中国医科大学学报

中国医科大学学报

中国医科大学学报 ›› 2013, Vol. 42 ›› Issue (11): 1028–1031.

• 论著 • 上一篇    下一篇

急性心肌梗死并发室间隔穿孔的临床特点及短期预后分析

邹德玲,陈艳丽,耿宁,刘兴利,杨川,庞文跃   

  1. 中国医科大学附属盛京医院心内科,沈阳110004
  • 收稿日期:2013-09-12 出版日期:2013-11-30 发布日期:2013-11-28
  • 作者简介:邹德玲(1970-),女,副教授,博士.
  • 基金资助:
    辽宁省教育厅高校科研计划(L2010688)

Clinical Characteristics and Short-term Prognosis of Ventricular Septal Rupture Following Acute Myocardial Infarction

ZOU De-ling,CHEN Yan-li,GENG Ning,LIU Xing-li,YANG Chun,P ANG Wen-yue   

  1. Department of Cardiology,Shengjing Hospital,China Medical University,Shenyang 110004,China
  • Received:2013-09-12 Online:2013-11-30 Published:2013-11-28

摘要: 目的分析急性心肌梗死(AMI)并发室间隔穿孔(VSR)的临床特点、诊治措施及短期预后影响因素。方法回顾性研究2005年12月至2012年12月中国医科大学附属盛京医院收治的AMI并发VSR病例的临床资料,按30d生存情况分为死亡组与存活组,对其临床特点及短期预后影响因素进行统计分析。结果3881例AMI中出现VSR的患者20例(0.5%)。平均年龄65.3岁,60%伴高血压,75%为前壁心肌梗死,心力衰竭发生率100%。8例行冠状动脉造影检查者显示梗死相关血管完全闭塞,无侧支循环形成。死亡9例(45%),平均死亡时间在入院后10.6d,介入治疗患者6例中5例存活,外科手术患者5例中4例存活,介入封堵患者2例均存活。死亡组与存活组在年龄、合并疾病、急性期左室舒张末期内径、心功能等方面无统计学差异。但死亡组女性患者相对较多、VSR直径较大。再灌注治疗、缺损修复患者的死亡率(14.3%)较未进行再灌注、未修复者(61.5%)有降低趋势(P=0.070)。结论老年、罪犯血管完全闭塞且无侧枝循环、急性前壁心肌梗死患者易于发生VSR。再灌注治疗、介入封堵及外科手术修复缺损可能降低AMI并发VSR患者短期病死率。

关键词: 急性心肌梗死, 室间隔破裂, 预后

Abstract: Objective To analyze the clinical characteristics and determine the risk factors which influence the short-term prognosis in patients with ventricular septal rupture(VSR) following acute myocardial infarction(AMI) . Methods A total of 20 patients with consecutive VSR following AMI,hospitalized in our hospital between December 2005 and December 2012,were enrolled in this study. The subjects were divided into dead group (n=9) and survived group (n=11) according to the survival situation at the 30th day post AMI. The clinical characteristics of patients were compared between the two groups .The risk factors affecting the short-term prognosis was explored by statistical analysis. Results Among 3881 patients with acute myocardial infarction,20 (0.5%)patients were found with ventricular septal rupture. The average age was 65.3 years. 12(60%)patients had hypertension,75%patients were diagnosed as acute anterior infarction.All patients suffered with heart failure. Total occlusion of infarct-related arteries was found in all 8 patients with coronary arteriagraphy,and there was no collateral circulation establishment. The average survival period of patients in dead group was 10.6 days after hospitalization. 5 patients survived in 6 cases that received percutaneous coronary intervention. 4 of the 5 patients survived after surgical repair. All the 2 patients who received transcatheter VSR closure survived. There were no significant statistics differences between the two groups in age,comparing diseases,LVED and LVEF. The trend was there were more female patients and lager diameter of the rupture defect in the dead group. There was descending trend for the mortality of patients who receiving reperfusion strategies or VSR repair (14.3%) than these receiving conservative management (61.5%),respectively (p=0.070). Conclusion Female gender,total occlusion of infarct-related arteries and no collateral circulation establishment,anterior AMI are the risk factors of VSR following AMI. Reperfusion therapy,transcatheter VSR closure,and surgical repair are properly efficient therapies to reduce the mortality of AMI patients with VSR.

