介入封堵治疗急性心肌梗死后室间隔穿孔预后的危险因素及残余分流对预后的影响  

Risk factors of post-infarction ventricular septal rupture after percutaneous closure and the effect of different residual shunt after closure on the prognosis

作　　者：蒋亚鹏 孙子瑞[1] 陈同峰 刘煜昊 张静 叶发民 郭素萍 Jiang Ya-peng;Sun Zi-rui;Chen Tong-feng;Liu Yu-hao;Zhang Jing;Ye Fa-min;Guo Su-ping(Department of Cardiology,Henan Provincial People's Hospital,Henan University People's Hospital,Zhengzhou 450000,China)

机构地区：[1]河南大学人民医院河南省人民医院心内科,河南郑州450000 [2]阜外华中心血管病医院河南省人民医院心脏中心冠心病重症监护室,河南郑州450000

出　　处：《中国急救医学》2021年第11期954-958,共5页Chinese Journal of Critical Care Medicine

基　　金：河南省医学科技攻关计划项目(2018020439)。

摘　　要：目的研究介入封堵治疗急性心肌梗死(acute myocardial infarction,AMI)后室间隔穿孔(ventricular septal rupture,VSR)患者预后的危险因素及术后残余分流对预后的影响。方法回顾性分析2012年1月1日至2020年9月30日在河南省人民医院心脏中心成功行介入封堵手术的患者76例,封堵后70例(92.1%)有残余分流,院内死亡15例,将其与存活病例进行差异性比较,并采用多因素Logistic回归分析院内死亡的危险因素;对出院的患者进行长期随访,中位随访时间760(IQR:1075)d,用多因素Cox回归分析随访期死亡的危险因素。依据术后残余分流量分为小量组(分流直径≤3 mm)及大量组(分流直径>3 mm),用Kaplan-Meier法做出两组生存曲线,并用Log-rank检验进行比较。结果多因素Logistic回归分析显示,心原性休克(OR105.36,95%CI 4.27~2600.78)、穿孔直径(OR 1.89,95%CI 1.13~3.14)为院内死亡的危险因素;多因素Cox回归分析显示,既往脑卒中病史(HR 2.90,95%CI 1.13~7.46)、心原性休克(HR29.51,95%CI 8.52~102.17)、穿孔直径(HR 1.28,95%CI 1.12~1.48)为随访期死亡的危险因素;小量残余分流组与大量组长期预后比较差异无统计学意义(Log-rank检验,P=0.601)。结论心原性休克、穿孔直径为介入封堵治疗AMI后VSR患者院内死亡及随访期死亡的危险因素,既往脑卒中病史为随访期死亡的危险因素,术后残余分流对预后无影响。Objective To explore the risk factors of patients with post-infarction ventricular septal rupture(VSR)after percutaneous closure and the effect of residual shunt on the prognosis.Methods A retrospective review was performed for 76 patients with successful percutaneous closure from January 1,2012 to September 30,2020 at Henan Provincial People’s Hospital heart center.Seventy(92.1%)patients had residual shunt and 15 patients died in hospital after closure.Multivariate Logistic regression model was used to analyze the risk factors of in-hospital death.Mean follow-up time among the patients who survived to discharge was 760(IQR:1075)days.Multivariate Cox proportional hazard regression was used to analyze the risk factors of follow-up mortality.According to residual shunt after percutaneous closure,the patients were divided into small residual shunt group(residual shunt diameter≤3 mm)and large residual shunt group(residual shunt diameter>3 mm).Survival curves were drawn with Kaplan-Meier,and was compared by Log-rank test.Results Multivariate Logistic analysis identified cardiogenic shock(OR 105.36,95%CI 4.27-2600.78),the size of defect(OR 1.89,95%CI 1.13-3.14)were risk factors of in-hospital death.Multivariate Cox proportional hazard regression showed risk factors associated with follow-up death included previous stroke(HR 2.90,95%CI 1.13-7.46),cardiogenic shock(HR 29.51,95%CI 8.52-102.17)and the size of defect(HR 1.28,95%CI 1.12-1.48).There was no significant difference in long-term survival rates between small and large residual shunt group(Log-rank test,P=0.601).Conclusions Cardiogenic shock and the size of defect are the risk factors of in-hospital and follow-up death;Previous stroke is risk factor of follow-up death.Residual shunt after closure had no effect on the prognosis.

关 键 词：急性心肌梗死(AMI) 室间隔穿孔(VSR) 介入封堵 残余分流 预后 

分 类 号：R542.22[医药卫生—心血管疾病]