急性心肌梗死合并室间隔穿孔临床分析

目的 探讨急性心肌梗死（acute myocardial infarction,AMI）后发生室间隔穿孔（ventricular septal rupture, VSR）患者的临床特点、治疗方法及其预后情况.方法 对2000年11月至2013年4月就诊于大连医科大学附属第一医院的23例确诊为AMI合并VSR患者的临床资料进行回顾性分析.结果 此期间共收治AMI患者5 300例,其中合并VSR 23例,发生率为0.43％.其中男性15例（65.2％）,年龄（71±10）岁.合并原发性高血压14例,前壁心肌梗死15例,左心室射血分数34.2％±20.1％.诊断VSR的平均时间为3.6 d.5例患者择期手术治疗.COX回归模型发现女性（P=0.009）、心率（P=0.002）是影响患者生存期的主要因素.结论 AMI合并VSR在临床中并不多见,内科保守治疗效果较差,内科保守治疗维持血流动力学稳定后行手术治疗可提高生存率.

Clinical features in patients with ventricular septal rupture complicated with acute myocardial infarction

Objectives To investigate the clinical features,treatments and outcomes of patients with ventricular septal rupture （VSR） complicated with acute myocardial infarction （AMI）.Methods Clinical data of 23 patients with VSR complicated with AMI in The First Affiliated Hospital of Dalian Medical University from November 2000 to April 2013 were analyzed retrospectively.Results Totally 5 300 patients with AMI were included,of which,23 were complicated with VSR （0.43%）.For the patients with VSR,15 cases were male; the average age was （71±10） years.There were 14 hypertensive patients and 15 patients diagnosed as anterior wall infarction.Left ventricular ejection fraction （LVEF） was 34.2%±20.1%.The median time from symptom onset to VSR diagnosis was 3.6 days.Five patients underwent surgical treatment.Surgical and non-surgical survival rates were 80.0% vs.11.1% （P=0.008）.Cox regression analysis indicated that female （P=0.009） and heart rate （P=0.002） were significant predictors of mortality.Conclusions AMI complicated with VSR is rare.The fatality rate is high in patients who received conservative medical treatment.The survival rate can be improved by ventricular septal perforation repair in hemodynamically stable patients.