介入封堵治疗心肌梗死后室间隔穿孔疗效观察  

Clinical Observation of Interventional Closure Therapy for Post-infarction Ventricular Septal Rupture

作　　者：蒋辉[1] 吴志勇[1] 卢荔红[1] 陈斌[1] 郭延松[1] JIANG Hui;WU Zhiyong;LU Lihong;CHEN Bin;GUO Yansong(Provincial Clinic College of Fujian Medical University,Department of Cardiology,Fujian Provincial Hospital,Fuzhou 350001, China)

机构地区：[1]福建医科大学省立临床医学院福建省立医院心内科,福州350001

出　　处：《福建医科大学学报》2019年第1期48-51,共4页Journal of Fujian Medical University

摘　　要：目的分析心肌梗死后室间隔穿孔(PI-VSR)的临床特征,评价经导管介入封堵治疗方案的疗效。方法回顾性分析10例PI-VSR例患者的临床特征,总结介入封堵治疗手术前后临床情况的改善程度,并观察随访6和12月的心功能水平。结果 10例患者中,成功完成介入封堵6例。随访期间,存活5例,1例于封堵术后12月,因反复心力衰竭死亡;3例于住院期间因严重心力衰竭、顽固心律失常、合并肺部感染死亡;1例未干预,12月后死于心力衰竭。成功介入封堵的6例患者,治疗距穿孔时间为(20.5±5.3)d(12～23 d),患者术前、术后平均美国纽约心脏病协会(NYHA)心功能评分分别为(3.43±0.55)及(2.58±0.62),平均左室射血分数分别为(40.0±5.3)%及(45.0±7.6)%,差别均无统计学意义(均为P<0.05)。随访封堵治疗后6及12月的心功能——6 min步行实验(6MWT)分别为(368±55)及(403±58)m,有逐渐改善趋势,但差别无统计学意义(P<0.05)。结论经导管介入封堵治疗PI-VSR安全可行,有改善患者心功能的趋势。Objective To analyze the clinical features of patients who were diagnosed with post-infarction ventricular septal rupture (PI-VSR), to assess the therapeutic effect of transcatheter interventional closure. Methods To make a retrospective analysis of the clinical features based on the clinical data of 10 patients who had confirmed PI-VSR and to summarize the clinical improvement after the interventional closure on the basis of the survival of the patients with the observation and postoperative follow-up of their 6- and 12-month cardiac function. Results Among the 10 patients, successful interventional closure therapy was accomplished in 6 patients, and 5 survived during follow-up period. One patient died of congestive heart failure after 12 months of non-intervention and one died of the same cause after 12 months of intervention. Three died of severe cardiogenic shock, intractable arrhythmia, and pulmonary infection during hospitalization. For the 6 successful interventional patients,the interventional treatment distance was(20.5±5.3)d(12~23 d), and according to New York Heart Disease Association(NYHA) criteria, the preoperative and postoperative heart function scores and the mean left ventricular ejection fraction in patients who received interventional closure therapy were (3.43±0.55) and (2.58±0.62),(40.0±5.3)% and (45.0±7.6)% respectively. The differences were not statistically significant( P =0.256 and P =0.072 respectively). Cardiac function criteria-6 minute walking test(6MWT)of 6 and 12 months after long-term follow-up closure therapy were (368±55)m and (403±58)m,with no statistically significant difference either( P =0.156). Conclusion Transcatheter interventional closure is proved to be safe and reliable for the treatment of PI-VSR and is effective in improving the cardiac function of the patients.

关 键 词：心脏 心肌梗死 室间隔 室间隔破裂 介入封堵术 

分 类 号：R322.11[医药卫生—人体解剖和组织胚胎学] R541[医药卫生—基础医学]