急性心肌梗死类型与心脏破裂发生情况分析  

Types of acute myocardial infarction and the characteristics of complicated cardiac rupture

作　　者：缪黄泰[1] 刘子衿[1] 聂绍平[1] 

机构地区：[1]首都医科大学附属北京安贞医院急诊危重症中心,北京100029

出　　处：《中华实用诊断与治疗杂志》2016年第9期872-874,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家高技术研究发展计划(2015AA020102);国家自然科学基金资助项目(81270284);北京自然科学基金资助项目(7141003)

摘　　要：目的分析ST段抬高型急性心肌梗死(ST-elevation myocardial infarction,STEMI)与非STEMI(non-STEMI,NSTEMI)患者发生心脏破裂的临床特征。方法急性心肌梗死后心脏破裂患者59例,根据心电图表现分为STEMI组48例和NSTEMI组11例,对存活患者进行跟踪随访,并将2组患者临床资料进行统计分析。结果 2组基线资料比较差异无统计学意义(P>0.05);STEMI组血白细胞计数[(11.91±5.01)×109/L]、谷丙转氨酶[(49.21±25.13)u/L]以及脑钠肽峰值[396.65(110.00,552.03)ng/L]高于NSTEMI组[(8.01±2.85)×109/L、(21.18±7.31)u/L、43.00(10.00,245.30)ng/L],凝血酶原时间[(12.56±1.93)s]较NSTEMI组[(11.20±0.59)s]明显延长,左室射血分数[(47.93±8.38)%]低于NSTEMI组[(59.36±12.92)%],2组比较差异均有统计学意义(P<0.05);2组住院期间药物使用情况比较差异无统计学意义(P>0.05),2组院内病死率均较高(85.4%vs 81.8%),但院内急性心力衰竭、再发心肌梗死、出血、心因性死亡发生率以及心脏破裂距心肌梗死时间比较差异无统计学意义(P>0.05);NSTEMI组院内脑梗死发生率(9.09%)高于STEMI组(0)(P<0.05)。结论心肌梗死后心脏破裂患者病死率高,STEMI患者心脏破裂风险高于NSTEMI患者,可能与心肌细胞大量坏死相关。Objective To analyze the clinical characteristics of complicated cardiac rupture in patients with acute ST-elevation myocardial infarction （STEMI） or acute non-STEMI （NSTEMI）. Methods Fifty-nine patients with cardiac rupture after acute myocardial infarction were divided into STEMI group （n= 48） and NSTEMI group （n= 11） according to the electrocardiography results. All survival patients were followed up. The clinical data of these two groups were statistically analyzed. Results There were no significant differences in the clinical baseline data between two groups （P〈 0.05）. The white blood cell count （（11.91±5.01） ×10^9/L）, glutamate pyruvate transaminase （（49.21±25.13） u/L）, and peak value of brain natriuretic peptide （396.65 （110.00, 552.03） ng/L） in STEMI group were significantly higher than thosein NSTEMI group （（8. 01±2.85）×10^9/L, （21. 18±7. 31） u/L, 43. 00（10.00, 245. 30） ng/L）, and prothrombin time （（12.56±1.93） s） was significantly longer, and left ventricular ejection fraction （（47.93± 8.38） %） was significantly lower in STEMI group than those in NSTEMI group （（11. 20±0. 59） s, （59. 36±12. 92）%） （P〈 0.05）. There was no significant difference in the drug use between two groups （P〈0.05）. The fatality rates in hospital were high in both two groups （85.4G vs 81.8%）. There were no significant differences in the incidences of acute heart failure, reinfarction, bleeding and cardiac death, and the time form cardiac rupture to myocardial infarction between two groups during hospitalization stay （P~ 0.05）, while the incidence of cerebral infarction was significantly higher in NSTEMI group （9.09%） than that in STEMI group （0） （P%0.05）. Conclusion Patients with cardiac rupture after myocardial infarction have a high fatality rate. The risk of cardiac rupture is significantly higher in STEMI patients than in NSTEMI patients, which may be associated with a large number of myocardial cell

关 键 词：急性心肌梗死 心脏破裂 心因死亡 

分 类 号：R542.22[医药卫生—心血管疾病]