老年心肌梗死后心脏游离壁破裂的临床特点及相关因素分析

Clinical characteristics and associated factors of myocardial free wall rupture after acute myocardial infarction in elderly patients

目的探讨老年急性心肌梗死后左心室游离壁破裂（FWR）的临床特点及相关因素。方法老年急性心肌梗死后FWR患者19例为观察组。无机械性并发症的急性心肌梗死患者35例为对照组，回顾分析比较两组临床资料。多因素Logistic回归分析老年急性心肌梗死后发生FWR的危险因素。结果观察组ST抬高型急性心肌梗死17例。其中前壁心肌梗死10例；FWR发生在1周内16例，平均发病时间（3．50±3．07）d。12例FWR发生在14：00～19：00。发病前有异常活动或可能诱因的8例；与对照组比较．FWR组前壁心肌梗死比例、肌酐水平较高（P〈0．05），B型钠尿肽（BNP）、高敏C反应蛋白（hs—CRP）水平明显升高（P〈0．01），而红细胞压积（HCT）、低密度脂蛋白水平及急诊PCI比例低于对照组（P〈0.01或0.05）。多因素二元Logistic回归分析显示血红细胞压积、肌酐水平与FWR相关（P〈0.05）。结论HCT降低而肌酐增高的老年急性心肌梗死患者,FWR的危险性增加。

Objective To analyze clinical characteristics and associated factors of left ventricular free wall rupture （FWR） after acute myocardial infarction （AMI） in elderly patients. Methods Clinical data of 19 AMI elderly patients complicated with FWR （FWR group） were retrospectively analyzed and compared with that of 35 AMI patients without mechanical complication （control group）. Multivariate logistic regression analysis was performed to identify associated factors of FWR. Results 17 cases were diagnosed as ST elevated AMI（FWR group）, of them, 10 had anterior infarction. FWR occurred within a week after AMI in 16 cases, with average of 3.50 ± 3.07day. 12 cases developed FWR at the period of 14：00-19：00. Undue physical exertion or other causes were documented in 8 patients with FWR. The incidence of anterior myocardial infarction, the level of plasma serum creatinine （P〈0.05）, brain natriuretic peptide,high sensitive C-creative protein （P〈0.01） were significantly higher, while the levels of hematocrit and LDL-C were significantly lower in FWR group than in control group （P〈0.01 or 0.05）. Multivariate logistic regression analysis revealed that hematocrit and serum creatinine to be associated with FWR. Conclusion The risk of FWR may increase in elderly AMI patients with lower serum hematocrit and higher serum creatinine.