中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2013年
3期
195-198
,共4页
胡小莹%邱洪%乔树宾%康连鸣%宋雷%张峻%谭小燕%叶绍东%丰雷
鬍小瑩%邱洪%喬樹賓%康連鳴%宋雷%張峻%譚小燕%葉紹東%豐雷
호소형%구홍%교수빈%강련명%송뢰%장준%담소연%협소동%봉뢰
心肌梗死%室间隔破裂%危险因素
心肌梗死%室間隔破裂%危險因素
심기경사%실간격파렬%위험인소
Myocardial infarction%Ventricular septal rupture%Risk factors
目的 分析急性心肌梗死(AMI)合并室间隔穿孔(VSR)患者近期预后的相关因素,并对VSR患者进行危险分层.方法 回顾性入选2002年1月至2010年10月在阜外心血管病医院确诊为AMI合并VSR患者70例.比较AMI后VSR患者存活≤30 d(n =39)及存活＞30d(n=31)患者的年龄、性别、病史、检验结果等指标,分析研究存活≤30 d患者的危险因素.根据logistic多元回归分析结果制定VSR患者近期预后危险评分(SPIV).结果 AMI后VSR患者存活≤30 d与存活＞30d患者临床指标比较显示,女性、前壁心肌梗死、Killip分级≥Ⅲ级、不合并室壁瘤形成、近心尖部室间隔穿孔及AMI发作到诊断VSR时间(AMI-VSR时间)≤4 d等差异有统计学意义(P均＜0.05).logistic多元回归分析发现,女性(P =0.013)、前壁心肌梗死(P=0.023)、Killip分级≥Ⅲ级(P=0.022)、不合并室壁瘤(P=0.023)、不合并糖尿病(P=0.009)、AMI-VSR时间≤4 d(P=0.027)为VSR患者存活≤30 d的独立危险因素.SPIV≥9分患者30 d病死率77.4％ (24/31),为高危患者;SPIV＜8分患者30 d病死率28.6％ (8/28),为低危患者.结论 AMI合并VSR存活≤30 d的独立危险因素包括女性、前壁心肌梗死、不合并室壁瘤、不合并糖尿病、Killip分级≥Ⅲ级及AMI-VSR时间≤4 d,对于高危患者应采取更积极的治疗方案以挽救生命.
目的 分析急性心肌梗死(AMI)閤併室間隔穿孔(VSR)患者近期預後的相關因素,併對VSR患者進行危險分層.方法 迴顧性入選2002年1月至2010年10月在阜外心血管病醫院確診為AMI閤併VSR患者70例.比較AMI後VSR患者存活≤30 d(n =39)及存活＞30d(n=31)患者的年齡、性彆、病史、檢驗結果等指標,分析研究存活≤30 d患者的危險因素.根據logistic多元迴歸分析結果製定VSR患者近期預後危險評分(SPIV).結果 AMI後VSR患者存活≤30 d與存活＞30d患者臨床指標比較顯示,女性、前壁心肌梗死、Killip分級≥Ⅲ級、不閤併室壁瘤形成、近心尖部室間隔穿孔及AMI髮作到診斷VSR時間(AMI-VSR時間)≤4 d等差異有統計學意義(P均＜0.05).logistic多元迴歸分析髮現,女性(P =0.013)、前壁心肌梗死(P=0.023)、Killip分級≥Ⅲ級(P=0.022)、不閤併室壁瘤(P=0.023)、不閤併糖尿病(P=0.009)、AMI-VSR時間≤4 d(P=0.027)為VSR患者存活≤30 d的獨立危險因素.SPIV≥9分患者30 d病死率77.4％ (24/31),為高危患者;SPIV＜8分患者30 d病死率28.6％ (8/28),為低危患者.結論 AMI閤併VSR存活≤30 d的獨立危險因素包括女性、前壁心肌梗死、不閤併室壁瘤、不閤併糖尿病、Killip分級≥Ⅲ級及AMI-VSR時間≤4 d,對于高危患者應採取更積極的治療方案以輓救生命.
목적 분석급성심기경사(AMI)합병실간격천공(VSR)환자근기예후적상관인소,병대VSR환자진행위험분층.방법 회고성입선2002년1월지2010년10월재부외심혈관병의원학진위AMI합병VSR환자70례.비교AMI후VSR환자존활≤30 d(n =39)급존활＞30d(n=31)환자적년령、성별、병사、검험결과등지표,분석연구존활≤30 d환자적위험인소.근거logistic다원회귀분석결과제정VSR환자근기예후위험평분(SPIV).결과 AMI후VSR환자존활≤30 d여존활＞30d환자림상지표비교현시,녀성、전벽심기경사、Killip분급≥Ⅲ급、불합병실벽류형성、근심첨부실간격천공급AMI발작도진단VSR시간(AMI-VSR시간)≤4 d등차이유통계학의의(P균＜0.05).logistic다원회귀분석발현,녀성(P =0.013)、전벽심기경사(P=0.023)、Killip분급≥Ⅲ급(P=0.022)、불합병실벽류(P=0.023)、불합병당뇨병(P=0.009)、AMI-VSR시간≤4 d(P=0.027)위VSR환자존활≤30 d적독립위험인소.SPIV≥9분환자30 d병사솔77.4％ (24/31),위고위환자;SPIV＜8분환자30 d병사솔28.6％ (8/28),위저위환자.결론 AMI합병VSR존활≤30 d적독립위험인소포괄녀성、전벽심기경사、불합병실벽류、불합병당뇨병、Killip분급≥Ⅲ급급AMI-VSR시간≤4 d,대우고위환자응채취경적겁적치료방안이만구생명.
Objective To analyze the short-term prognosis and risk factors of ventricular septal rupture (VSR) following acute myocardial infarction (AMI).Methods A total of 70 consecutive VSR patients following AMI hospitalized in our hospital from January 2002 to October 2010 were enrolled in this study.We compared the clinical characteristics of patients with VSR who survived ≤ 30 days (n =39) and survived ＞ 30 days (n =31) post AMI.A short-term prognosis index of VSR (SPIV) was established based on the logistic regression analysis.Results The single factor analysis showed that the risk factors of death within 30 days of VSR patien were female,anterior AMI,Killip class 3 or 4,apical VSR and non-aneurysm (all P＜0.05).Logistic regression analysis revealed that female(P =0.013),anterior AMI (P=0.023),non-aneurysm (P =0.023),non-diabetes (P =0.009),Killip class 3 or 4 (P =0.022) and time from AMI to VSR less than 4 days(P =0.027) were independent risk determinants for death within 30 days post VSR.Patients with SPIV ≥9 were associated with high risk [77.4％ (24/31)] of dying within 30 days post AMI.SPIV≤8 were associated with low risk as the 30 days mortality is 28.6％ (8/28).Conclusion Female gender,anterior AMI,non-aneurysm,non-diabetes,Killip class 3 or 4 and time from AMI to VSR less than 4 days are independent risk factors of short-term mortality of VSR.
