急性心肌梗死并发室间隔穿孔的临床分析  

Acute myocardial infarction complicated with ventricular septal perforation:a retrospective analysis

作　　者：徐桂玲[1] 曲巍[2] 于波[3] 

机构地区：[1]康平县人民医院重症监护病房,辽宁康平110500 [2]沈阳市第四人民医院干诊内科,辽宁沈阳110016 [3]中国医科大学附属第一医院循环内科,辽宁沈阳110001

出　　处：《临床荟萃》2015年第3期280-282,共3页Clinical Focus

基　　金：辽宁省科技厅第一批科学技术计划项目(20122250834)

摘　　要：目的对急性心肌梗死并发室间隔穿孔(AMI+VSP)临床特征进行分析,对保守治疗及手术治疗预后结果进行分析。方法对65例AMI+VSP患者的临床指标,治疗方法及预后进行回顾性分析。结果 65例AMI+VSP患者中,前壁心肌梗死占70.8%(46/65),非前壁心肌梗死占29.2%(19/65);超声心动图结果显示左心室舒张末内径(52.7±11.3)mm,左心室射血分数(49.2±14.5)%,VSP直径(9.4±6.5)mm;VSP位于心尖及心尖附近占66.2%(43/65);AMI^VSP总体时间平均为(7.2±3.2)天,溶栓组AMI^VSP时间短于未溶栓组(P<0.05);63.1%(41/65)患者进行了冠状动脉造影(CAG),内科保守治疗44.6%(29/65),转外科手术55.4%(36/65);30天总体病死率58.5%(38/65),1年72.3%(47/65),手术治疗组30天病死率及1年病死率均低于保守治疗组(P<0.01)。结论 AMI+VSP以发病急,病死率高为特点,外科手术较保守治疗更能提高抢救成功率及生存率。Objective To analyze the clinical characteristics of acute myocardial infarction complicated with ventrical septal perforation （AMI＋VSP） and to explore the outcomes of expectant treatment and surgical treatment. Methods The clinical characteristics, treatment methods and outcomes of 65 AMI＋VSP patients were retrospectively analyzed. Results Among the 65 patients with AMI＋VSP, AMI occurred at anterior wall in 46 patients （70.8%） and at non anterior wall in 19 patients （29.2 % ）. Ultrosonic cardiogram showed the left ventricle end diastolic diameter was （52.7±11.3） mm, the left ventricle ejection fraction was （49.2 ± 14.5） % and the VSP diameter was （9.4 ± 6.5） mm. VSP occurred at or near apex in 43 patients （66.2~/oo）. The total interval between AMI and VSP was （7.2±3.2） days in average, which was shorter in the patients treated with thrombolytie therapy than in the patients treated with non--thrombolytic therapy （ P 〈0.05）. Coronary angiography was carried out on 41 patients （63.1 %）, 29 patients received expectant treatment （44.6 %） and 36 patients underwent cardial surgery （55.4 %）. The total mortality was 58.5%o （38/65） in 30 days and 72.3% （38/65） in one year. The 30 d and one year mortalities in the surgical treatment group were remarkably lower than those in the expectant treatment group （both P 〈0.01）. Conclusion AMI＋VSP is clinically characterized by emergent onset and high fatality rate. Surgical treatment can achieve better outcomes than expectant treatment.

关 键 词：心肌梗死 室间隔破裂 心血管造影术 死亡率 

分 类 号：R542.22[医药卫生—心血管疾病]