急性心肌梗死伴与不伴心脏破裂临床病理分析

Comparison of clinic and pathology in heart rupture of patient with acute myocardial infarction

目的 :探讨急性心肌梗死 ( AMI)心脏破裂的原因、好发部位及与冠状动脉狭窄的关系。方法 :AMI死亡并行尸体解剖检查 6 3例 ,其中 AMI伴心脏破裂 18例 ,不伴心脏破裂 45例。结果 :AMI伴心脏破裂组高血压、溶栓治疗及首次心肌梗死发生率明显升高 ( P<0 .0 5 ) ,而性别、梗死后心绞痛、心源性休克、心肌酶谱峰值、梗死面积与心脏破裂无明显关系 ( P >0 .0 5 )。心脏破裂多发生在 AMI后 3d内 ,第 1天占 33.3% ,多见于前壁、心尖部及下壁。尸体解剖示破裂处心肌变薄伴出血 ,梗死相关血管多为高度狭窄。结论 :高血压、溶栓治疗及首次心肌梗死均为心脏破裂的危险因素。AMI的超急性期是心脏破裂的高发期。

Objective:To analysis the cause and the site of heart rupture and the relation between coronary arteries narrowed and heart rupture.Method:A total of 63 patients with acute myocardial infarction (AMI) were examined by necropsy.They were 47 men and 16 women with a mean age of (63±15) years. Group Ⅰ was AMI with heart rupture (n=18),group Ⅱ was AMI without heart rupture (n=45).Result:① Hypertension and thromboclastic treatment and a first AMI occurred mostly in group Ⅰ(P< 0.05 ).② Sex and chest pain of postinfarction and peak of myocardial enzymes and area of infarction were not different between both groups (P> 0.05 ). ③ Heart rupture occurred mostly within 3 days, 33.3 % for 18 patients with heart rupture in 1st day after AMI. The sites of AMI were more anterior wall, cardiac apex and inferior wall. ④In③ necropsy cases showed thin and hemorrage in rupture wall and the arteries relative to infarction were more narrow. Conclusion:① Hypertension and thromboclastic treatment and a first AMI were the risk factors of heart rupture. ②The heart rupture occurred possibly during the acute phase. ③The severe narrow of LAD and RCA increased incidence of heart rupture.