心肌梗死合并室间隔穿孔的外科治疗及预后分析  

Surgical treatment and prognosis of myocardial infarction complicated with ventricular septal perforation

作　　者：刘韬帅[1] 刘卫业 黄柱辉 赵洋[1] 郑居兵[1] 董然[1] LIU Taoshuai;LIU Weiye;HUANG Zhuhui;ZHAO Yang;ZHENG Jubing;DONG Ran(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing,100029,P.R.China;Department of Critical Care Medicine,The People’s Hospital of Zhaoyuan City,Zhaoyuan,265400,Shandong,P.R.China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,北京100029 [2]招远市人民医院重症医学科,山东招远265400

出　　处：《中国胸心血管外科临床杂志》2021年第9期1061-1065,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨心肌梗死合并室间隔穿孔患者的外科治疗方法及手术疗效。方法回顾性分析2009~2018年首都医科大学附属北京安贞医院心脏外科收治的心肌梗死合并室间隔穿孔60例患者的临床资料,其中男39例、女21例,平均年龄(63.3±8.3)岁。结果 43例(71.7%)穿孔位于心尖部,11例(18.3%)位于后间隔,6例(10.0%)位于前间隔。单支冠状动脉病变24例(40.0%)。术前置入主动脉内球囊反搏14例(23.3%),室间隔穿孔至外科手术时间为48.3(3~217)d。所有患者均行室间隔穿孔修补术,其中53例(88.3%)患者同期行室壁瘤缝闭或切除,49例(81.7%)患者同期行冠状动脉旁路移植术(平均远端吻合口数为2个)。术后在院并发症包括8例(13.3%)死亡、8例(13.3%)心力衰竭、5例(8.3%)心室颤动、3例(5.0%)心脏压塞、11例(18.3%)二次开胸以及11例(18.3%)残余分流。除8例在院死亡患者以外,其余52例治愈出院患者均接受随访,中位随访时间为4.9年,患者2年和5年生存率为95.8%,8年生存率为89.0%;主要心血管不良事件发生率为19.2%,包括3例(5.8%)死亡、5例(9.6%)心力衰竭、2例(3.8%)心肌梗死、4例(7.7%)脑血管事件。结论对于心肌梗死后并发室间隔穿孔的患者,外科手术是积极有效的治疗手段,围术期死亡率虽高,但恰当的手术时机和手术方法仍可达到满意的远期疗效。Objective To investigate the surgical methods and efficacy of myocardial infarction combined with ventricular septal perforation. Methods The clinical data of 60 patients with myocardial infarction combined with ventricular septal perforation admitted to the Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, from 2009 to 2018 were retrospectively analyzed. There were 39 males and 21 females, aged 63.3±8.3 years.Results Among the 60 patients, 43(71.7%) patients were perforated in the apex, 11(18.3%) in the posterior septum and6(10.0%) in the anterior septum. There were 24(40.0%) patients of single coronary artery disease. Fourteen(23.3%)patients received intra-aortic balloon counterpulsation before surgery. The waiting time from ventricular septal perforation to surgery was 48.3(3-217) d. All patients underwent ventricular septal perforation repair, among whom 53(88.3%) patients received ventricular aneurysm closure or resection, and 49(81.7%) patients received coronary artery bypass graft with an average of 2 distal anastomoses during the same period. Perioperative complications in the hospital included 8(13.3%) deaths, 8(13.3%) heart failure, 5(8.3%) ventricular fibrillation, 3(5.0%) pericardial tamponade, and 11(18.3%) secondary thoracotomy and 11(18.3%) residual shunt. Except for 8 patients who died in the hospital, the other 52 cured and discharged patients were followed up. The median follow-up time was 4.9 years. The 2-year and 5-year survival rate of the patients was 95.8%, and the 8-year survival rate was 89.0%. Major adverse cardiovascular events incidence was19.2%, including 3(5.8%) deaths, 5(9.6%) heart failure, 2(3.8%) myocardial infarction, and 4(7.7%) cerebrovascular events. Conclusion For patients with ventricular septal perforation after myocardial infarction, surgery is an effective treatment method. Although the perioperative mortality rate is high, satisfactory long-term results can be achieved by carefully choosing the operation timing and methods.

关 键 词：心肌梗死 室间隔穿孔 外科修补 治疗 

分 类 号：R654.2[医药卫生—外科学]