急性ST段抬高型心肌梗死的梗死部位与并发心脏破裂患者的特征及预后研究

Characteristics and prognosis of infarct site in patients with acute ST-segment elevation myocardial infarction and complicated with heart rupture

目的:分析不同部位的急性ST段抬高型心肌梗死与其并发的心脏破裂患者的临床特征及预后。方法:收集2010-01-2015-12于北京安贞医院、北京积水潭医院及保定市第一中心医院确诊为急性ST段抬高型心肌梗死后心脏破裂的患者111例。根据心肌梗死发生的部位,将上述患者分为前壁组(含或不含侧壁)、下壁组(含或不含后壁)、右室组、多室壁组,对存活患者进行跟踪随访,并将不同组别患者的临床资料及预后进行统计分析。结果:心脏破裂患者中,前壁组69例、下壁组19例、右室组13例、多室壁组10例。各组患者的临床资料比较显示,年龄、性别、身高、体重、体质指数、血红蛋白及破裂部位等均存在显著差异。各组患者住院治疗中,替格瑞洛及β受体阻滞剂的使用存在显著性差异。各组患者的住院不良事件发生率均很高,院内总体病死率高达60.4%,组间未见显著性差异。各组心脏破裂距心肌梗死时间中位数为0~3d。存活患者出院30d的总生存率为56.8%。结论:不同梗死部位的急性ST段抬高型心肌梗死并发心脏破裂患者的临床基线特征及预后存在一定差异;心脏破裂患者院内病死率高,预后差,需要早期干预、强化护理和积极治疗。

Objective：To analyze the clinical features and prognosis of patients with acute ST segment elevation myocardial infarction in different sites complicated with heart rupture.Method：A total of 111 patients with heart rupture after acute ST segment elevation myocardial infarction were collected from Beijing Anzhen Hospital,Beijing Jishuitan Hospital and Baoding First Central Hospital from January 2010 to December 2015.According to the location of myocardial infarction,the patients were divided into anterior wall group（including or without lateral wall）,inferior wall group（with or without posterior wall）,right ventricular group and multi-wall group.The surviving patients were followed up,and the clinical data and prognosis of the patients in different groups were analyzed statistically.Result：Among the patients with heart rupture,69 cases were in the anterior wall group,19 cases in the inferior wall group,13 cases in the right ventricular group,and 10 cases in the multi wall group.The clinical data of each group showed that there were significant differences in age,sex,height,weight,BMI,hemoglobin,and the location of rupture.There was a significant difference in the use of Ticagrelor and beta blockers in the treatment of each group.The incidence of adverse events was high in each group,and the overall mortality rate was as high as 60.4%in the hospital.There was no significant difference between the groups.The median time of cardiac rupture from myocardial infarction ranged from 0 to 3 days.The overall survival rate was 56.8% for the surviving patients after discharge for 30 days.Conclusion：The clinical baseline characteristics and prognosis of patients with acute ST segment elevation myocardial infarction complicated with cardiac rupture at different sites of infarction are different.In patients with heart rupture,in-hospital mortality is high and prognosis is poor.Early intervention,intensive care and active treatment are needed.