经皮介入封堵治疗急性心肌梗死后室间隔穿孔69例  

Efficacy and safety of percutaneous closure of ventricular septal rupture after acute myocardial infarction:a clinical study of 69 cases

作　　者：陈同峰 张静[1] 高传玉[1] 郭素萍[1] 叶发民[1] 孙子瑞[1] 蒋亚鹏 程江涛[1] 韩宇[1] 刘煜昊[1] Chen Tongfeng;Zhang Jing;Gao Chuanyu;Guo Suping;Ye Famin;Sun Zirui;Jiang Yapeng;Cheng Jiangtao;Han Yu;Liu Yuhao(Department of Cardiology,Central China Fuwai Hospital(Central China Fuwai Hospital of Zhengzhou University),Heart Center of Henan Provincial People′s Hospital,Henan Key Laboratory of Coronary Heart Disease Control,Henan Research Center for Cardiovascular Epidemiology,Zhengzhou 450003,China)

机构地区：[1]华中阜外医院(郑州大学华中阜外医院)心血管科,河南省人民医院心脏中心,河南省冠心病防治重点实验室,河南省心血管流行病学研究中心,郑州450003

出　　处：《中华心血管病杂志》2021年第11期1094-1101,共8页Chinese Journal of Cardiology

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20200092);河南省医学科技攻关计划联合共建项目(2018020439)。

摘　　要：目的初步探讨经皮介入封堵治疗急性心肌梗死(AMI)后室间隔穿孔(VSR)的疗效及安全性及术后30 d死亡的危险因素。方法本研究为回顾性病例系列研究。连续入选2013年10月至2020年5月于河南省人民医院心内科及华中阜外医院心内科行介入封堵治疗的69例AMI后VSR患者。依据术后30 d是否存活将患者分为存活组(53例)和死亡组(16例)。收集并分析纳入患者住院期间临床资料,于术后30 d对院内存活患者进行电话随访。主要安全性指标为封堵失败发生率及术后30 d全因死亡率,次要安全性指标为手术相关并发症及其他非手术操作直接相关并发症发生率。有效性指标包括纽约心脏协会(NYHA)心功能分级、右心导管及超声心动图检测指标。采用多因素logistic回归分析VSR患者介入封堵术后30 d死亡的危险因素。结果本研究共纳入69例行介入封堵治疗的VSR患者,年龄67(64,71)岁,其中女性42例(60.9%)。全因死亡16例(23.2%),其中院内死亡13例,随访期间死亡3例。封堵失败4例(5.8%)。成功介入封堵的65例患者中,手术相关并发症共12例(18.5%),其中瓣膜损伤8例(12.3%)。与无并发症患者相比,出现手术相关并发症患者术后30 d死亡率较高[5/12比13.2%(7/53),P=0.022]。发生MACE 1例(1.5%),多器官功能衰竭1例(1.5%),消化道出血2例(3.1%)。成功封堵的65例患者均完成术后超声心动图复查;出院时,56例存活患者完成心功能评估;术后30 d随访时,53例存活患者完成电话随访。出院时及术后30 d患者的NYHA心功能分级分布情况与术前比较差异均有统计学意义(P均<0.001),Ⅰ、Ⅱ级患者占比与术前比较差异均有统计学意义[分别为76.8%(43/56)比23.1%(15/65),P<0.001;77.4%(41/53)比23.1%(15/65),P<0.001]。封堵治疗术后患者的肺循环与体循环血流量比(Qp/Qs)、肺动脉收缩压(PASP)及左心室舒张末期内径(LVDd)较术前降低,主动脉收缩压(ASP)和左心室射血分数(Objective To investigate the efficacy and safety of percutaneous closure of ventricular septal rupture(VSR)after acute myocardial infarction(AMI)and the risk factors of all-cause mortality at 30 days after operation.Methods This is a retrospective case series study.A total of 69 patients with post-AMI VSR,underwent percutaneous closure of VSR from October 2013 to May 2020 in Department of Cardiology of Henan Provincial People′s Hospital and Department of Cardiology of Central China Fuwai Hospital,were included.Patients were divided into survival group(53 cases)and non-survival group(16 cases)according to the status at 30 days after operation.Clinical data were collected and analyzed during hospitalization.Telephone follow-up was performed 30 days after operation.The primary safety endpoint was occlusion failure and all-cause mortality at 30 days post operation.The secondary safety endpoint was the operation related or non-operation related complications.Efficacy endpoint included NYHA classification of cardiac function,index measured by right heart catheterization and echocardiography.Multivariate logistic regression was performed to analyze the risk factors of all-cause mortality at 30 days after operation.Results A total of 69 patients,aged 67(64,71)years,including 42 women(60.9%),were enrolled in this study.All-cause death occurred in 16 patients(23.2%),including 13 in-hospital death and 3 death during follow-up.There were 4 cases of closure failure(5.8%).Among the 65 patients with successful closure,12(18.5%)experienced operation-related complications,among which 8(12.3%)experienced valve injury.The mortality was significantly higher in patients with operation-related complications than that in patients without operation-related complications(41.7%(5/12)vs.13.2%(7/53),P=0.022).One case received percutaneous closure of VSR and PCI,this patient experienced new-onset AMI immediately post procedure and died thereafter(1.5%).One case(1.5%)developed multiple organ failure and 2 cases(3.1%)developed gastrointestin

关 键 词：室间隔破裂 介入封堵 疗效 安全性 

分 类 号：R542.22[医药卫生—心血管疾病]