65例急性心肌梗死合并室间隔穿孔患者的临床分析  

Clinical Analysis of 65 Patients with Acute Myocardial Infarction Complicated by Ventricular Septal Rupture

作　　者：张俊彦 陈忠秀[1] 王觅也 刘然 赵宏森 冯沅[1] 陈玉成[1] 王华[1] 何森[1] 贺勇[1] ZHANG Junyan;CHEN Zhongxiu;WANG Miye;LIU Ran;ZHAO Hongsen;FENG Yuan;CHEN Yucheng;WANG Hua;HE Sen;HE Yong(Department of Cardiology,West China Hospital,Sichuan University,Chengdu 610041,Sichuan,China;Information Center of West China Hospital,Sichuan University,Chengdu 610041,Sichuan,China)

机构地区：[1]四川大学华西医院心内科,四川成都610041 [2]四川大学华西医院信息中心,四川成都610041

出　　处：《心血管病学进展》2022年第10期942-946,共5页Advances in Cardiovascular Diseases

摘　　要：目的总结急性心肌梗死合并室间隔穿孔(AMI-VSR)患者的临床特点及预后。方法回顾性分析四川大学华西医院2012年1月—8月收治的AMI-VSR患者65例,描述其基线资料特征、穿孔性质和治疗情况;进行电话随访,收集其预后情况。并对以上指标进行多因素logistic回归分析。结果65例AMI-VSR患者,继发于前壁心肌梗死患者55例(84.6%),其AMI-VSR时间为0.25~15.00 d[(3.9±3.4)d];其中院内死亡40例(61.5%),出院后1年内死亡11例(16.9%),好转出院并且存活至今11例(16.9%),失访3例(4.6%)。其中手术治疗6例,院内死亡0例,出院后1年内死亡0例,全部6例患者存活至今。接受外科手术或介入治疗患者院内死亡率以及出院后1年内死亡率显著低于保守治疗患者(P<0.05)。多因素logistic回归结果显示AMI患者的TIMI评分≥7分是AMI-VSR患者院内以及出院后1年内死亡的独立危险因素(OR=30.034,95%CI 1.65~546.70,P<0.05)。结论VSR是AMI严重的并发症;AMI的TIMI评分≥7分是AMI-VSR患者院内及出院后1年内死亡的独立危险因素。外科手术或介入封堵治疗可显著改善患者的近期以及远期预后,AMI后2周以上行外科手术治疗成功率高,对于极其危重的患者,可适当提前外科手术时间。具体更有说服力的结论仍需进一步的临床研究。Objective To summarize clinical characteristics and the prognosis of patients with acute myocardial infarction complicated by ventricular septal rupture(AMI-VSR).Methods We retrospectively analyzed 65 patients with AMI-VSR admitted in our hospital from January to August 2012.The characteristics of baseline data,perforation and treatments were investigated.The prognosis information was collected by telephone follow-ups.Multifactorial logistic regression analysis of above indicators was conducted.Results In 65 patients with AMI-VSR,55 cases were secondary to anterior wall infarction(84.6%)with the duration of AMI-VSR ranging from 0.25 to 15.00 d[(3.9±3.4)d],40 cases(61.5%)died in-hospital,11 cases(16.9%)died within 1 year after discharge,11 cases(16.9%)were discharged on improvements and survived to date,and 3 cases(4.6%)get loss to follow-up.Meanwhile,among surgically treated 6 patients,0 case died in hospital,0 case died within 1 year after discharge,and all 6 cases survived to date.The mortalities in hospital and within 1 year after discharge were significantly lower in patients received surgical or interventional treatments than those received conservative treatments(P<0.05).Logistic regression showed that TIMI score≥7 of patients with acute heart attack was an independent risk factor for in-hospital and 1-year post-discharge mortalities in AMI-VSR patients(OR=30.034,95%CI 1.65~546.70,P<0.05).Conclusion VSR is a serious complication that mostly occurs within one week after AMI.TIMI score≥7 is an independent risk factor for deaths in-hospital and 1-year post-discharge in AMI-VSR patients.Surgical or interventional treatments could significantly improve the immediate and long-term prognosis of AMI-VSR patients,with a high success rate of surgical treatment expected more than 2 weeks after AMI.For extremely critical patients,the time of operation may be appropriately advanced.Further clinical studies are needed for convincing conclusions.

关 键 词：室间隔穿孔 急性心肌梗死 临床分析 

分 类 号：R542.22[医药卫生—心血管疾病]