急性心肌梗死并发心脏破裂危险因素分析

目的分析急性心肌梗死(AMI)并发心脏破裂的临床特点、危险因素及预后,并探讨临床防治措施。方法回顾性收集AMI患者1561例,其中发生心脏破裂患者21例为心脏破裂组,随机选取未发生心脏破裂的AMI患者105例为对照组,采集2组患者临床资料及治疗方案,分析AMI并发心脏破裂的危险因素。结果与对照组比较,心脏破裂组年龄、入院心率、女性、肌钙蛋白、N末端B型钠尿肽前体、尿素明显升高(P<0.05,P<0.01),急诊PCI、血红蛋白、红细胞计数、使用β受体阻滞剂及血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体阻滞剂(ARB)比例明显降低,差异有统计学意义[42.86%vs 72.38%,P=0.011;(119.33±19.37)g/L vs (139.29±17.65)g/L,P=0.001;(4.13±0.62)×10^12/L vs (4.60±0.69)×10^12/L,P=0.010;47.62%vs 73.33%,P=0.020;23.81%vs 52.38%,P=0.017]。结论女性、高龄、再灌注时间延迟、入院心率快、高NT-ProBNP、高肌钙蛋白、低血红蛋白、低红细胞计数是AMI患者心脏破裂的危险因素,早期的再灌注治疗、ACEI/ARB、β受体阻滞剂的使用是预防AMI后发生心脏破裂的重要措施。

Risk factors for acute myocardial infarction with cardiac rupture

Objective To study the clinical prevention and treatment of acute myocardial infarction(AMI)with cardiac rupture by analyzing its clinical characteristics,risk factors and outcome.Methods One hundred and twenty-six AMI patients were divided into cardiac rupture group(n=21)and control group(n=105).Their clinical data were recorded and their treatment plan was worked out.The risk factors for AMI with cardiac rupture were analyzed.Results The age was significantly older,the heart rate on admission and the serum levels of troponin,NT-ProBNP and urea were significantly higher,the number of female patients was significantly greater while the ratio of PCI,hemoglobin,red blood cell count,beta blockers and ACEI/ARB drugs that were used in treatment of AMI with cardiac rupture was significantly lower in cardiac rupture group than in control group(42.86%vs 72.38%,P=0.011;119.33±19.37 g/L vs 139.29±17.65 g/L,P=0.001;4.13±0.62×10^12/L vs 4.60±0.69×10^12/L,P=0.010;47.62% vs 73.33%,P=0.020;23.81%vs 52.38%,P=0.017).Conclusion Female,advanced age,delayed reperfusion,rapid heart rate on admission,high serum NT-ProBNP and troponin levels,low hemoglobin level and low red blood cell count are the risk factors for cardiac rupture in AMI patients.Early reperfusion and use of ACEI/ARB drugs and beta blocker play an important role in preventing cardiac rupture in AMI patients.