心肌梗死后室间隔穿孔患者的外科治疗体会

Effect of surgery therapy in patients with ventricular septal rupture after acute myocardial infarction

目的分析急性心肌梗死(acute myocardial infarction,AMI)后室间隔穿孔患者的外科手术治疗方法和疗效。方法回顾性分析自2006年1月至2009年12月10例AMI后室间隔穿孔患者的临床资料,其中5例患者同期行室壁瘤切除术,1例患者同期接受冠状动脉旁路移植术,着重分析外科手术治疗的疗效。结果手术死亡2例,手术死亡率20%(2/10),均死于严重低心排血量综合征。超声心动图检查提示所有患者未发现有室间隔残余分流,7例有轻度二尖瓣反流。术后左心室舒张期末内径(LVEDD)与术前比较有减小,差异无统计学意义[(54.0±8.2)mm vs.(48.0±8.3)mm,t=1.6262,P=0.1213];左心室射血分数(LVEF)较术前有提高,差异无统计学意义(48%±12%vs.50%±6.2%,t=0.4682,P=0.6452)。结论外科手术是AMI后室间隔穿孔的有效治疗手段。手术时机的合理选择,围手术期的积极治疗能明显提高术后患者的生存率。

Objectives To summary the efficacy of surgical treatment in patients with ventricular septal rupture after acute myocardial infarction.Methods From January 2006 to December 2009,clinical data of 10 patients with ventricular septal rupture after acute myocardial infarction were retrospectively analized and the efficacy of surgical treatment were focued on.Among them,5 cases performed ventricular aneurysm resection and 1 patient underwent coronary artery bypass grafting at the same period.Results There were 2 perioperative deaths because of severe low cardiac output syndrome.No residual shunt ventricular septal were found in all patients and mild mitral egurgitation were found in 7 cases.Echocardiography showed that postoperative left ventricular end diastolic diameter（LVEDD） reduced compared with that before operation and the difference was not significent[（54.0±8.2） mm vs.（48.0±8.3）mm,t=1.6262,P=0.1213 ];left ventricular ejection fraction（LVEF） increased,but the difference had no significance（48%±12% vs.50%±6.2%,t=0.4682,P=0.6452）.Conclusions Surgical treatment is a effective treatment for ventricular septal perforation after acute myocardial infarction.To choose reasonable timing of surgery and make aggressive treatment of perioperative can significantly improve survival rates.