心肌梗死后心脏破裂的现代临床特征和挑战  

Cardiac rupture post myocardial infarction: mordern clinical characteristics and challenge

作　　者：卢群[1] 马姗[2,3] 宋安齐[2] 杜晓军 LU Qun;MA Shan;SONG An-qi;DU Xiao-jun(Department of Internal Medicine-Cardiovascular,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Internal Medicine-Cardiovascular,Cardiovascular Hospital,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China;Department of Physiology and Pathophysiology,Basic Medical College of Xi'an Jiaotong University,Xi'an 710061,China;Baker Heart and Diabetes Institute,Melbourne,Victoria,Australia,3004)

机构地区：[1]西安交通大学第一附属医院心血管内科,西安710061 [2]西安交通大学第二附属医院心血管病院心血管内科,西安710004 [3]西安交通大学基础医学院生理与病理生理学系,西安710061 [4]Baker Heart and Diabetes Institute,Melbourne,Victoria,Australia,3004

出　　处：《中国医学前沿杂志（电子版）》2019年第11期30-40,共11页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：国家自然科学基金(81870300);陕西省科技惠民计划(S2016YFHM0009)

摘　　要：心脏破裂是急性心肌梗死后的致命并发症。在近30年间,心肌梗死患者院内死亡率显著下降,与此同时,心脏破裂的发生率也明显降低。然而,心脏破裂后患者的死亡率依然居高不下,是构成心肌梗死患者近期死亡的重要原因之一。因此,心脏破裂依然是现代心脏病学所面临的重要挑战之一。直接经皮冠状动脉介入治疗(primary percutaneous coronary inte rvention,pPCI)成为心肌梗死患者的常规治疗,新近的临床研究发现,高达50%的心脏破裂发生于心肌梗死后的48 h内,而且已有报道发现pPCI术后患者发生心脏破裂。自21世纪以来,对心脏破裂的危险预测和治疗手段并无明显进展。本文综述自pPCI常规应用以来心脏破裂的临床特征、发生率和预后的动态变化,讨论近15年中有关心脏破裂的病理生理机制、危险因素和治疗的临床前期研究,并提出亟待解答的重要问题。Cardiac rupture after the onset of myocardial infarct is the most malignant complication.In the last few decades,there has been a significant reduction in the in-hospital mortality of patients with myocardial infarct.Meanwhile the incidence of cardiac rupture has been declined significantly.However,the prognosis of patients with cardiac rupture remains extremely poor.In fact,cardiac rupture is responsible for 20%~30% of the in-hospital mortality forming a major challenge to modern cardiology.Since the era of primary percutaneous contrary intervention(pPCI),approximately 50% of cardiac rupture occurs within the first 48 hours after the onset of myocardial infarct.Furthermore,cardiac rupture has been shown to occur in patients are treated with pPCI.Unfortunately,there has been lack of solid progress in the risk stratification and treatment of cardiac rupture,apparently due in part to the view that cardiac rupture no longer exists in the clinic.In this review,we summarize the dynamic changes in clinical characteristics,prevalence and prognosis of post-MI cardiac rupture,and discuss the pre-clinical research findings regarding the pathogenesis,risk factors and therapeutic interventions.Finally,we propose pivotal questions in this filed that remain to be addressed in near future.

关 键 词：心脏破裂 心肌梗死 猝死 ST段抬高型心肌梗死 小鼠模型 

分 类 号：R54[医药卫生—心血管疾病]