急性心肌梗死合并室间隔穿孔5例临床分析

Clinical Analysis of Ventricular Septal Rupture after Acute Myocardial Infarction

目的探讨急性心肌梗死后发生室间隔穿孔的临床特征、治疗方法及其预后.方法对昆明医学院附属延安医院心内科2007年1月至2010年4月收治的5例急性心肌梗死并室间隔穿孔患者的临床资料进行回顾性分析.结果此期间共收治急性ST段抬高心肌梗死674例,发生室间隔穿孔5例,发生率0.7%.其中男性2例(40%),女性3例(60%);平均年龄68岁;合并高血压病3例(60%),合并糖尿病1例(20%).5例中前壁心肌梗死4例(80%),其中前壁合并侧壁心肌梗死1例(20%);单纯下壁1例(20%).超声心动图提示室间隔缺损范围0.5～1.9cm,多数在室间隔近心尖部破裂.2例(40%)施行外科手术治疗者均存活,2例药物治疗者经药物保守治疗均死亡.结论急性心肌梗死合并室间隔穿孔少见,内科保守治疗死亡率高,外科手术治疗可提高生存率。

Objective To analyze the clinical features,treatment and prognosis of ventricular septal rupture after myocardial infarction.Method Clinical data of 5 patients with ventricular septum repture after acute myocardial infarction who were hospitalized between January 2007 and April 2010 were analyzed retrospectively.Results Among 674 patients with acute ST-segement elevation myocardial infarction,5（0.7%）patients were found with ventricular septal rupture,including 2 male and 3 female patients.The average age was 68 years.3（60%）patients had hypertension,1（20%）patient had diabetes.4（80%）patients were diagnosed as acute anterior infarction.1 patient also had lateral infarction.1 patient were diagnosed as inferior infarction.The defect on rentricular septurrm and its size were confirmed by ectocardiography.The size of the rupture varied from 0.5 cm to 1.9 cm.Surgery was performed in 2（40%）patients,and they survired.All the 2 patients who only received medical therapy died.Conclusions Ventricular septal rupture after acute myocardial infarction is relatively fare.The mortality rate is high in patients who only received conservative medical treatment.Surgical therapy can improve the survival rate of patients.