急性下壁心肌梗死累及右心室的临床特点及预后

目的总结急性下壁心肌梗死合并右室心梗的临床特征和院内死亡率。方法对76例急性下壁心肌梗死未累及右室患者(Ⅰ组)和56例急性下壁心肌梗死累及右室患者(Ⅱ组)的临床资料进行回顾性对比分析。结果年龄、性别、冠心病危险因素及家族史等,两组间比较差异无统计学意义;但反映心肌梗死面积的CK及CK-MB峰值Ⅱ组较Ⅰ组高;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)发生率,Ⅱ组高于Ⅰ组,两组比较差异有统计学意义(P<0.05)。接受再灌流治疗的患者病死率在两组间差异无统计学意义(P>0.05),而接受常规治疗患者病死率Ⅱ组显著高于Ⅰ组(P<0.05)。结论下壁心肌梗死累及右室有并发症发生率高、近期预后差的特点,早期溶栓或急诊介入治疗可明显改善患者预后。

Clinical Features and Prognosis of Acute Inferior Myocardial Infarction Complicating Right Ventricular Infarction

Objective Investigate the clinical features,prognosis and in-hospital mortality of patients with inferior wall myocardial infarction(IWMI) complicating right ventricular myocardial infarction(RVMI).Methods The clinical data of patients with RVMI(group II,56 cases) or without RVMI(group I,76 cases) were retrospectively analyzed.Results There are no significant differences in age,sex,risk factor of coronary heart disease,and family history between the two groups.The incidence of hypotension,cardiac shock,tachyarrhythmia(paroxysmal atrial fibrillation,non-sustained ventricular tachycard),brady arrhythmias(sinus bradycardia and atrio ventficular block)and in-ospital mortality was higher in II group than I group(P<0.05).Fatality rate of patients receiving reperfusion between two groups have no significant differences(P>0.05),but fatality rate of patients receiving regular treatment of group I is significant higher than in group II(P<0.05) the.Conclusion IWMI with RVMI shows complicated clinical manifestation and delivers a worse prognosis owing to arrhythmic and mechanical complications.Early thrombolysis therapy or interventional therapy could significantly improve patients' prognosis.