心肌梗死后前间隔和后间隔穿孔患者的临床特征及介入封堵治疗效果比较  

Clinical Features and Efficacy of Interventional Occlusion Therapy in Patients With Anterior or Posterior Septal Perforation After Myocardial Infarction

作　　者：孙子瑞 陈同峰[1] 韩宇[1] 江继承 蒋亚鹏 张静[1] 高传玉[1] 刘煜昊[1] SUN Zirui;CHEN Tongfeng;HAN Yu;JIANG Jicheng;JIANG Yapeng;ZHANG Jing;GAO Chuanyu;LIU Yuhao(Department of Structral Heart Disease,Fuwai Central China Cardiovascular Hospital,Henan Provincial People’s Hospital,Zhengzhou,450000,Henan,China)

机构地区：[1]河南省人民医院阜外华中心血管病医院结构性心脏病区,郑州市450000

出　　处：《中国循环杂志》2021年第8期743-748,共6页Chinese Circulation Journal

基　　金：河南省医学科技攻关计划项目(2018020439);河南省医学科技攻关计划省部共建项目(SB201902031)。

摘　　要：目的:对比心肌梗死后不同部位室间隔穿孔患者的临床特征及介入封堵术效果。方法:回顾性分析2015年1月至2020年5月我院心脏中心67例行介入封堵术的室间隔穿孔患者,根据室间隔穿孔部位将患者分为前间隔组(n=44)和后间隔组(n=23),比较两组患者术前、术中临床资料及术后随访结果。结果:封堵手术前,与前间隔组相比,后间隔组二尖瓣反流面积[3.05(1.40)cm^(2)vs.3.09(1.60)cm^(2)]、三尖瓣反流面积[4.05(3.50)cm^(2)vs.6.60(2.80)cm^(2)]更大,血压更低[收缩压(:108.86±14.93)mmHg vs.(97.04±11.23)mmHg;舒张压(:68.80±9.46)mmHg vs.(56.09±6.47)mmHg,1 mmHg=0.133 kPa],差异均有统计学意义(P均<0.05)。67例患者中,介入封堵术失败4例。其中,前间隔组2例,原因均为术中心脏破裂;后间隔组2例,1例因术中反复心室颤动而放弃封堵,1例封堵器脱落转外科治疗。63例介入封堵成功的患者中,院内死亡7例。前间隔组6例死亡,其中4例因二尖瓣、三尖瓣大量反流引起心力衰竭,最终死亡;2例严重溶血,导致多器官功能衰竭死亡。后间隔组1例患者于术后第二天因突发心脏骤停而死亡。封堵手术后,后间隔组二尖瓣反流面积仍明显大于前间隔组[3.10(2.40)cm^(2)vs.2.17(1.28)cm^(2),P=0.002]。两组在手术时间、X线辐射量、封堵器直径、院内死亡率、术后残余分流、术后三尖瓣反流面积及重症监护室滞留时间等方面的差异均无统计学意义(P均>0.05)。远期随访结果显示,两组的再次住院率、脑血管事件及二次冠状动脉事件发生率差异均无统计学意义(P均>0.05)。生存曲线分析也显示,两组的远期生存率差异无统计学意义(P>0.05)。结论:由于解剖学特点,后间隔穿孔患者较前间隔穿孔患者术前及术后瓣膜反流更严重,但介入封堵术的远期疗效相当。Objectives:To compare the clinical features and efficacy of interventional occlusion between patients with anterior or posterior septal rupture after myocardial infarction.Methods:This retrospective analysis included 67 patients with ventricular septal perforation who underwent interventional occlusion in the heart center of our hospital from January 2015 to May 2020.According to the location of ventricular septal perforation,the patients were divided into the anterior septal perforation group(n=44)and the posterior septal perforation group(n=23).The preoperative and intraoperative clinical data and postoperative follow-up results of the two groups were compared.Results:Before interventional occlusion,compared with the anterior septal perforation group,the mitral regurgitation(regurgitation area:3.05[1.40]cm^(2) vs.3.09[1.60]cm^(2),P=0.034)and the tricuspid regurgitation(regurgitation area:4.05[3.50]cm^(2) vs.6.60[2.80]cm^(2),P=0.014]were more serious in the posterior septal perforation group,while the blood pressure(systolic blood pressure:[108.86±14.93]mmHg vs.[97.04±11.23]mmHg,P=0.001;diastolic blood pressure:[68.80±9.46]mmHg vs.[56.09±6.47]mmHg,P<0.001;1 mmHg=0.133 kPa)was significantly lower in the posterior septal perforation group.Percutaneous closure failed in 4 out of 67 patients,due to intraoperative cardiac rupture(n=2)in the anterior septal perforation group,1 case due to recurrent ventricular fibrillation during operation and another case due to detachment of occlude(who was transferred to surgical treatment)in the posterior septal perforation group.Among the 63 patients with successful interventional occlusion,7 patients died during hospitalization,and 6 cases in the anterior septal perforation group including 4 cases with massive regurgitation of mitral and tricuspid valves and heart failure,2 cases of severe hemolysis and multiple organ failure;1 patient died in the posterior septal perforation group due to sudden cardiac arrest on the second day after operation.After interventional occlusion,

关 键 词：急性心肌梗死 介入封堵术 前间隔 后间隔 穿孔 

分 类 号：R541.7[医药卫生—心血管疾病]