[1]张俊彦 陈忠秀王觅也 刘然 赵宏森 冯沅 陈玉成王华何森贺勇.65例急性心肌梗死合并室间隔穿孔患者的临床分析[J].心血管病学进展,2022,(10):942.[doi:10.16806/j.cnki.issn.1004-3934.2022.10.018]
　ZHANG Junyan,CHEN Zhongxiu,WANG Miye,et al.Clinical analysis of 65 patients with acute myocardial infarction combined with ventricular septal rupture[J].Advances in Cardiovascular Diseases,2022,(10):942.[doi:10.16806/j.cnki.issn.1004-3934.2022.10.018]
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65例急性心肌梗死合并室间隔穿孔患者的临床分析()
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《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2022年10期
页码:
942
栏目:
论著
出版日期:
2022-10-25

文章信息/Info

Title:
Clinical analysis of 65 patients with acute myocardial infarction combined with ventricular septal rupture
作者:
张俊彦1 陈忠秀1王觅也2 刘然2 赵宏森2 冯沅1 陈玉成1王华1何森1贺勇1
（1.四川大学华西医院心内科，四川 成都610041；2.四川大学华西医院信息中心，四川 成都610041）
Author(s):
ZHANG Junyan1; CHEN Zhongxiu1; WANG Miye2; LIU Ran2; ZHAO Hongsen2; FENG Yuan1; CHEN Yucheng1; WANG Hua1; HE Sen1; HE Yong 1
（1. Department of Cardiology,West China Hospital,Sichuan University，Chengdu 610041，Sichuan，China；2.Information Center of West China Hospital, Sichuan University，Chengdu 610041, Sichuan, China）
关键词:
室间隔穿孔; 急性心肌梗死; 临床分析
Keywords:
Ventricular septal rupture;  Acute myocardial infarction;  Clinical analysis
DOI:
10.16806/j.cnki.issn.1004-3934.2022.10.018
文献标志码:
A
摘要:
目的：总结急性心肌梗死（Acute myocardial infraction, AMI）合并室间隔穿孔（Ventricular septal rupture, VSR）患者的临床特点及预后。方法：回顾性分析我院2012年1月到2021年8月收治的AMI合并VSR患者65例，描述其基线资料特征、穿孔性质、治疗情况；并进行电话随访，收集其预后情况。并对以上指标进行多因素logistic回归分析。结果：65例AMI合并VSR患者，继发于前壁心梗患者55例（84.6%）；其AMI-VSR时间为0.25-15天（3.9±3.4天）；其中院内死亡40例（61.5%），出院后1年内死亡11例（16.9%），好转出院并且存活至今11例（16.9%），失访3例（4.6%）。其中手术治疗6例，院内死亡0例，出院后1年内死亡0例，全部6例患者存活至今。接受外科手术或介入治疗患者院内死亡率以及出院后1年内死亡率显著低于保守治疗患者（P<0.05）。多因素logistic回归结果显示急性心梗患者的TIMI评分大于等于7分是AMI-VSR患者院内以及出院后1年内死亡的独立危险因素（OR值为30.034，95%置信区间为1.65～546.7，P<0.05）。结论：VSR是AMI严重的并发症； AMI的TIMI评分大于等于7分是AMI-VSR患者院内及出院后一年死亡的独立危险因素。外科手术或介入封堵治疗可显著改善患者的近期以及远期预后，AMI后2周以上行外科手术治疗成功率高，对于极其危重的患者，可适当提前外科手术时间；具体更有说服力的结论仍然需要进一步的临床研究。
Abstract:
Objective To summarize the clinical characteristics and prognosis of patients with acute myocardial infraction (AMI) combined with ventricular septal rupture (VSR). Methods We retrospectively analyzed 65 patients with AMI combined with VSR admitted to our hospital from January,2012 to August,2021, describing their baseline data characteristics, features of perforation, and treatment and conducted telephone follow-up to collect their prognosis information. And multi-factor logistic regression analysis was performed for the above indicators. Results Sixty-five patients with AMI combined with VSR, secondary to anterior wall infarction in 55 patients (84.6%). The duration of AMI-VSR ranged from 0.25 to 15 days (3.9±3.4 days) among them, 40 cases (61.5%) died in-hospital, 11 cases (16.9%) died within 1 year after discharge, 11 cases (16.9%) were discharged on improvement and survived to date, and 3 cases (4.6%) were lost to follow-up. Among them, 6 cases were treated surgically, 0 cases died in hospital, 0 cases died within 1 year after discharge, and all 6 patients survived to date. The in-hospital mortality rate and the mortality rate within 1 year after discharge were significantly lower in patients who received surgical or interventional treatment than in those who received conservative treatment (P<0.05). Multifactorial logistic regression showed that TIMI score greater than or equal to 7 in patients with acute heart attack was an independent risk factor for in-hospital and 1-year post-discharge mortality in patients with AMI-VSR (OR 30.034, 95% confidence interval 1.65-546.7, P<0.05). Conclusion VSR is a serious complication of AMI that occurs mostly within one week after acute infarction. a TIMI score of AMI greater than or equal to 7 is an independent risk factor for in-hospital and 1-year post-discharge mortality in patients with AMI-VSR. Surgical treatment can significantly improve the immediate and long-term prognosis of patients, with a high success rate of surgical treatment more than 2 weeks after AMI, and for extremely critical patients, the surgical time can be appropriately advanced to save more patients lives the interventional blocking approach can also play a good role, and further clinical studies are still needed for more convincing conclusions.

