急性心肌梗死患者合并心脏破裂的分析

目的:观察急性心肌梗死(AMI)患者发生心脏破裂的特点。方法:连续入选2004年1月至2006年2月收入我院心内科监护室(CCU)确诊为AMI患者共1324例,经超声心动图证实心脏破裂18例。结果:前壁梗死509例,下壁梗死528例,非ST段抬高心肌梗死287例。发生心脏破裂18例(1.36%),其中游离壁破裂9例,室间隔穿孔9例。13例发病72h内破裂,5例在发病4～7d破裂。男性8例(8/973,0.82%),女性10例(10/351,2.85%),女性明显高于男性(P=0.005)。发生心脏破裂患者年龄[(72.6±8.2)岁]明显高于无破裂者[(63.3±12.2)岁,P=0.000]。成功再灌注治疗者心脏破裂发生率(5/575,0.87%)明显少于无再灌注者(13/749,1.74%,P=0.041)。所有合并心脏破裂者全部死亡。前壁梗死合并心脏破裂的发生明显多于下壁和非ST段抬高心肌梗死(2.16%,1.32%,0%,P=0.041)。结论:AMI合并心脏破裂的发生率为1.36%,其预后极差。女性、高龄、前壁梗死患者易于发生心脏破裂。成功再灌注治疗减少心脏破裂的发生。

Cardiac rupture in patients with acute myocardial infarction

Objective:To analyze the characteristics of cardiac rupture(CR)in patients with acute myocardial infarction(AMI).Method:1324 consecutive cases of AMI from January 2004 to February 2006 were selected.18 cases occured CR confirmed by echocardiogram.Result:Anterior infarction 509 cases,inferior infarction 528 cases and non-ST elevated myocardial infarction 287 cases.CR occurred in 18 patients(1.36%),left ventricular free wall rupture 9 cases,perforation of ventricular septum 9 cases.13(72%)cases occurred within first 3 days from symptom onset and others occurred in 4-7 days.The incidence of CR in male(8/973,0.82%)were significantly lower than that of female(10/351,2.85%),P=0.005.Patients with CR were older than without(72.6±8.2 yr vs 63.3±12.2 yr,P=0.000).The incidence of CR in patients with successful reperfusion were significantly lower than without(5/575,0.87% vs 13/749,1.74%.P=0.041).All patients with CR died.The incidence of CR in anterior infarction were significantly higher than that of inferior and non-ST elevated infarction(2.16%,1.32%,0%,P=0.041).Conclusion:The incidence of CR were 1.36% and the prognosis of CR after AMI were fatal.CR more occurred in female,elder and anterior infarction in patients with AMI.Successful reperfusion could reduce the incidence of CR.