老年急性心肌梗死并发室间隔穿孔7例临床分析  

Ventricular septal rupture after myocardial infarction:analysis of 7 senile patients

作　　者：林连君[1] 刘新民[1] 祁芸云[1] 王禹川[1] 刘芳[1] 

机构地区：[1]北京大学第一医院老年科,北京市100034

出　　处：《中华老年多器官疾病杂志》2008年第3期198-200,共3页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的分析急性心肌梗死(AMI)并发室间隔穿孔的临床病例特点,为该并发症的早期诊断和治疗提供依据。方法对7例室间隔穿孔患者的临床特征、治疗和预后进行回顾性分析。结果AMI并室间隔穿孔患者室间隔破裂穿孔常发生于前壁心肌梗死的患者,穿孔部位多位于室间隔近心尖部。高危因素包括高血压、年龄(60～69岁)、女性、缺乏侧支循环和广泛前壁透壁性心肌梗死和右室梗死(常可导致低血压)、无心绞痛病史。患者多存在房性快速型心律失常,新出现右束支传导阻滞提示预后严重不良。室间隔破裂的预后很差。内科保守治疗的院内死亡率高。结论注重体征及尽早行超声心动检查是早期诊断该并发症的关键,进行积极的内科治疗并力争外科手术的机会能降低死亡率。Objective To provide evidence for the early diagnosis and treatment of ventricular septal rupture after myocardial infarction by means of analyzing the clinical characteristics. Methods The data of clinical characteristics, treatment and prognosis of 7 patients with ventricular septal rupture were analyzed retrospectively. Results The most common site of myocardial infarction was anterior wall. The site of rupture was usually at the ventricular septum near the apex. The risk factors were hypertension, advanced age, female, extensive anterior wall transmural myocardial infarction and right ventricalar infarction, without collateral circulation and previous angina, etc. The atrial tachycardia was usually observed. The occurrence of right bundle branch block was a signal of death. In-hospital mortality was high by conservative medical therapy. Conclusion Paying attention to the physical examination and echocardiography are the key factors for the early diagnosis of ventricular septal rupture. Active medical treatment and striving for surgical treatment can decrease the mortality.

关 键 词：心肌梗死 室间隔破裂 临床分析 治疗方法 

分 类 号：R542.22[医药卫生—心血管疾病]