急性下壁梗死伴或不伴右心室心肌梗死患者临床特征的比较

Clinical characteristics in patients with acute inferior wall myocardial infarction accompanied by or without right ventricular myocardial infarction

目的：比较急性下壁心肌梗死（IWMI）伴或不伴右心室心肌梗死（RVMI）患者的临床特征差异。方法纳入2006年10月~2012年12月总参保健处发病12 h内入院的急性下壁心肌梗死（IWMI）患者256例，根据冠状动脉造影（CAG）结果将患者分为IWMI不合并RVMI组（n=167）和IWMI合并RVMI组（n=89），比较两组患者冠心病发病主要危险因素（包括吸烟、高血压、糖尿病、高脂血症、冠心病家族史）、临床表现、并发症和治疗用药的差异。结果两组患者冠心病主要危险因素无差异（P＞0.05）。IWMI合并RVMI患者出现低血压（80.0% vs.19.8%，P＜0.05）、颈静脉怒张（50.6%vs.1.8%）和Kussmaul征（51.7%vs.1.2%）的比例明显增加（P均＜0.01），需要更多地应用正性肌力药物（60.7%vs.16.2%）来维持血压，且病死率较高（77.9%vs.0.6%，P＜0.05）。结论在IWMI基础上伴RVMI多合并右心功能障碍，可导致预后不良。

Objective To analyze the clinical characteristics of acute inferior wall myocardial infarction （IWMI） accompanied by or without right ventricular myocardial infarction （RVMI）. Methods The patients （n=256） with IWMI hospitalized within 12 h after disease onset were chosen and divided into group without RVMI （n=167） and group of IWMI accompanied by RVMI （n=89） according to outcomes of CAG. The differences in major risk factors （smoking, hypertension, diabetes, hyperlipidemia and family history of coronary heart disease）, clinical symptoms, complications and drug administration were analyzed and compared in two groups. Results There were no differences in major risk factors in two groups. The percentages of hypotension （80.0%vs. 19.8%, P〈0.05）, distension of jugular vein （50.6%vs. 1.8%） and Kussmaul sign （51.7%vs. 1.2%） were higher in group of IWMI accompanied by RVMI （P〈0.01）. More positive inotropic drugs （60.7%vs. 16.2%） were needed for keeping blood pressure, and morality （77.9%vs. 0.6%, P〈0.05） was higher in group of IWMI accompanied by RVMI. Conclusion IWMI accompanied by RVMI is commonly complicated with right heart failure, which will induce poor prognosis.