心肌梗死合并室间隔穿孔的临床特征及近期预后分析

目的 初步探讨急性心肌梗死(AMI)并发室间隔穿孔(VSR)的临床特点、高危因素及近期预后情况.方法选择我院2001年1月至2012年6月期间AMI后VSR的患者73例,分析其临床特征、治疗方案及近期(1月内)死亡率.结果 73例AMI后VSR患者,前壁心肌梗死明显多于下壁、后壁,穿孔部位亦以室间隔心尖部常见.在梗死后1个月内有34例(46.6%)患者存活,39例(53.4%)死亡.与近期存活组相比,近期死亡组的女性比例、VSR直径、左室舒张末期内径、左室射血分数、是否置入IABP差异有统计学意义(P＜0.05).Logistic回归分析显示,左室射血分数低及未使用IABP辅助与近期死亡相关.结论 AMI合并VSR近期死亡率高.左室射血分数低、VSR直径大、左室舒张末期内径大、女性、未置入IABP辅助为近期死亡的高危因素,左室射血分数低及未使用IABP辅助为独立危险因素.对于AMI后VSR有近期死亡高危因素的患者,在积极药物治疗及使用循环辅助装置基础上尽早外科手术治疗可能改善近期预后.

The clinical characteristics and short-term prognosis analysis of acute myocardial infarction merger ventricular septal rupture

Objective To investigate the clinical character, high risk factor and recent prognosis of acute myocardial infarction （AMI） combined ventricular septal rupture （VSR）. Methods Analysis the clinical character, treatment and recent mortality of 73 cases of acute myocardial infarction combined ventricular septum rupture between Jan 2001 to Jun 2012. Results In the 73 cases of AMI combined VSR, the fraction in anterior wall were more common than in inferior and posterior wall. And the most common rupture position was interventficular sep- tum apex. Comparing with recent survival group, the female ratio, VSR diameter and left ventricular end-diastolic diameter in the recent death group were significantly higher. Logistic regression analysis shows lower ejection frac- tion and no IABP planted were related with recent death. Conclusion AMI combined VSR possesses high mortality. Lower ejection fraction, larger diameter of VSR, larger left ventricular end-diastolic diameter, female and no IABP planted are high risk factor of recent death. Furthermore, low ejection fraction and no IABP planted are independent risk factors. Active medical therapy and cycle auxiliary device plus earlier operation may be beneficial to those patients suffered AMI combined VSR with high risk factor.