of delayed surgery is the 37;day after infarction.
作者
鞠帆
袁昕
李宝童
罗晓康
武恒朝
杨滔
孙寒松
JU Fan;YUAN Xin;LI Baotong;LUO Xiaokang;WU Hengchao;YANG Tao;SUN Hansong(Adult Cardiac Surgery Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)
出处
《中国循环杂志》
CSCD
北大核心
2022年第3期256-264,共9页
Chinese Circulation Journal
关键词
心肌梗死
室间隔穿孔
手术时机
危险因素
myocardial infarction
ventricular septal rupture
surgery timing
risk factor