参考文献/References:

[1]胡小莹,邱洪,乔树宾等. 70例急性心肌梗死合并室间隔穿孔患者的临床分析[J]. 中国循环杂志,2013,28(2):107-110.[2]穆纯杰,潘湘斌,潘世伟等. 急性心肌梗死室间隔穿孔介入封堵后残余分流致急性左心衰竭一例[J]. 中国胸心血管外科临床杂志,2020,27(12):1505-1508.[3]Topaz O,Taylor AL,et al. Interventricular septal rupture complicating acute myocardial infarction:from pathophysiologic features to the role of invasive and noninvasive diagnostic modalities in current management[J].?m J Med,1992,93(6):683-688.?4]Tang L,Fang Z,Hu X,et al. Non-surgical repair of ventricular septal rupture after acute myocardial infarction[J].?nt J Cardiol,2015,185:328-332.[5]Collet JP,Thiele H,Barbato E,et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation[J]. Eur Heart J,2021,42(14):1289-1367. [6]陈同峰,孙子瑞,蒋亚鹏等.2 8例心肌梗死后室间隔穿孔介入封堵患者主动脉内球囊反搏应用分析[J]. 临床心血管病杂志,2020,36(5):423-428.[7]李汉美,项理,许建屏等. 急性心肌梗死后合并室间隔穿孔外科修复105例:阜外医院16年随访结果[J]. 中国胸心血管外科临床杂志,2019,26(05):451-456. [8]Crenshaw BS,Granger CB,Birnbaum Y,et al. Risk factors,angiographic patterns,and outcomes in patients with ventricular septal defect complicating acute myocardial infarction[J].?irculation,2000,101(1):27-32.?9]Jones BM,Kapadia SR,Smedira NG,et al. Ventricular septal rupture complicating acute myocardial infarction:a contemporary review[J].?ur Heart J,2014,35(31):2060-2068.[10]Ibanez B,James S,Agewall S,et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation:The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)[J].?ur Heart J,2018,39(2):119-177.[11]胡小莹. 急性心肌梗死合并室间隔穿孔患者的临床特点及近期预后因素分析[D]. 北京协和医学院,2013.[12]Noguchi K,Yamaguchi A,Naito K,et al. Short-term and long-term outcomes of postinfarction ventricular septal perforation[J].?en Thorac Cardiovasc Surg,2012,60(5):261-267.?13]Morrow DA,Antman EM,Charlesworth A,et al. TIMI risk score for ST-elevation myocardial infarction:a convenient,bedside,clinical score for risk assessment at presentation:an intravenous nPA for treatment of infarcting myocardium early Ⅱ trial substudy[J].?irculation,2000,102(17):2031-2037.[14]Schoenbaum M,Unützer J,Sherbourne C,et al. Cost-effectiveness of practice-initiated quality improvement for depression:results of a randomized controlled trial[J].?AMA,2001,286(11):1325-1330.[15]Arai R,Fukamachi D,Akutsu N et al. Ventricular septal rupture after recent myocardial infarction in the very elderly[J].?nt Heart J,2020,61(4):831-837.

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更新日期/Last Update: 2022-12-26