中国医科大学学报

中国医科大学学报
  • 中文核心期刊
  • 中国科技核心期刊
  • 中国高校百佳科技期刊
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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
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