急性ST段抬高心肌梗死24h内死亡原因分析  

Causes of death in first 24 hours in patients with ST elevation myocardial infarction

作　　者：张月军[1] 杨磊[1] 徐欣[1] 杨承健[1] 

机构地区：[1]无锡市第二人民医院心内科,江苏无锡214002

出　　处：《临床心血管病杂志》2010年第11期814-815,共2页Journal of Clinical Cardiology

摘　　要：目的:探讨急性ST段抬高心肌梗死(STEMI)患者早期24h内死亡的原因。方法:对STEMI523例患者中24h内死亡17例的死亡病因、梗死部位、治疗方法、临床特征等临床资料进行分析。结果:死因为心脏破裂12例,占总病死率70.6%;心力衰竭合并心源性休克4例,占23.5%;恶性心律失常1例,占5.9%;心脏破裂的病死率高于心力衰竭合并心源性休克、恶性心律失常(P<0.01)。心脏破裂死亡的12例中溶栓9例,未溶栓2例,急诊介入术1例。结论:心脏游离壁破裂是STEMI患者早期24h内死亡的主要病因;静脉溶栓治疗可能增加心脏破裂的发生率,尤其对于老年STEMI患者,宜尽早行急诊介入术或冠状动脉搭桥术以减少心脏破裂的发生。Objective：To analyse the causes of death in first 24 hours in patients with ST elevation myocardial infarction（STEMI）.Method：The total of 523 consecutive cases of STEMI from 2001 to 2009 were selected.The age,sex,location of infarction and causes of death were analysed.Result：Among 17 cases died in first 24 hours in patients with STEMI,12 cases died of ventricular free wall rupture,1case died of malignant arrhythmia and 4 cases died of acute heart failure with cardiogenic shock.There were 9cases of ventricular free wall rupture associated with thrombolysis.Conclusion：Ventricular free wall rupture is the major cause of death in the first 24 hours from onset in patients with STEMI.Treatment of thrombolysis may increase the incidence of ventricular free wall rupture in older patients,particularly over 70 years old.Primary PCI or CABG in patients with older age may be an optimal option.

关 键 词：心肌梗死 心脏游离壁破裂 溶栓 

分 类 号：R542.2[医药卫生—心血管疾病]