急性心肌梗死并室间隔穿孔临床特点及预后分析

Clinical features and prognosis analysis of patients with acute myocardial infarction and ventricular septal rupture

目的分析急性心肌梗死（acute myocardial infarction,AMI）并发室间隔穿孔（ventricular septal rupture,VSR）的临床特点及预后,为该病的早期诊断及治疗提供证据。方法对深圳市孙逸仙心血管医院2014年1月至2015年1月收治的6例急性ST段抬高型心肌梗死并发VSR患者的临床资料进行回顾性分析。结果 4例合并原发性高血压（高血压）,3例合并糖尿病;前壁心肌梗死5例,下壁心肌梗死1例;心源性休克4例。超声心动图提示VSR直径范围6～20 mm,多数位于心尖部,6例均行主动脉内球囊反搏术（IABP）,4例行直接球囊扩张术（PTCA）,1例行直接经皮冠状动脉介入治疗,1例行择期经皮冠状动脉介入治疗,3例行室间隔修补术,其中2例存活,其余4例死亡,病死率66.7%。结论 AMI并发VSR并不多见,大多发生在前壁AMI患者中,这些患者会迅速发展为心源性休克,内科治疗病死率高;若能尽早开通犯罪血管,并在主动脉内球囊反搏及血管活性药物的支持治疗下,维持血流动力学稳定至4～8周,行室间隔修补术,可提高存活率。

Objectives To analyze the clinical features and prognosis of patients with ventricular septal rupture （VSR） complicated with acute myocardial infarction （AMI）, and provide evidence for early diagnosis and treatment of the disease. Methods From January 2014 to January 2015, clinical data of 6 patients who were diagnosed as acute ST- segment elevation myocardial infarction and VSR in Sun Yat-Sen Cardiovascular Hospital of Shenzhen City were retrospectively analyzed. Results Four patients with hypertension, 3 patients were with diabetes history; 5 patients were with anterior myocardial infarction, 1 patient was were with inferior wall myocardial infarction ; 4 patients were with cardiac shock. Eehocardiography showed that diameters of the ventricular septal defects ranging from 6 to 20 mm, and most of them were located in interventricular septum near the apex. Six cases were implanted intra-aortic balloon pump （IABP） to support cycle function. Four patients underwent primary percutaneous transluminal coronary angioplasty （PTCA）, 1 case underwent emergency percutaneous coronary intervention （PCI）, 1 case underwent orthopedic PCI, 3 cases underwent ventricular septal repair. At last, 2 cases survived, the remaining 4 cases died and the mortality was 66.7%. Conclusions AMI complicated with VSR is rare, mostly in patients with anterior myocardial infarction. The mortality of medical treatment is high. Restoring patency of the culprit vessel as early as possible, supporting with vasoactive drug therapy and IABP, maintaining hemodynamic stability for 4-8 weeks before ventricular septal perforation repair can improve the survival rate.