心肌梗死后室间隔穿孔的外科治疗及机械辅助装置在围手术期的应用特点  

Surgical Treatment of Postinfarction Ventricular Septal Defect and Perioperative Application of Mechanical Circulatory Support

作　　者：刘子娜 李良 鞠帆 李宝童 常硕 张本青 武恒朝 孙寒松 LIU Zina;LI Liang;JYU Fan;LI Baotong;CHANG Shuo;ZHANG Benqing;WU Hengchao;SUN Hansong(Department of Adult Cardiovascular Surgery,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院成人外科中心,北京100037

出　　处：《中国分子心脏病学杂志》2024年第5期6342-6347,共6页Molecular Cardiology of China

摘　　要：目的探讨心肌梗死后室间隔穿孔的外科治疗及机械辅助装置在围手术期的应用特点。方法回顾性分析2006年1月至2020年12月在中国医学科学院阜外医院接受外科治疗的心肌梗死后室间隔穿孔患者107例,男性65例(60.7%),平均年龄(62.83±8.32)岁。根据围手术期是否应用机械辅助装置(MCS)将患者分为两组:MCS组(n=50)和非MCS组(n=57),分析对比两组患者的基线资料及手术、术后情况。运用logistic回归分析患者围手术期死亡的危险因素,对存活患者进行远期随访。结果所有患者均在体外循环下行手术治疗,体外循环时间120.0(86.0,135.0)min,主动脉阻断时间76.0(60.0,97.0)min,8例患者在围手术期死亡。与非MCS组相比,MCS组患者年龄更大,脏器功能更差,穿孔至手术时间更短,急诊手术比例更高,体外循环时间、术后机械通气时间、ICU时间、住院时间更长,术后行肾脏替代治疗比例更高。MCS组围手术期死亡率明显高于非MCS组(P=0.002)。多因素logistic回归分析提示:年龄(OR=1.704,95%CI:1.064~2.727,P=0.026)、既往脑血管意外(OR=145.889,95%CI:1.705~12485.825,P=0.028)为围手术期死亡的危险因素。全组患者中位随访时间67(26,105)个月,随访期间6例死亡,平均生存时间为(150.15±5.84)个月,5年生存率89.75%,10年生存率84.64%。结论心肌梗死后室间隔穿孔外科治疗围手术期MCS应用比例高,高龄、既往脑血管意外为围手术期死亡的危险因素,外科治疗中远期预后良好。Objective To investigate the surgical treatment of postinfarction ventricular septal defect(PIVSD)and perioperative application of mechanical circulatory support.Methods A retrospective analysis was performed on 107 patients with PIVSD who received surgical treatment in Fuwai hospital,from January 2006 to December 2020,including 65 males(60.7%),with an average age of 62.83±8.32 years.Patients were divided into two groups according to whether mechanical circulatory support(MCS)was used in perioperative period:MCS group(n=50)and non-MCS group(n=57).Baseline data,operation and postoperative data of the two groups were analyzed.Univariable and multivariable analyses were performed to identify predictors of perioperative mortality.ResultsAll patients underwent surgery under cardiopulmonary bypass.The time of cardiopulmonary bypass was 120.0(86.0,135.0)min,and the time of aortic occlusion was 76.0(60.0,97.0)min.8 patients died during perioperative period.Compared with the non-MCS group(n=57),patients in the MCS group(n=50)were older,with worse organ function,shorter time from perforation to surgery,higher proportion of emergency surgery,longer cardiopulmonary bypass,longer postoperative mechanical ventilation,longer ICU stay and longer hospital stay,and had a higher proportion of postoperative CRRT.The perioperative mortality in MCS group was significantly higher than that in non-MCS group(P=0.002).Multivariate logistic regression analysis suggested that age(OR=1.704,95%CI:1.064-2.727,P=0.026)and previous cerebrovascular accidents(OR=145.889,95%CI:1.705-12485.825,P=0.028)were risk factors for perioperative death.The median follow-up time of the whole group was 67(26,105)months,during which 6 patients died.The estimated mean survival time was(150.15±5.84)months.The 5-year survival rate was 89.75%,and the10-year survival rate was 84.64%.Conclusion The application ratio of MCS in perioperative treatment of PIVSD was high.Old age and previous cerebrovascular accidents were the risk factors for perioperative death,and the

关 键 词：心肌梗死 室间隔穿孔 外科治疗 机械辅助 危险因素 

分 类 号：R654.2[医药卫生—外科学]