急性心肌梗死后心脏破裂的危险因素分析  

Risk factors of cardiac rupture in patients with acute myocardial infarction

作　　者：刘子衿[1] 缪黄泰[2] 聂绍平[2] 

机构地区：[1]首都医科大学附属第六临床医学院,100029 [2]首都医科大学附属北京安贞医院急诊危重症中心

出　　处：《中华心血管病杂志》2016年第10期862-867,共6页Chinese Journal of Cardiology

基　　金：首都特色临床应用研究（Z141107002514014）;北京市自然科学基金（7141003）

摘　　要：目的 探讨急性心肌梗死后心脏破裂的危险因素.方法 2012年1月至2015年3月在北京安贞医院住院的急性心肌梗死患者共10 284例,其中确诊为心肌梗死后心脏破裂患者81例（急性左心室游离壁破裂患者67例,室间隔穿孔患者14例）.回顾性分析患者的临床资料,并采用二元logistic回归分析心肌梗死后心脏破裂的危险因素.结果 ST段抬高型心肌梗死患者发生心脏破裂的比例高于非ST段抬高性心肌梗死患者[1.5％ （70/4 724）比0.2％ （11/5 560）,P＜0.01].二元logistic回归分析显示,年龄（OR=0.827,95％ CI0.726-0.941,P＜0.01）、住院期间再次心肌梗死（OR =0.001,95％ CI0.000 -0.418,P＜0.05）、收缩压（OR=1.114,95％ CI 1.029 - 1.206,P＜0.01）、左前降支病变（OR=0.003,95％ CI0.000 -0.334,P＜0.05）、血红蛋白（OR=1.129,95％ CI1.051-1.212,P＜0.01）、血清总蛋白（OR=1.453,95％ CI1.070-1.971,P＜0.05）及血清镁（OR=0.000,95％ CI0.000-0.001,P＜0.01）与心肌梗死后发生心脏破裂相关.结论 合并高龄、住院期间再次心肌梗死、低收缩压、左前降支病变、血红蛋白降低、低总蛋白和高血镁的急性心肌梗死患者容易发生心脏破裂,应注意防治.Objective To analyze the risk factors of cardiac rupture in patients with acute myocardial infarction.Methods Clinical data were analyzed from 10 284 acute myocardial infarction patients admitted to Beijing Anzhen Hospital from January 2012 to March 2015.Cardiac rupture occurred in 81 patients,including 67 patients of acute left ventricular free wall rupture and 14 patients of ventricular septal defect,were retrospectively analyzed.Binary logistics regression analysis was performed to analyze the risk factors of cardiac rupture.Results Incidence of cardiac rupture was significantly higher in patients with ST-segment elevation myocardial infarction than in patients with non-ST-segment elevation myocardial infarction （1.5% （70/4 724） vs.0.2% （11/5 560）,P 〈0.01）.Binary logistic regression analysis showed that age （OR =0.827,95% CI 0.726-0.941,P 〈 0.01）,recurrent myocardial infarction during hospital （OR =0.001,95% CI 0.000-0.418,P 〈 0.05）,systolic blood pressure （OR =1.114,95% CI 1.029-1.206,P 〈 0.01）,left anterior descending artery lesion （OR =0.003,95 % CI 0.000-0.334,P 〈 0.05）,lower hemoglobin（OR =1.129,95% CI 1.051-1.212,P 〈 0.01）,serum total protein （OR =1.453,95% CI 1.070-1.971,P 〈 0.05）,and serum magnesium level （OR =0.000,95 % CI 0.000-0.001,P 〈 0.01） were associated with cardiac rupture.Conclusion Older age,recurrent myocardial infarction,lower systolic blood pressure,left anterior descending artery lesion,lower serum hemoglobin,lower serum total protein,and higher serum magnesium level are risk factors of cardiac rupture and these factors should be carefully managed to prevent the occurrence of cardiac rupture.

关 键 词：心肌梗死 心脏破裂 危险因素 

分 类 号：R542.22[医药卫生—心血管疾病]