急性心肌梗死后室间隔穿孔的临床及预后

Clinical features and prognosis in patients with ventricular septal rupture complicating acute myocardial infarction

目的:探讨急性心肌梗死(AMI)后发生室间隔穿孔(VSR)的临床特征、治疗方法及其预后。方法:对20例AMI并发VSR患者的临床资料进行回顾性分析。结果:20例患者中,男12例,女8例,平均年龄(65.5±19.5)岁,14例有原发性高血压,8例有吸烟史;所有患者均无陈旧性心肌梗死病史,16例无心绞痛病史,17例有前壁心肌梗死;15例VSR发生于心肌梗死后1周内,其中3例发生在溶栓后,1例发生在PCI术后第1天;所有病例均经超声心动图证实,穿孔直径范围6～28mm,17例位于室间隔近心尖部;12例前壁心肌梗死患者施行了冠状动脉造影,其中2例未见明显狭窄,其余10例前降支闭塞或重度狭窄;20例患者均给予药物治疗,12例药物治疗的同时给予主动脉内球囊反搏(IABP)支持,3例行介入封堵术,2例行外科手术治疗,均存活,余15例死亡。结论:AMI并发室间隔破裂并不常见,但一旦发生多数迅速发展至心源性休克,内科治疗病死率很高,常规药物治疗联合IABP支持维持患者血流动力学稳定2～3周后再行介入或手术治疗,可提高生存率。

Objective：To explore the clinical features, treatment and outcomes in patients with ventricular sep- tal rupture （VSR） complicating acute myocardial infarction （AMI）. Method：The clinical experience and data of 20 post-infarct VSR patients were retrospectively anlysed. Result：Among the 20 patients, 12 （60 % ） were males and 6 （40%） were females, average aged was （65.5±19.5）. Fourteen （70%） cases had hypertention and 8 （40%） had smoking history. All patients had not myocardial infarction history, and 16 （80%） had not angina pectoris histo- ry. Anterior wall infarction was in 17 （85%）. The majority （75%） of ventricular septal ruture occurred within the first seven days. Coronary angiography were performed in 12 patients with anterior acute myocardial infarc- tion. Ten patients had LAD occlusion. Surgery or transcatheter closure was respectively performed in 5 patients, and all were survival. Last 15 （70 % ） patients died. Conclusion：VSR complicating AMI is uncommon. The mortal ity remains extremely high in patients with medical therapy after maintaining the patientsp hemodynamie stable for 2 ~ 3 can improve the survival rate. Surgery treatment （repair or transcatheter closure） weeks by medical therapy and the support of IAI3P,