急性心肌梗死合并室间隔穿孔介入封堵治疗的安全性及近期效果评估  

Evaluation of the safety and short-term eff ect of transcatheter closure of acute myocardial infarction with ventricular septal rupture

作　　者：孙子瑞 江继承 蒋亚鹏 陈同峰[1] 韩宇[1] 韩艳[1] 高传玉[1] 刘煜昊[1] SUN Zi-rui;JIANG Ji-cheng;JIANG Ya-peng;CHEN Tong-feng;HANYu;HAN Yan;GAO Chuan-yu;LIU Yu-hao(Department of Structral Heart Dease,Henan Provincial People’s Hospital,Central China Fuwai Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]河南省人民医院,华中阜外医院结构性心脏病区,河南郑州450000

出　　处：《中国介入心脏病学杂志》2020年第5期270-273,共4页Chinese Journal of Interventional Cardiology

基　　金：河南省医学科技攻关计划项目(2018020439)。

摘　　要：目的探讨急性心肌梗死合并室间隔穿孔介入封堵治疗的安全性和近期效果。方法纳入2017年1月至2019年5月河南省人民医院32例急性心肌梗死后合并室间隔穿孔患者,通过分析其穿孔形态、大小,按照缺损直径加10 mm原则选择封堵器进行封堵。术后1、6、12个月随访超声心动图、心电图,测量6 min步行试验(6MWT),抽血化验N末端B型脑钠肽前体(NT-proBNP),了解心功能。结果32例患者中30例(93.8%)封堵成功,失败2例,术后死亡3例。27例出院患者中成功随访25例,随访结果显示,术前、术后1个月、术后6个月及术后12个月左心室舒张末期内径[(69.8±9.9)mm比(63.5±6.5)mm比(52.5±5.8)mm比(51.7±4.2)mm,P<0.001]、NT-proBNP[(3.6±0.4)pg/ml比(3.1±0.5)pg/ml比(2.9±0.4)pg/ml比(2.8±0.3)pg/ml,P<0.001]比较,均呈下降趋势,差异均有统计学意义;6MWT术后1个月、术后6个月及术后12个月逐渐改善[(280.4±91.5)m比(301.0±75.5)m比(310.5±82.6)m,P=0.024],整体趋势比较差异有统计学意义。25例患者胸部X线及心电图检查未见明显异常,无封堵器脱落以及死亡等严重不良事件发生。结论急性心肌梗死合并室间隔穿孔行介入封堵术是一种微创、有效的治疗方法,术后心功能得到有效改善,值得临床推广。Objective To explore the safety and short-term effect of transcatheter closure of acute myocardial infarction with ventricular septal rupture.Methods From January 2017 to may 2019,32 patients with ventricular septal perforation after acute myocardial infarction were enrolled in this study.The occluder was selected according to the principle of defect diameter plus 10 mm by analyzing the shape and size of perforation.1,6,12 months after the operation,echocardiography and ECG were followed up,6-minute walking test(6MWT)was measured,N-terminal B-type brain natriuretic peptide precursor(NT-proBNP)was detected by blood sampling to understand the cardiac function.Results Among the 32 cases,30 cases(93.8%)were occluded successfully,2 cases failed,3 cases died after operation.25 of 27 patients were followed up successfully.The follow-up results showed that LVEDD,NT-proBNP,6MWT were improved,and no serious adverse events such as occluder dropping and death occurred.Conclusions It is a minimally invasive and eff ective treatment method for acute myocardial infarction with ventricular septal perforation.The cardiac function has been improved after the operation.

关 键 词：急性心肌梗死 室间隔穿孔 介入封堵术 

分 类 号：R542.22[医药卫生—心血管疾病]