心肌梗死继发室间隔穿孔外科手术后死亡的相关因素分析

Analysis of mortality relative factors in patients with ventricular septal rupture complicating myocardial infarction

目的探讨心肌梗死继发室间隔穿孔外科术后病死率及死亡相关因素。方法回顾性分析2005年1月至2018年12月在首都医科大学附属北京安贞医院心脏外科接受手术的全部51例心肌梗死继发室间隔穿孔患者的资料。男性34例,女性17例,年龄(63±8)岁(范围:44~82岁)。患者发生室间隔穿孔至手术的时间为(44±39)d(范围:3~187 d)。采用t检验和χ^2检验对术后死亡的相关因素进行单因素分析,多因素分析采用Logistic回归。结果8例患者在术后住院期间死亡,43例存活,术后30 d病死率为15.7%(8/51)。3例患者在室间隔穿孔1周内接受手术,其中死亡2例;推迟至4周后手术,院内病死率为6.5%(2/31)。单因素分析结果显示,术前肾功能不全、术前肌酐水平、心功能Ⅳ级、三尖瓣重度关闭不全、术后血液滤过治疗、术后第1天肌酐水平、手术距室间隔穿孔时间>4周与心肌梗死继发室间隔穿孔外科术后死亡相关。多因素分析结果显示,高龄(OR=1.32,95%CI:1.05~1.75,P=0.033)、心功能(纽约心脏病协会分级)Ⅳ级(OR=2.25,95%CI:1.62~2.82,P=0.003)、三尖瓣重度关闭不全(OR=1.82,95%CI:1.31~2.43,P=0.001)、术前肾功能不全(OR=1.78,95%CI:1.26~2.32,P=0.015)、手术距室间隔穿孔时间<1周(OR=2.50,95%CI:1.52~2.98,P=0.012)是心肌梗死继发室间隔穿孔外科术后死亡的独立相关因素。结论外科手术是处理心肌梗死继发室间隔穿孔的有效手段,患者高龄、心功能Ⅳ级、术前肾功能不全、三尖瓣重度关闭不全、手术距室间隔穿孔时间<1周是患者发生外科手术后死亡的独立相关因素。

Objective To examine the mortality rate and relative factors associate with ventricular septal rupture in myocardial infarction patients.Methods A total of 51 patients who suffered from myocardial infarction complicating with ventricular septal rupture received operative procedures between January 2005 and December 2018 in Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,were retrospectively analyzed.There were 34 males and 17 females,with an age of(63±8)years(range:44 to 82 years).The time between ventricular septal rupture and surgical procedure was(44±39)days(range:3 to 187 days).The t test andχ^2 test were used for univariate analysis,Logistics regression model was used for multivariate analysis of in-hospital mortality relative factors.Results There were 8 patients dead in hospital,43 patients survived,the overall mortality rate was 15.7%in hospital.The post-operation mortality rate was 2/3 of who suffered ventricular septal rupture and underwent operation within 1 week,but it′s markedly decreased to 6.5%if the time over 4 weeks.Univariate analysis showed that renal failure before operation,creatinine before operation,left ventricular ejection fraction,cardiac function(New York Heart Association)gradeⅣ,severe tricuspid regurgitation,dialysis post-operation,creatinine of the first day of post-operation,the time between and operation more than 4 weeks were in-hospital mortality relative factors.Multivariate analysis reflected that advanced age(OR=1.32,95%CI:1.05 to 1.75,P=0.033),cardiac function gradeⅣ(OR=2.25,95%CI:1.62 to 2.82,P=0.003),severe tricuspid regurgitation(OR=1.82,95%CI:1.31 to 2.43,P=0.001),renal failure before operation(OR=1.78,95%CI:1.26 to 2.32,P=0.015),the time between ventricular septal rupture and operation less than 1 week(OR=2.50,95%CI:1.52 to 2.98,P=0.012),were independent in-hospital mortality relative factors.Conclusions The surgery operation is an effective way to deal with ventricular septal rupture combined with myocardial infarction.The independent relative factors of in-hospital mortality are advanced age,cardiac function gradeⅣ,renal failure before operation,severe tricuspid regurgitation,the time between ventricular septal rupture and operation less than 1 week.