急性心肌梗死合并室间隔穿孔的诊治及预后分析  

Management and prognosis of acute myocardial infarction patients with ventricular septal perforation

作　　者：张良[1] 徐涵 王珏[1] ZHANG Liang;XU Han;WANG Jue(Department of Cardiac Surgery,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院心脏外科,325000 [2]温州医科大学附属第一医院麻醉科,325000

出　　处：《浙江医学》2021年第23期2589-2592,2595,共5页Zhejiang Medical Journal

基　　金：国家自然科学基金项目(81670255);国家重点研发计划项目(2016YFC1302001)。

摘　　要：目的分析评估急性心肌梗死(AMI)合并室间隔穿孔(VSR)患者的临床特征、治疗方式及预后情况。方法选择2006年12月至2020年5月温州医科大学附属第一医院收治的AMI合并VSR患者37例,据患者接受治疗出院后30 d内生存情况,分为存活组7例和死亡组30例。比较两组患者的一般资料及治疗方式,包括单纯药物保守治疗、药物治疗同时应用主动脉内球囊反搏(IABP)支持治疗、内科介入性封闭治疗和外科开放性手术治疗等,分析患者死亡的危险因素。根据是否进行外科开放性手术治疗分为手术患者和非手术患者,比较500 d累计生存率。结果出院后30 d内,30例患者死亡,其中25例(67.57%)单纯药物保守治疗均死亡,3例(8.11%)药物治疗同时应用IABP支持治疗后死亡,1例(2.70%)内科介入性封闭治疗后发生感染性休克死亡,1例(2.70%)接受外科开放性手术后发生心源性休克死亡,7例(18.92%)外科开放性手术治疗存活。存活组患者年龄小于死亡组,WBC、TBil、Killip Ⅲ~Ⅳ级比例均低于死亡组(均P<0.05);MAP、外科手术治疗比例均高于死亡组,差异均有统计学意义(均P<0.05)。多因素logistic回归分析结果提示年龄和WBC是患者死亡的危险因素(均P<0.05)。Kaplan-Meier生存曲线显示手术患者的500 d累计生存率明显高于非手术患者(P<0.01)。结论单纯药物保守治疗以及内科介入性封闭治疗并不能达到较好的预后效果,外科开放性手术仍是治疗AMI合并VSR的有效方案,选择合适的手术方案以及手术时机,能带来最有益的临床结果。Objective To analyze the management and prognosis of acute myocardial infarction(AMI)patients with ventricular septal perforation(VSR).Methods Thirty seven AMI patients with VSR admitted to the First Affiliated Hospital of Wenzhou Medical University from December 2006 to May 2020 were included in the analysis.According to the survival status of the patients within 30 days after being treated and discharged from the hospital,they were divided into survival group(7 cases)and fatal group(30 cases).General information and treatment methods,including conservative therapy,medical therapy combined with intra-aortic balloon pump(IABP)support therapy,interventional perforation occlusion or open surgical treatment were compared between the two groups,and independent risk factors for death were analyzed.According to whether open surgical treatment was performed,they were divided into surgical group and non-surgical group,and the 500 days cumulative survival rate of the two groups was compared.Results Within 30 days after admission,30 patients died,including 25 patients(67.57%)treated by medication-only conservative therapy,3 patients(8.11%)treated by medication with IABP supportive therapy,1 patient(2.70%)with septic shock after treated by internal interventional occlusion,and 1 patient(2.70%)with cardiogenic shock after treated by open surgery,and 7 patients(18.92%)survived(survival group),all of whom were treated by open surgery.The age,white blood cell count,total bilirubin level and the proportion of Killip Ⅲ~Ⅳ in the survival group were lower than those in the fatal group(all P<0.05),while the proportion of mean arterial pressure and surgical treatment in the survival group were higher than those in the fatal group(all P<0.05).The multivariate logistic regression analysis showed that age and white blood cell count were independent risk factors of fatality of patients(all P<0.05).Kaplan-Meier survival curve showed that the cumulative survival rate of 500 days in the operation group was significantly higher than that

关 键 词：急性心肌梗死 室间隔穿孔 临床分析 外科治疗 预后 

分 类 号：R542.22[医药卫生—心血管疾病]