心肌梗死后室间隔穿孔预后及相关因素分析  

Analysis of clinical outcomes and associated risk factors following surgical treatment of postinfarction ventricular septal rupture

作　　者：杨晓芳[1] 付琳 赵雪婷[1] 关明[1] 邢家林[1] 侯晓彤[2] 黑飞龙 YANG Xiaofang;FU Lin;ZHAO Xueting;GUAN Ming;XING Jialin;HOU Xiaotong;HEI Feilong(Department of Extracorporeal Circulation and Mechanical Circulation Assistants,Center for Cardiac Intensive Care,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所体外循环及机械循环辅助科,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心脏外科危重症中心,100029

出　　处：《心肺血管病杂志》2024年第12期1305-1311,共7页Journal of Cardiovascular and Pulmonary Diseases

基　　金：首都卫生发展科研专项项目(首发2022-2Z-20612)。

摘　　要：目的:探讨心肌梗死后室间隔穿孔患者心脏外科术后短期预后及死亡相关危险因素。方法:选取2018年1月至2023年12月,北京安贞医院行体外循环下心脏外科手术的心肌梗死(myocardial infarction,MI)后室间隔穿孔(ventricular septal rupture,VSR)患者,分为院内死亡组和生存组,比较两组患者围术期临床资料和术后结局,并进行单因素及多因素分析明确院内死亡的危险因素。结果:共纳入72例患者,其中院内死亡组6例(8.3%),生存组66例(91.7%)。单因素Logistic回归提示既往高血压、慢性阻塞性肺疾病、肾功能不全、术前更低的HGB、更高的肌酸激酶、未行药物溶栓、术前连续性肾脏替代治疗、KilliP≥Ⅲ级、更长的手术时间、更长的体外循环时间、更长的主动脉阻断时间及联合二尖瓣/三尖瓣手术是院内死亡的潜在危险因素。将单因素Logistic回归中P值<0.1的变量纳入多因素Logistic回归,结果显示:PLT(OR=-0.106,95%CI:-0.10~0.14,P=0.042)、HGB(OR=0.52,95%CI:0.29~0.94,P=0.029)、联合二尖瓣/三尖瓣手术(OR=0.034,95%CI:0.002~0.59,P=0.02)是MI后VSR术后死亡的相对危险因素。结论:患者术前状态更差、血流动力学更不稳定、心功能受损更严重、更长的手术时间与外科术后死亡相关。PLT、HGB、联合二尖瓣/三尖瓣手术是院内死亡的危险因素。Objective:To investigate the short-term prognosis and death-related risk factors following surgical treatment of postinfarction ventricular septal rupture(VSR).Methods:A retrospective study was conducted to collect data from patients who underwent cardiac surgery with cardiopulmonary bypass(CPB)for VSR after MI at Anzhen Hospital from January 2018 to December 2023.The patients were divided into an in-hospital mortality group and a survival group.Clinical data and postoperative outcomes were compared between the two groups,and univariate and multivariate analyses were performed to identify risk factors for in-hospital mortality.Results:A total of 72 patients were included,with 6(8.3%)in the in-hospital mortality group and 66(91.7%)in the survival group.Univariate Logistic regression analysis revealed that hypertension,chronic obstructive pulmonary disease(COPD),renal insufficiency,lower preoperative HGB,higher creatine kinase(CK),no thrombolytic therapy,preoperative continuous renal replacement therapy(CRRT),Killip class≥Ⅲ,longer operative time,longer CPB time,longer aortic cross-clamp(ACC)time,and combined mitral/tricuspid valve surgery were potential risk factors for in-hospital mortality.Variables with a P<0.1 in the univariate Logistic regression were included in the multivariate Logistic regression analysis.The results showed that platelet count[-0.106(-0.10-0.14),P=0.042],HGB[0.52(0.29-0.94),P=0.029],and combined mitral/tricuspid valve surgery[0.034(0.002-0.59),P=0.02]were independent risk factors for mortality after VSR surgery following MI.Conclusion:A worse preoperative status,more unstable hemodynamics,more severe impairment of cardiac function,and longer surgical duration are associated with postoperative mortality in surgical patients.Platelet count,HGB,and combined mitral/tricuspid valve surgery were independent risk factors for in-hospital mortality.

关 键 词：心肌梗死 室间隔穿孔 心脏外科手术 预后 

分 类 号：R54[医药卫生—心血管疾病]