急性心肌梗死合并室间隔穿孔的临床分析  

Clinical analysis of venticular septal repture after acute myocardial infarction

作　　者：刘健[1] 王伟民[1] 崔嵬 吴淳[1] 

机构地区：[1]北京大学人民医院心内科,北京市100044 [2]河南省巩义市人民医院心内科

出　　处：《中国介入心脏病学杂志》2004年第6期332-334,共3页Chinese Journal of Interventional Cardiology

摘　　要：目的　探讨急性心肌梗死后发生室间隔穿孔的临床特征、治疗方法及其预后。方法　对北京大学人民医院 1990年 1月至 2 0 0 4年 7月收治的 16例急性心肌梗死并室间隔穿孔患者的临床资料进行回顾性分析。结果　此期间共收治急性ST抬高心肌梗死 2 0 5 7例 ,发生室间隔穿孔 16例 ,发生率 0 7%。其中男性 8例 (5 0 % ) ,女性 8例 (5 0 % ) ;平均年龄 5 9 4± 11 6岁 ;合并高血压病 7例(43 8% ) ,合并糖尿病 5例 (31 3% ) ,吸烟 5例 (31 3% )。 16例中前壁心肌梗死 15例 (93 8% ) ,其中前壁合并下后壁 6例 (37 5 % ) ;单纯下壁 1例 (6 3% )。 11例施行冠状动脉造影 ,梗死相关血管中前降支占 90 9% (10 /11) ,完全闭塞占 81 8% (9/11) ,无侧支循环形成。心源性休克 3例 (18 8% ) ,Killip分级心功能Ⅳ级 11例 (6 8 8% ) ,Ⅲ级 5例 (31 3% )。 12例 (75 % )室间隔穿孔发生在梗死后的 1周内 ,超声心动图提示室间隔缺损范围 0 6 8～ 2 5cm ,多数在室间隔近心尖部破裂。 10例 (6 2 5 % )施行外科手术治疗者中 3例存活 ,6例药物治疗者经保守治疗 30d内均死亡。结论　急性心肌梗死合并室间隔穿孔少见 ,多为广泛前壁心肌梗死的患者 ,内科保守治疗死亡率高 ,外科手术治疗可提高生存率。Objective To analyze the clinical feature, treatment and prognosis of ventricular septal rupture after myocardial infarction Methods Clinical data of 16 patients with ventricular septum repture after acute myocardial infarction were who were hospitalized between January 1990 and July 2004 were analyzed retrospectively Results Among 2?057 patients with acute ST segement elevation myocardial infarction, 16(0 7%) patients (8 males and 8 females) were found to have ventricular septal rupture The average age was 59 4±11 6 years 7 (43 8%) patients had hypertension, 5(31 3%) patients had diabetes and 5 (31 3%) patients smoked 15(93 8%) patients were diagnosed as acute anterior infarction and among them, 6 patients also had posterior infarction 1 patient were diagnosed as inferior infarction 11 patients received coronary arteriography and ventriculography, and in 10 cases, the infarct related arteries (IRA) were found to be LAD (90 9%) Total occlusion was found in 9 cases out of the 11 patients (81 8%) Cardiogenic shock was found in 3(18 8%) patients 12 cases (75%) of ventricular septal rupture occurred within the first seven days after the onset of symptoms The defect on rentricular septumn and its size were confirmed by means of ectocardiography The size of the rupture varied from 0 68 cm to 2 5 cm Surgery was performed in 10 (62 5%) patients, and 3 of them survired All the 6 patients who only received medical therapy died within 30 days Conclusion Ventricular septal rupture after AMI was relatively rare which mostly happened in patients with acute anterior infarction Mortality rate was righ in patients who only received conservative medical treatment Surgical therapy could improve the survival rate

关 键 词：室间隔穿孔 急性心肌梗死 外科手术治疗 前壁心肌梗死 患者 临床分析 侧支循环 内科保守治疗 北京大学人民医院 梗死相关血管 

分 类 号：R542.22[医药卫生—心血管疾病] R541[医药卫生—内科学]