急性心肌梗死合并左心室附壁血栓126例临床分析  

Clinical analysis of 126 cases of acute myocardial infarction with left ventricular thrombus

作　　者：张立新[1] 吉庆伟[1] 公威 营晓 相爽 Zhang Lixin;Ji Qingwei;Gong Wei;Ying Xiao;Xiang Shuang(Department of Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China)

机构地区：[1]首都医科大学附属北京安贞医院急诊危重症中心,100029

出　　处：《疑难病杂志》2020年第6期570-573,共4页Chinese Journal of Difficult and Complicated Cases

基　　金：国家自然科学基金(81970292);北京市自然科学基金(7191002);北京市医院管理中心青年人才培养“青苗”计划(QML20190603);北京市医院管理局重点医学专业发展计划(ZYLX201710)。

摘　　要：目的探讨急性心肌梗死合并左心室附壁血栓的临床特点。方法收集2016年1月—2017年12月在首都医科大学附属北京安贞医院行超声心动图诊断急性心肌梗死合并左心室附壁血栓患者126例的临床资料,并进行回顾性分析。结果126例患者中男115例(91.3%),所有患者均有节段性室壁运动异常及室壁瘤形成,平均左心室射血分数(42.4±9.7)%;广泛前壁心肌梗死36例(28.6%),前壁合并下壁心肌梗死14例(11.1%),前壁心肌梗死56例(44.4%),下壁、后壁合并右室心肌梗死6例(4.8%),下壁心肌梗死4例(3.2%),非ST段抬高型心肌梗死患者10例(7.9%);冠状动脉造影检查62例(49.2%),其中15例为急诊冠状动脉造影检查,冠状动脉造影示左主干病变中重度狭窄6例(9.7%),前降支完全、次全闭塞或中重度狭窄59例(95.2%),回旋支完全、次全闭塞或中重度狭窄19例(30.6%),右冠状动脉完全、次全闭塞或中重度狭窄25例(40.3%)。结论LVEF降低、室壁瘤形成是急性心肌梗死发生左心室附壁血栓的危险因素。Objective To investigate the clinical characteristics of patients with left ventricular mural thrombosis after acute myocardial infarction.Methods The clinical data of 126 patients with acute myocardial infarction and left ventricular mural thrombus diagnosed in our hospital from January 2016 to December 2017 were collected and analyzed retrospectively.Results Of the 126 patients,115 were male(91.3%).All patients had segmental wall motion abnormalities and ventricular aneurysm,with an average ejection fraction(42.4±9.7)%.There were 36 cases of extensive anterior myocardial infarction(28.6%),14 cases of anterior and inferior myocardial infarction(11.1%),56 cases of anterior myocardial infarction(44.4%),and 6 cases of the inferior and posterior wall with right ventricular myocardial infarction(4.8%),inferior myocardial infarction in 4 cases(3.2%),non-ST segment elevation myocardial infarction in 10 cases(7.9%).Coronary angiography was performed in 62 cases(49.2%),of which 15 underwent emergency coronary angiography.Coronary angiography showed severe stenosis of the left main lesion in 6 cases(9.7%),complete or subtotal occlusion of the anterior descending artery in 59 cases(95.2%),complete,subtotal occlusion,or severe stenosis of the left circumflex artery in 19 cases(30.6%),and complete,subtotal occlusion,or severe stenosis of right coronary artery in 25 cases(40.3%).Conclusion The clinical features of patients with acute myocardial infarction complicated with left ventricular mural thrombosis may be helpful for the prevention and treatment of the disease.

关 键 词：心肌梗死 左心室附壁血栓 室壁瘤 左心室射血分数 

分 类 号：R54[医药卫生—心血管疾病]