急性心肌梗死合并室间隔穿孔的近期预后因素分析

Short-term prognosis and risk factors of ventricular septal rupture following acute myocardial infarction

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。方法回顾性人选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≤30d（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≤30d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≤30d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）≤4d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≤4d（P=0．027）为VSR患者存活≤30d的独立危险因素。SPIV≥9分患者30d病死率77．4％（24／31），为高危患者；SPIV〈8分患者30d病死率28．6％（8／28），为低危患者。结论AMI合并VSR存活≤30d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≤4d，对于高危患者应采取更积极的治疗方案以挽救生命。

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.