急性下壁心肌梗死伴右室梗死的临床表现和预后分析

目的探讨急性下壁心肌梗死(心梗)不伴或伴右室心梗患者的临床特征、治疗和预后。方法回顾既往6年住我院的103例急性下壁心梗患者,比较下壁心梗不伴右室心梗(65例)和伴右室心梗(38例)两组患者的临床特征和院内死亡率。结果发生低血压、心源性休克、快速心律失常(阵发性心房颤动,非持续性室性心动过速)、缓慢心律失常(包括窦性心动过缓,Ⅲ度房室传导阻滞)在下壁伴右室心梗组高于下壁心梗组,两组比较有显著性差异(P<0.05)。两组左心室射血分数(LVEF)及经皮冠脉介入(PCI)治疗患者的院内病死率比较无显著差异(P>0.05)。结论血流动力学障碍和心律失常是右室心梗住院并发症高的主要因素,右室心梗是独立于左室功能损害的危险因素,早期介入治疗能改善住院死亡率。

Clinical features and prognosis of right ventricular infarction complicating inferior myocardial infarction

Objective The aim of this study was to investigate clinical features and the prognostic of right ventricular myocardial infarction(RVMI) in patients complicating inferior wall myocardial infarction(IWMI).Methods 103 cases admitted with IWMI during last 6 years were retrospectively studied.The clinical manifestations and in-hospital mortality were compared between IWMI Group(65 cases) and IWMI RVMI Group(38 cases).Results The incidence of hypotension,cardiac shock,tachyarrhythmia (paroxysmal atrial fibrillation,non-sustained ventricular tachycard),brady arrhythmias(sinus bradycardia and atrio ventricular block)and in-ospital mortality was higher in IWMI with RVMI than isolate IWMI(P<0.05).The left ventricular ejection fraction and in-hospital mortality in patients treated by percutaneous coronary intervention(PCI) was no significant deviation in two groups (P>0.05).Conclusion IWMI with RVMI show complicated clinical manifestation and present a worse prognosis owing to arrhythmic and mechanical complications.RVMI is the risk factor independent on impair left ventricular function.interventional therapy could significantly decrease its in-hospital mortality.