急性心肌梗死室间隔破裂的外科治疗

Surgical repair of postinfarction ventricular septal rupture

目的 探讨急性心肌梗死后室间隔破裂的发病特点、手术时机及治疗效果。 方法 自 1985年～ 1999年共收治 2 0例急性心肌梗死后室间隔破裂患者 ,其中 14例行手术治疗 ,6例内科治疗 ,分析 2组临床资料及治疗结果 ,并对手术治疗组进行随访 4个月～ 14年。 结果 6例内科治疗的患者 ,于室间隔破裂后 6h～ 7d内全部死亡 ;14例手术治疗的患者中 ,4例采用折叠缝合修补室间隔破裂 ,10例行补片修补 ,全部同期行室壁瘤切除 ,并有 3例行冠状动脉搭桥手术。围手术期死亡 5例 (35 7% ) ,术后发生残余分流 2例 (14 3% )。 2例分别于术后 7年及 9年死于心功能衰竭 ,1例失访 ,余 6例良好。 结论 急性心肌梗死后室间隔破裂的手术时机应根据患者的心脏功能状态进行选择。术前改善心脏功能的治疗十分重要。破裂后 3d内紧急手术病死率较高 ,1周内容易发生残余分流。手术应尽量在 1周后进行。

Objective[WT5”BZ] To study the characteristics of occurrence of postinfarction ventricular septal rupture (VSR) and preliminarily evaluate the proper timing of operation and its effect. [WT5”HZ]Methods[WT5”BZ] Twenty patients with postinfarction VSR were divided into two groups: surgical repair (14 patients), and conventional treatment (6 patients). Clinical data were analyzed and the 14 patients were followed up for 4 months-14 years. [WT5”HZ]Results[WT5”BZ] The 6 patients died within 6 hours 7 days. Of the 14 patients treated surgically, however, 4 had their ruptures closed by the technique of plication and the rest by prosthetic patches. Concomitant procedures included resection of postinfarction ventricular aneurysm in all 14 patients and coronary artery grafting bypass in 3. Five patients (35 7%) died during perioperation, and 14.3% had residual ventricular septal defects. 2 patients died of heart failure 7 and 9 years after the operation respectively, 1 was lost to follow up, and the rest were in good condition. [WT5”HZ]Conclusions[WT5”BZ] The proper timing of operation determined by the cardiac function of patients. It is necessary to improve condition of circulation before operation. The mortality rate of emergency operation is high within 3 days after VSR, and residual VSR tends to develop in a week after the repair. Operation should be performed a week after VSR. The early operative mortality is closely related to preoperative cardiogenic shock and postoperative complications. [WT5”HZ]