Key words: myocardial infarction, ventricular septal rupture, prognosis

中图分类号: 

  • R542.22
[1]Arnaoutakis GJ, Zhao Y, George TJ, et al. Surgical repair of ventricular septal defect after myocardial infarction: outcomes from the society of thoracic surgeons national database[J]. Ann Thorac Surg, 2012, 94(2): 436-444
[2] Yip HK, Fang CY, Tsai KT, et al. The potential impact of primary percutaneous coronary intervention on ventricular septal rupture complicating acute myocardial infarction[J]. Chest,2004,125( 5): 1622-1628.
[3] Birnbaum Y, Fishbein MC, Blanche C, et al. Ventricular septal rupture after acute myocardial infarction[J]. N Engl J Med, 2002, 347(18): 1426-1432.
[4] Ikeda N, Yasu T, Kubo N, et al. Effect of reperfusion therapy on cardiac rupture after myocardial infarction in Japanese[J]. Circ J, 2004, 68(5): 422-426.
[5] Antman EM,Anbe DT,Armstrong PW,et al. ACC /AHA guidelines forthe management of patients with ST-elevation myocardial infarction-executive summary: a report of the ACC/AHA Task Force on Practice Guidelines[J]. J Am Coll Cardiol,2004,44(3): 671-719.
[6] Zhu XY, Qin YW, Han YL, et al. Long-term efficacy of transcatheter closure of ventricular septal defect in combination with percutaneous coronary intervention in patients with ventricular septal defect complicating acute myocardial infarction: a multicentre study[J]. Euro Intervention, 2013, 8(11):1270-1276.
[7] Thiele H,Kaulfersch C,Daehnert I, et al. Immediate primary transcatheter closure of postinfarction ventricular septal defects[J]. Eur Heart J,2009, 30(1): 81-88.
[1] 徐国帅, 蔡相军, 陈江波, 吕庆, 刘洪涛. AEG-1和CHD5在胃癌中的表达及其临床意义[J]. 中国医科大学学报, 2018, 47(9): 797-802.
[2] 马艳梅, 常箫匀. 结直肠癌患者围手术期肠内外联合营养支持与预后的关系[J]. 中国医科大学学报, 2018, 47(7): 604-608.
[3] 姜文娟, 刘文静, 李晓曦, 沈雪莉. 1例急性原发性胼胝体变性病例的回顾分析[J]. 中国医科大学学报, 2018, 47(7): 657-659.
[4] 芦婷婷, 王治博. 术前血浆纤维蛋白原和D-二聚体水平与结直肠癌预后的关系[J]. 中国医科大学学报, 2018, 47(6): 513-518.
[5] 武佳科, 田春阳, 何东旭, 宋佳, 于彤彤, 孙志军, 孙兆青. 休克指数对行经皮冠状动脉介入治疗的急性心肌梗死患者长期预后的预测价值[J]. 中国医科大学学报, 2018, 47(6): 522-526.
[6] 刘晓, 王彤, 蒋怡芳, 王媛. 病原学阳性与阴性的医院获得性肺炎患者临床特征及预后比较[J]. 中国医科大学学报, 2018, 47(5): 406-410,414.
[7] 俞达辉, 吴道立, 袁冲, 褚文炎. 癌组织中CD45RO表达水平与肺腺癌患者临床病理特征及生存率的关联分析[J]. 中国医科大学学报, 2018, 47(5): 448-453.
[8] 邵洋, 胡延平, 刘勇. 慢性淋巴细胞白血病患者长链非编码RNA RP5-180C18.1的表达及其预后评价作用[J]. 中国医科大学学报, 2018, 47(4): 341-345.
[9] 张苏宁, 刘宗昂. 小细胞肺癌中DBC1的表达及预后相关性研究[J]. 中国医科大学学报, 2018, 47(3): 222-225.
[10] 王鸾, 蔡雪, 赵敏. 急性百草枯中毒死亡危险因素分析[J]. 中国医科大学学报, 2018, 47(3): 237-239,243.
[11] 李蕙伊, 刘畅, 赵洋子, 曾仁庆, 甘淼, 王涛, 于诗源, 崇巍. 急诊科成人创伤患者院内死亡危险因素分析[J]. 中国医科大学学报, 2018, 47(2): 128-131.
[12] 赵轲, 张永建, 刘奇, 徐迪, 陈宝钧. miR-107与非小细胞肺癌的临床病理特征及预后的关联[J]. 中国医科大学学报, 2018, 47(10): 933-938.
[13] 裘敬平, 党军, 蔡峰, 李光. 基于病史、体征、血常规的食管癌预后评分系统的初步构建[J]. 中国医科大学学报, 2018, 47(1): 36-41.
[14] 唐津天 ,王伯庆 ,唐泽天 ,佟庆 ,薛峰 ,徐林 ,易超 ,晏冬. 循环 miR-106a/b 表达水平在肝细胞癌的诊断及预后中的作用[J]. 中国医科大学学报, 2017, 46(9): 830-835.
[15] 杜守治 ,董斌 ,齐中华. 急性心肌梗死和急性脑梗死 miRNA 疾病标志物的初步筛查[J]. 中国医科大学学报, 2017, 46(8): 681-685.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!

中国医科大学学报版权所有©2018

未经允许,严禁擅自转载本站图文资料

地址:中国 沈阳市沈北新区蒲河路77号 110122

辽ICP备05014850

JOURNAL OF CHINA MEDICAL UNIVERSITY

ADDRESS: NO.77 PUHE ROAD

SHENYANG NORTH NEW AREA, SHENYANG

LIAONING PROVINCE, P.R. CHINA