超声对急性心肌梗死并发室间隔穿孔患者封堵术围手术期内血流动力学的评估  

The analysis of survival factors and hemodynamic assessment by echocardiography in perioperative patients with ventricular septal perforation after acute myocardial infarction

作　　者：郭娟[1] 王浩[1] 杨远婷 易仁凤 吴志勇[2] 任伟[2] 曹省[1] 邓倾[1] 周青[1] Guo Juan;Wang Hao;Yang Yuanting;Yi Renfeng;Wu Zhiyong;Ren Wei;Cao Sheng;Deng Qin;Zhou Qing(Department of Ultrasound,Renmin Hospital of Wuhan University,Wuhan 430030,China;Department of Cardiovascular Surgery,Renmin Hospital of Wuhan University,Wuhan 430030,China)

机构地区：[1]武汉大学人民医院超声科,武汉430030 [2]武汉大学人民医院心血管外科,武汉430030

出　　处：《中华超声影像学杂志》2019年第8期645-650,共6页Chinese Journal of Ultrasonography

摘　　要：目的筛选并分析随访我院急性心肌梗死(acute myocardial infarction,AMI)并发室间隔穿孔(ventricular septal rupture,VSR)经封堵治疗患者围手术期内影响存活的主要危险因素,观察存活者术前及术后心脏功能及血流动力学变化特征。方法回顾性分析2014年7月至2019年2月武汉大学人民医院17例VSR封堵患者,依据30 d存活情况分为30 d内存活组(11例)和死亡组(6例),收集两组患者围手术期的一般临床资料和术前超声心动图测值,确定出有统计学意义的相关危险因素;比较VSR存活患者术前、术后心脏超声测量参数的变化,分析VSR术后血流动力学的恢复特征。结果单因素Logistic相关分析显示年龄(OR=0.90,95%CI 0.73~1.14,P=0.045)、穿孔后至手术的时间(OR=1.89,95%CI 1.35~2.23,P=0.003)、术前左室射血分数值(OR=0.89,95%CI 0.57~1.24,P=0.039),心源性休克的发生率(OR=1.45,95%CI 1.12~1.78,P=0.027)及VSR大小(OR=11.45,95%CI 7.89~15.56,P=0.012)均是与30 d内死亡率密切相关的影响因素。与术前相比,VSR存活组术后左室舒张末期容积和肺动脉收缩压均显著减低(P<0.05)。结论术后短期内左室舒张末期容积及肺动脉收缩压的下降提示预后较好。超声心动图在VSR患者术前筛查、术中监测及术后随访中均有重要的临床价值。Objective To follow up and analyze patients with ventricular septal rupture(VSR) after acute myocardial infarction (AMI) who underwent VSR occlusion, screen the main risk factors of survival in perioperative patients with VSR after AMI, and observe the postoperative cardiac function and hemodynamic changes by echocardiography. Methods Seventeen VSR patients were divided into the survival group (11 cases) and the death group (6 cases) within 30 days according to the survival time. The changes of cardiac ultrasound parameters before and after the operation of VSR survivors were compared, and the hemodynamic recovery characteristics of VSR survivors were analyzed. Results Age, the time to VSR occlusion, preoperative left ventricular ejection fraction, cardiogenic shock, and the size of VSR were all the factors that were closely related to the 30-day mortality of VSR with odds ratio of 0.90(95%CI 0.73 to 1.14, P=0.045), 1.89(95%CI 1.35 to 2.23, P=0.003), 0.89(95% CI 0.57 to 1.24, P=0.039), 1.45(95% CI 1.12 to 1.78, P=0.027) and 11.45(95%CI 7.89 to 15.56, P=0.012), respectively (all P<0.05). Compared with the preoperative measurements, the left ventricular end-diastolic volume and pulmonary artery systolic pressure were significantly reduced in the VSR survival group (P<0.05). Conclusions The decrease of left ventricular end diastolic volume and pulmonary artery systolic pressure after operation indicates a better prognosis in the short period. Echocardiography is a vital tool in preoperative screening, intraoperative monitoring and postoperative follow-up in VSR occlusion.

关 键 词：超声心动描记术 室间隔破裂 急性心肌梗死 

分 类 号：R654.2[医药卫生—外科学] R540.45[医药卫生—临床医学]