急性心肌梗死并发心脏破裂患者的临床特征和死因分析

Analysis of clinical characteristics and death causes in patients with acute myocardial infarction complicated by cardiac rupture

目的 分析急性心肌梗死并发心脏破裂患者的死亡因素。 方法 收集首都医科大学附属北京安贞医院2012年1月至2014年12月确诊为急性心肌梗死后心脏破裂的患者，分为死亡组与存活组，将两组患者的临床资料进行统计分析，并对其中差异有统计学意义的危险因素进行Logistic回归分析。结果 共纳入59例确诊心肌梗死后心脏破裂患者，其中死亡患者50例，存活患者9例，死亡组患者的年龄明显高于存活组[（69.94±9.24）、（61.56±9.14）岁，t＝2.511，P＝0.015]，恶性心律失常的发生率也显著偏高（22.0%比0，χ2＝4.070，P＝0.044），嗜酒史的比例则低于存活组（12.0%比44.4%，χ2＝5.704，P＝0.017），死亡组与存活组患者的FPG[（8.97±3.98）、（6.06±1.25） mmol/L，t＝4.153，P〈0.01]、TG[（1.78±0.50）、（1.39±0.20） mmol/L，t＝4.146，P〈0.01]比较差异均有统计学意义，死亡组与存活组患者肺动脉高压比例（22.0%比0，χ2＝4.070，P＝0.044）和脑钠肽水平[（406.50（110.00，570.28） ng/L比33.00（20.00，176.00） ng/L，P＝0.004]比较差异均有统计学意义，而死亡组患者左心室舒张末期内径小于存活组患者[（47.76±5.13）、（52.22±4.66） mm，t＝－2.434，P＝0.018]，死亡组与存活组患者磺达肝癸钠（26.0%比0，χ2＝4.920，P＝0.027）、普通肝素（48.0%比88.9%，χ2＝5.138，P＝0.023）和硝酸酯类（72.0%比100%，χ2＝5.361，P＝0.021）等药物的使用率差异有统计学意义，死亡组患者院内急性心力衰竭的发生率高于存活组（11.0%比0，χ2＝3.258，P＝0.071），但差异无统计学意义。Logistic回归分析结果显示，高龄、FPG与心脏破裂患者的死亡呈显著相关性（OR值分别为1.151、1.974，P均〈0.05）。结论 心肌梗死后心脏破裂患者具有极高的住院病死率。高龄和FPG是危险因素，而普通肝素的使用是保护因素，对此类患者应及时评估患者预后并采取针对性措施。

Objective To analyze death causes in patients with acute myocardial infarction complicated by cardiac rupture.Methods The patients who were admitted with cardiac rupture after acute myocardial infarction in Beijing Anzhen Hospital Affiliated to Capital Medical University from January 2012 to December 2014 were enrolled.These patients were divided into death group and survival group.Then statistical analysis was performed for the clinical data of these patients in two groups, Logistic regression analysis was used to analyze the risk factors with statistical significance. Results A total of 59 patients diagnosed cardiac rupture after acute myocardial infarction were enrolled in this study, including 50 patients died, and 9 patients survived.There were significant differences between the two groups of patients with clinical baseline data.Compared with the survival group, death group had higher age（（69.94±9.24） years old vs.（61.56±9.14） years old, t=2.511, P=0.015）, the higher incidence of malignant arrhythmia（22.0% vs.0, χ2=4.070, P=0.044）, the lower proportion of alcohol abuse（12.0% vs.44.4%, χ2=5.704, P=0.017）, higher fasting blood glucose（（8.97±3.98） mmol/L vs.（6.06±1.25） mmol/L, t=4.153, P〈0.01） and triglycerides（（1.78±0.50） mmol/L vs.（1.39±0.20） mmol/L, t=4.146, P〈0.01）, higher proportion of pulmonary arterial hypertension（22.0% vs.0, χ2=4.070, P=0.044） and brain natriuretic peptide（406.50（110.00, 570.28） ng/L vs.33.00（20.00, 176.00） ng/L, P=0.004）, smaller the left ventricular end diastolic diameter（（47.76±5.13） mm vs.（52.22±4.66） mm, t=-2.434, P=0.018）. The use of fondaparinux sodium（26.0% vs.0, χ2=4.920, P=0.027）, heparin（48.0% vs.88.9%, χ2=5.138, P=0.023） and nitrates（72.0% vs.100.0%, χ2=5.361, P=0.021） were significantly differences.The occurrence of acute heart failure in patients in death group was significantly higher than the survival group（11.0% vs.0, χ2=3.258, P=0.071）, but the difference was not significant.Logistic regression analysis showed that old age（OR=1.151）, fasting blood glucose（OR=1.974） and heart rupture were significantly correlated（P〈0.05）.Conclusion Cardiac rupture patients have a high mortality rate after myocardial infarction.Advanced age and fasting blood glucose were risk factors, while the use of common heparin is protective factor.Patients should be evaluated in a timely manner to assess the prognosis and to take targeted measures.