26例老年人急性心肌梗死后室间隔破裂临床分析

目的 探讨急性心肌梗死（AMI）后室间隔破裂的诊断、治疗时机和治疗方法。方法 回顾性分析我院1984年1月至2000年6月诊治的26例AMI后室间隔破裂患者的临床资料，并进行分组分析。结果 男9例，女17例，男女比例1：1．9，平均年龄64．1岁。内科治疗7例，急性期（梗死后4周以内）死亡6例，其中2例合并左室游离壁破裂；手术治疗19例，死亡6例，2组结果差异有显著性（P＜0．05）。手术组在AMI后4周以内手术16例，存活10例；4周以后手术3例，存活3例，二者差异无显著性（P＞0．05）。术后死因分别为心源性休克、急性肾功能衰竭和多脏器功能衰竭。随访8例，平均26个月（3个月－8年），6例存活，其心功能（Killip分级）I级5例，Ⅱ级1例。结论 床旁超声心动图和漂浮导管有助于早期诊断室间隔破裂并决定手术时机，一旦确诊应在内科加强治疗的基础上于AMI后4周内手术治疗。

Clinical analysis of 26 patients with infarct-related interventricular septum rupture

Objective To discuss the diagnosis, the thereapeutic timing and the means of post-infarct interventricular septal rupture (VSR). Methods The clinical experience and data of 26 post-infarct VSR patients from January 1984 to June 2000 in our hospital were retrospectively analysed. Results Nine male and17 female patients aged 64.1 years on the average (60-72). Out of 7 cases internal medically treated, 6 died; and among 19 cases being performed on, 6 died. It was showed a significant difference between two groups (P<0.05). In operation group, 16 patients were operated on within 4 weeks after infarction and 10 patients survived while all 3 patients being operated on 4 weeks after infartion survived, showing statistical significant difference between these two subgroups (P<0.05). The patients were died of low cardiac output, acute renal failure or multiple organ failure. Eight cases were followed up after operation with the mean interval of 26 months (3 months to 8 years). Six patients survived with cardiac function of class I (Killip)(5 cases) or class II(one case). Conclusions Echocardiography and Swan-Ganz catheter examination at the bedside contributes to early diagnosis and help deciding the timing of operation. Once the diagnosis is confirmed the operation should be performed within 4 weeks after the onset of acute myocardial infarction.