急性右室心肌梗死的临床特征分析

目的:对急性右室心肌梗死(RVI)的临床特征、再灌注治疗结果及近期预后等方面的问题进行探讨.方法:将46例RVI患者按有无右心衰竭及心原性休克进行危险分层:A组为无右心衰竭组(32例),接受溶栓处理与直接经皮介入治疗(PCI);B组为右心衰竭或同时合并心原性休克组(14例),均接受直接经皮介入治疗;运用多因素回归模型对不良心血管事件及住院死亡率与年龄、性别、高血压、糖尿病、吸烟等危险因素的关系作回归分析.结果:46例RVI病人中42例作了冠脉造影检查,造影显示梗死相关血管(IRA)为右冠者35例,IRA为回旋支者9例,IRA为前降支者2例;单支病变者15例,双支病变者21例,三支/=多支病变者10例;住院期间有11例发生心绞痛,其中行直接PCI组9例,均为较重的三支病变患者;住院期间溶栓治疗组与直接PCI组分别各有1例在住院期间发生再梗,均行紧急PCI干预;住院期间死亡3例,其中溶栓组1例,直接PCI组2例;B组患者住院期间不良心血管事件发生率及死亡率高于A组;多因素回归分析显示,右心衰竭合并心原性休克、女性、年龄、多支病变均为住院期间不良心血管事件及死亡发生的独立预测因子.结论:RVI不良心血管事件及死亡率较高,心脏功能、年龄、性别及血管病变严重性对其具有重要影响;直接PCI疗效在降低RVI特别是合并右心衰竭或心原性休克患者的住院死亡率方面优于溶栓疗法.

Analysis on the Clinical Features of Acute Right Ventricular Myocardial Infarction

Objective: The study had searched for the clinical features, as well as the results of reperfusion treatment and their influences on clinical prognoses, in 46 patients with acute right ventricular myocardial infarction(RVI) .Methods: The patients were risk-stratified into two groups, classA (n=32)comprised patients without right ventricular(RV) failure, classB(n=14)with RV failure or cardiogenic shock. All class A received either thrombolytic therapy(TT) or PCI and class B received PCI alonely. All patients were evaluated for in-hospital major adverse cardiac events and short-term mortality and multivariate regressed analysis were do in all patients.Results: Major in-hospital adverse cardiac event rate in class B were higher than class, female, elderly, multi-vessel lesion all were lonely prognosis factors of major adverse cardiac events and cardiac mortality. Conclusion: Direct PCI was advantaged to TT in decreased the in- hospital mortality of the patients with RV failure or cardiogenic shock.