摘要
目的:分析总结心肌梗死后心肌夹层患者的临床特征、治疗及预后。方法:利用中文、英文数据库,包括PubMed、Embase、Cochrane图书馆、中国知网、维普网、万方数据库和中国生物数据库,对2020年10月以前中英文文献报道的54例心肌梗死后心肌夹层患者的临床资料进行汇总。对手术治疗患者(n=28)与非手术治疗患者(n=26)、死亡患者(n=16)与生存患者(n=38)之间的临床资料进行比较分析。结果:54例患者中,男性38例(70.4%),38例(70.4%)由超声心动图确诊。手术治疗患者的死亡率低于非手术治疗患者(17.9%vs.42.3%,P=0.049),室间隔穿孔发生率高于非手术治疗患者(53.6%vs.26.9%,P=0.046)。死亡患者的左心室下后壁或右心室壁心肌梗死(75.0%vs.39.5%)、心肌夹层伴有室间隔穿孔(62.5%vs.31.6%)、心肌夹层位于左心室心尖以外部位(81.3%vs.52.6%)、非手术治疗的比例(68.8%vs.39.5%)均高于生存患者(P均<0.05)。Logistic回归分析显示,非手术治疗是心肌梗死后心肌夹层患者死亡的危险因素(OR=9.144,95%CI:1.574~53.117,P=0.014)。结论:心肌梗死后心肌夹层临床罕见,超声心动图是首选诊断方法,手术治疗能降低死亡率。
Objectives:To analyze the clinical features,treatment and prognosis of patients with myocardial dissection after myocardial infarction.Methods:The clinical data of patients with myocardial dissection after myocardial infarction reported in Chinese and English literature before October 2020 were reviewed.They were divided into operation group(n=28)and non-operation group(n=26).The clinical data of operation group and non-operation group,dead patients(n=16)and survival patients(n=38)were compared and analyzed.Results:A total of 54 patients were included,including 38 males(70.4%),and 38 patients(70.4%)were diagnosed by echocardiography.The mortality of patients in the operation group was lower than that in the non-operation group(17.9%vs.42.3%,P=0.049),and the perforation rate of ventricular septum in the operation group was higher than that in the nonoperation group(53.6%vs.26.9%,P=0.046).Compared with 38 survival patients,proportion of left ventricular inferior posterior wall or right ventricular wall myocardial infarction(75.0%vs.39.5%,P=0.017),myocardial dissection with ventricular septal perforation(62.5%vs.31.6%,P=0.035),myocardial dissection outside the left ventricular apex(81.3%vs.52.6%,P=0.049)and the proportion of non-surgical treatment(68.8%vs.39.5%,P=0.049)were significantly higher in 16 dead patients.Logistic regression analysis showed that non-operation treatment was a risk factor for death in patients with myocardial dissection after myocardial infarction(OR=9.144,95%CI:1.574-53.117,P=0.014).Conclusions:Myocardial dissection after myocardial infarction is rare in clinical practice.Echocardiography is the first choice for diagnosis.Surgical treatment can reduce mortality in these patients.
作者
朱新艳
付煜玮
温朝阳
ZHU Xinyan;FU Yuwei;WEN Chaoyang(Department of Ultrasound,Peking University International Hospital,Beijing(102206),China)
出处
《中国循环杂志》
CSCD
北大核心
2022年第5期482-486,共5页
Chinese Circulation Journal
基金
国家自然科学基金(81771833)
北京市自然科学基金(7172209)。
关键词
心肌梗死
心肌夹层
血肿
室间隔穿孔
myocardial infarction
myocardial dissection
hematoma
ventricular septal rupture
