急性心肌梗死后室间隔穿孔患者的预后及相关因素分析  

Prognosis and related factors of patients with ventricular septal rupture after acute myocardial infarction

作　　者：张晶晶 张静 高传玉 郭素萍 刘煜昊 赵子牛 肖文涛 曹雪明 Zhang Jingjing;Zhang Jing;Gao Chuanyu;Guo Suping;Liu Yuhao;Zhao Ziniu;Xiao Wentao;Cao Xueming(Heart Center,Fuwai Central China Cardiovascular Hospital,Henan Provincial People’s Hospital,the People’s Hospital of Zhengzhou University,Zhengzhou 451464,ChinaCorresponding)

机构地区：[1]阜外华中心血管病医院,河南省人民医院心脏中心,郑州大学人民医院,451464

出　　处：《中国心血管杂志》2022年第6期543-547,共5页Chinese Journal of Cardiovascular Medicine

基　　金：河南省医学科技攻关联合共建项目(LHGJ20220105)。

摘　　要：目的分析急性心肌梗死(AMI)后室间隔穿孔(VSR)患者的预后及相关因素。方法回顾性分析阜外华中心血管病医院冠心病重症监护室2018年1月至2021年12月收治的AMI合并VSR患者118例,根据住院期间是否死亡分为死亡组(66例)和存活组(52例),比较两组基线资料特征,Logistic回归分析导致院内死亡的危险因素,Kaplan-Meier生存曲线分析手术患者的术后累计生存率。结果两组收缩压、升压药应用、体外膜肺氧合辅助、呼吸机辅助、持续性肾脏替代治疗比例、白细胞、C反应蛋白、肌酐、B型利钠肽、肌钙蛋白I、乳酸、序贯器官衰竭评分(SOFA评分)、手术差异均有统计学意义(均为P<0.05)。Logistic回归分析提示,白细胞(OR=1.198,95%CI:1.074~1.335,P=0.001)和SOFA评分(OR=1.54,95%CI:1.301~1.823,P<0.001)是院内死亡的独立危险因素,而手术与院内死亡呈负相关(OR=0.006,95%CI:0.001~0.058,P<0.001)。Kaplan-Meier生存曲线分析提示,手术患者累积生存率显著高于未手术组(Log-Rank=112.70,P<0.001)。结论进监护室时的白细胞升高及较高的SOFA评分是院内死亡的危险因素。手术治疗(包括介入封堵和外科修补术)可改善AMI合并VSR患者预后。Objective To analyze the clinical data of patients with ventricular septal rupture(VSR)after acute myocardial infarction(AMI),and to explore the prognosis and related factors of these patients.Methods A retrospective analysis was performed on 118 AMI patients complicated with VSR admitted to the Coronary Intensive Care Unit of Fuwai Central China Cardiovascular Hospital from January 2018 to December 2021.Patients were divided into death group(n=66)and survival group(n=52),and the baseline data of the two groups were compared.The risk factors for nosocomial death were analyzed by logistic regression,and the cumulative survival rate of patients after surgery was analyzed by Kaplan-Meier survival curve.Results There were statistically significant differences between the death group and survival group in systolic blood pressure,levels of white blood cell counts,C-reactive protein,creatinine,B-type brain natriuretic peptide(BNP),troponin I(cTnI)and lactic acid,use of vasoactive medications,proportion of ECMO,respiration,continuous renal replacement therapy,SOFA score and surgical treatment(all P<0.05).Logistic regression analysis suggested that white blood cell counts(OR=1.198,95%CI:1.074-1.335,P=0.001)and SOFA score(OR=1.54,95%CI:1.301-1.823,P<0.001)were independent risk factors for nosocomial death,while surgery was negatively correlated with in-hospital death(OR=0.006,95%CI:0.001-0.058,P<0.001).Kaplan-meier survival curve analysis showed that the cumulative survival rate of patients undergoing surgery was significantly higher than that of patients without surgery(Log-Rank=112.70,P<0.001).Conclusions White blood cell counts and SOFA score are risk factors for nosocomial death.Surgical treatment(including interventional closure and surgical repair)can improve the prognosis of AMI patients with VSR.

关 键 词：急性心肌梗死 室间隔穿孔 危险因素 预后 

分 类 号：R542.22[医药卫生—心血管疾病]