临床荟萃
臨床薈萃
림상회췌
CLINICAL FOCUS
2015年
3期
280-282
,共3页
心肌梗死%室间隔破裂%心血管造影术%死亡率
心肌梗死%室間隔破裂%心血管造影術%死亡率
심기경사%실간격파렬%심혈관조영술%사망솔
myocardial infarction%ventricular septal rupture%angiocardiography%mortality
目的：对急性心肌梗死并发室间隔穿孔（AMI＋VSP）临床特征进行分析，对保守治疗及手术治疗预后结果进行分析。方法对65例 AMI＋VSP患者的临床指标，治疗方法及预后进行回顾性分析。结果65例 AMI＋VSP患者中，前壁心肌梗死占70．8％（46／65），非前壁心肌梗死占29．2％（19／65）；超声心动图结果显示左心室舒张末内径（52．7±11．3）mm，左心室射血分数（49．2±14．5）％，VSP 直径（9．4±6．5）mm；VSP 位于心尖及心尖附近占66．2％（43／65）；AMI～VSP 总体时间平均为（7．2±3．2）天，溶栓组 AMI～VSP 时间短于未溶栓组（P ＜0．05）；63．1％（41／65）患者进行了冠状动脉造影（CAG），内科保守治疗44．6％（29／65），转外科手术55．4％（36／65）；30天总体病死率58．5％（38／65），1年72．3％（47／65），手术治疗组30天病死率及 1年病死率均低于保守治疗组（P＜0．01）。结论 AMI＋VSP以发病急，病死率高为特点，外科手术较保守治疗更能提高抢救成功率及生存率。
目的：對急性心肌梗死併髮室間隔穿孔（AMI＋VSP）臨床特徵進行分析，對保守治療及手術治療預後結果進行分析。方法對65例 AMI＋VSP患者的臨床指標，治療方法及預後進行迴顧性分析。結果65例 AMI＋VSP患者中，前壁心肌梗死佔70．8％（46／65），非前壁心肌梗死佔29．2％（19／65）；超聲心動圖結果顯示左心室舒張末內徑（52．7±11．3）mm，左心室射血分數（49．2±14．5）％，VSP 直徑（9．4±6．5）mm；VSP 位于心尖及心尖附近佔66．2％（43／65）；AMI～VSP 總體時間平均為（7．2±3．2）天，溶栓組 AMI～VSP 時間短于未溶栓組（P ＜0．05）；63．1％（41／65）患者進行瞭冠狀動脈造影（CAG），內科保守治療44．6％（29／65），轉外科手術55．4％（36／65）；30天總體病死率58．5％（38／65），1年72．3％（47／65），手術治療組30天病死率及 1年病死率均低于保守治療組（P＜0．01）。結論 AMI＋VSP以髮病急，病死率高為特點，外科手術較保守治療更能提高搶救成功率及生存率。
목적：대급성심기경사병발실간격천공（AMI＋VSP）림상특정진행분석，대보수치료급수술치료예후결과진행분석。방법대65례 AMI＋VSP환자적림상지표，치료방법급예후진행회고성분석。결과65례 AMI＋VSP환자중，전벽심기경사점70．8％（46／65），비전벽심기경사점29．2％（19／65）；초성심동도결과현시좌심실서장말내경（52．7±11．3）mm，좌심실사혈분수（49．2±14．5）％，VSP 직경（9．4±6．5）mm；VSP 위우심첨급심첨부근점66．2％（43／65）；AMI～VSP 총체시간평균위（7．2±3．2）천，용전조 AMI～VSP 시간단우미용전조（P ＜0．05）；63．1％（41／65）환자진행료관상동맥조영（CAG），내과보수치료44．6％（29／65），전외과수술55．4％（36／65）；30천총체병사솔58．5％（38／65），1년72．3％（47／65），수술치료조30천병사솔급 1년병사솔균저우보수치료조（P＜0．01）。결론 AMI＋VSP이발병급，병사솔고위특점，외과수술교보수치료경능제고창구성공솔급생존솔。
ABSTRACT:Objective To analyze the clinical characteristics of acute myocardial infarction complicated with ventrical septal perforation (AMI+VSP)and to explore the outcomes of expectant treatment and surgical treatment. Methods The clinical characteristics,treatment methods and outcomes of 65 AMI+VSP patients were retrospectively analyzed.Results Among the 65 patients with AMI+VSP,AMI occurred at anterior wall in 46 patients (70.8%)and at non anterior wall in 19 patients (29.2%).Ultrosonic cardiogram showed the left ventricle end diastolic diameter was (52.7±11.3)mm,the left ventricle ejection fraction was (49.2±14.5)% and the VSP diameter was (9.4±6.5) mm.VSP occurred at or near apex in 43 patients (66.2%).The total interval between AMI and VSP was (7.2±3.2) days in average,which was shorter in the patients treated with thrombolytic therapy than in the patients treated with non-thrombolytic therapy (P<0.05).Coronary angiography was carried out on 41 patients (63.1%),29 patients received expectant treatment (44.6%)and 36 patients underwent cardial surgery (55.4%).The total mortality was 58.5% (38/65)in 30 days and 72.3% (38/65)in one year.The 30 d and one year mortalities in the surgical treatment group were remarkably lower than those in the expectant treatment group (bothP<0.01).Conclusion AMI+VSP is clinically characterized by emergent onset and high fatality rate.Surgical treatment can achieve better outcomes than expectant treatment.
