目的分析急性心肌梗死(AMI)并发心脏破裂的临床特点、危险因素及预后,并探讨临床防治措施。方法回顾性收集AMI患者1561例,其中发生心脏破裂患者21例为心脏破裂组,随机选取未发生心脏破裂的AMI患者105例为对照组,采集2组患者临床资料及...目的分析急性心肌梗死(AMI)并发心脏破裂的临床特点、危险因素及预后,并探讨临床防治措施。方法回顾性收集AMI患者1561例,其中发生心脏破裂患者21例为心脏破裂组,随机选取未发生心脏破裂的AMI患者105例为对照组,采集2组患者临床资料及治疗方案,分析AMI并发心脏破裂的危险因素。结果与对照组比较,心脏破裂组年龄、入院心率、女性、肌钙蛋白、N末端B型钠尿肽前体、尿素明显升高(P<0.05,P<0.01),急诊PCI、血红蛋白、红细胞计数、使用β受体阻滞剂及血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体阻滞剂(ARB)比例明显降低,差异有统计学意义[42.86%vs 72.38%,P=0.011;(119.33±19.37)g/L vs (139.29±17.65)g/L,P=0.001;(4.13±0.62)×10^12/L vs (4.60±0.69)×10^12/L,P=0.010;47.62%vs 73.33%,P=0.020;23.81%vs 52.38%,P=0.017]。结论女性、高龄、再灌注时间延迟、入院心率快、高NT-ProBNP、高肌钙蛋白、低血红蛋白、低红细胞计数是AMI患者心脏破裂的危险因素,早期的再灌注治疗、ACEI/ARB、β受体阻滞剂的使用是预防AMI后发生心脏破裂的重要措施。展开更多
目的:分析心包填塞死亡案例法医病理学特点。方法:收集30例心包填塞死亡案例的临床及法医病理学资料,记录既往病史、发病到死亡时间、临床表现、尸体解剖特点及血管心脏破裂口处病理检查结果。结果:30例心包填塞案例中病因最常见为主动...目的:分析心包填塞死亡案例法医病理学特点。方法:收集30例心包填塞死亡案例的临床及法医病理学资料,记录既往病史、发病到死亡时间、临床表现、尸体解剖特点及血管心脏破裂口处病理检查结果。结果:30例心包填塞案例中病因最常见为主动脉破裂(14例),其次为心脏破裂(12例,其中冠心病致心肌梗死后心脏破裂7例、外伤性心脏破裂5例);既往病史以冠心病和高血压为主,发病到死亡时间1 min^12 d;主要有胸闷、气促、腹痛、意识模糊等临床表现;心脏破裂案例破裂口以左心室壁为主,主动脉破裂口主要位于粥样硬化斑块处,心包积液量120~650 m L。结论:主动脉破裂及心脏破裂是心包填塞最常见原因,临床表现存在重叠部分,应注意防止误诊及漏诊。展开更多
Blunt cardiac rupture is a characteristic of high death rates and rapid death process. But sometimes it is hard to find out the cause of cardiac rupture of traumatized patients, especially when it relates the relation...Blunt cardiac rupture is a characteristic of high death rates and rapid death process. But sometimes it is hard to find out the cause of cardiac rupture of traumatized patients, especially when it relates the relationship between injury and disease. In the 2 cases reported herein, both of the 2 patients had pre-existent cardiac pathological changes when suffered from traumatic injury. Our aim is to evaluate autopsy findings from a medicolegal point of view, and offer our proposals on how to deal with this sort of cases.展开更多
We report a case of successful survival from ventricular free wall rupture without surgery, which was not overt rupture but micro-rupture. The patient was diagnosed with acute myocardial infarction (AMI) and underwent...We report a case of successful survival from ventricular free wall rupture without surgery, which was not overt rupture but micro-rupture. The patient was diagnosed with acute myocardial infarction (AMI) and underwent primary percutaneous coronary intervention (PCI). Myocardial blood leakage could be detected on transthoracic echocardiography with intravenous infusion of contrast dye 3 days after PCI. This examination revealed that there was not overt perforation but diffuse fissure. Because of his critical condition, he was treated conservatively without surgery. Nevertheless, he survived eventually.展开更多
文摘目的分析急性心肌梗死(AMI)并发心脏破裂的临床特点、危险因素及预后,并探讨临床防治措施。方法回顾性收集AMI患者1561例,其中发生心脏破裂患者21例为心脏破裂组,随机选取未发生心脏破裂的AMI患者105例为对照组,采集2组患者临床资料及治疗方案,分析AMI并发心脏破裂的危险因素。结果与对照组比较,心脏破裂组年龄、入院心率、女性、肌钙蛋白、N末端B型钠尿肽前体、尿素明显升高(P<0.05,P<0.01),急诊PCI、血红蛋白、红细胞计数、使用β受体阻滞剂及血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体阻滞剂(ARB)比例明显降低,差异有统计学意义[42.86%vs 72.38%,P=0.011;(119.33±19.37)g/L vs (139.29±17.65)g/L,P=0.001;(4.13±0.62)×10^12/L vs (4.60±0.69)×10^12/L,P=0.010;47.62%vs 73.33%,P=0.020;23.81%vs 52.38%,P=0.017]。结论女性、高龄、再灌注时间延迟、入院心率快、高NT-ProBNP、高肌钙蛋白、低血红蛋白、低红细胞计数是AMI患者心脏破裂的危险因素,早期的再灌注治疗、ACEI/ARB、β受体阻滞剂的使用是预防AMI后发生心脏破裂的重要措施。
文摘目的:分析心包填塞死亡案例法医病理学特点。方法:收集30例心包填塞死亡案例的临床及法医病理学资料,记录既往病史、发病到死亡时间、临床表现、尸体解剖特点及血管心脏破裂口处病理检查结果。结果:30例心包填塞案例中病因最常见为主动脉破裂(14例),其次为心脏破裂(12例,其中冠心病致心肌梗死后心脏破裂7例、外伤性心脏破裂5例);既往病史以冠心病和高血压为主,发病到死亡时间1 min^12 d;主要有胸闷、气促、腹痛、意识模糊等临床表现;心脏破裂案例破裂口以左心室壁为主,主动脉破裂口主要位于粥样硬化斑块处,心包积液量120~650 m L。结论:主动脉破裂及心脏破裂是心包填塞最常见原因,临床表现存在重叠部分,应注意防止误诊及漏诊。
文摘Blunt cardiac rupture is a characteristic of high death rates and rapid death process. But sometimes it is hard to find out the cause of cardiac rupture of traumatized patients, especially when it relates the relationship between injury and disease. In the 2 cases reported herein, both of the 2 patients had pre-existent cardiac pathological changes when suffered from traumatic injury. Our aim is to evaluate autopsy findings from a medicolegal point of view, and offer our proposals on how to deal with this sort of cases.
文摘We report a case of successful survival from ventricular free wall rupture without surgery, which was not overt rupture but micro-rupture. The patient was diagnosed with acute myocardial infarction (AMI) and underwent primary percutaneous coronary intervention (PCI). Myocardial blood leakage could be detected on transthoracic echocardiography with intravenous infusion of contrast dye 3 days after PCI. This examination revealed that there was not overt perforation but diffuse fissure. Because of his critical condition, he was treated conservatively without surgery. Nevertheless, he survived eventually.
