急性心肌梗死合并室间隔穿孔介入封堵与药物治疗比较

Comparison of interventional occlusion and drug therapy for acute myocardial infarction complicated with ventricular septal perforation

目的比较介入封堵与药物治疗在急性心肌梗死后室间隔穿孔(PI-VSD)患者中的治疗效果及预后。方法回顾2012年1月至2019年12月武汉亚洲心脏病医院心内科64例PI-VSD患者资料,比较两种治疗方式的治疗效果及患者预后。结果患者平均年龄(66.5±9.9)岁,男36例(56.25%);其中38例行室间隔封堵治疗,3例因位置或破口面积太大不适合封堵,3例封堵后患者因心力衰竭死亡。38例造影结果提示:前降支病变29例(76.3%),右冠状动脉病变9例(23.7%);修复穿孔后残余漏(0.4±0.1)cm,术后左心室射血分数(45.6±4.4)%。药物治疗组主动脉内球囊反搏(IABP)使用率低于介入封堵组(30.7%比63.2%,P=0.052),差异无统计学意义;IABP使用时间短于介入封堵组[(4.9±8.8)d比(10.5±11.1)d,P=0.038],差异有统计学意义。介入手术成功率84.2%(32/38),术后生存率91.4%(32/35),药物治疗生存率7.7%(2/26)。患者生存率相关因素分析提示:患者生存率与血流动力学是否稳定及是否行介入治疗有关,差异均有统计学意义(均P<0.001)。结论PI-VSD介入封堵治疗是安全、有效的,创伤较小,介入封堵治疗效果较药物治疗更佳,降低了患者死亡率。

Objective This study compared the therapeutic ef fects and prognosis of interventional occlusion and drug therapy in patients with post infarction ventricular septal defect(PI-VSD).Methods We reviewed the data of patients with PI-VSD in our hospital from January 2012 to December 2019.We included 64 patients with PI-VSD and compared the therapeutic effects and prognosis between the two treatments.Results The average age of all patients was(66.5±9.9)years old,with 36(56.25%)males.There were 38 cases treated with interventional occlusion,3 cases were not suitable for occlusion due to the position or size of the perforation,3 cases died because of heart failure after the occlusion.The results of angiography showed:29(76.3%)cases of anterior descending branch lesions,9(23.7%)cases of right coronary artery lesions;the mean residual leakage was(0.4±0.1)cm after interventional occlusion of perforation and postoperative LVEF was(45.6±4.4)%.Compared with the intervention group,drug group shoed lower rate of IABP usage(30.7%vs.63.2%,P=0.052)and shorter IABP usage time[(4.9±8.8)d vs.(10.5±11.1)d,P=0.038].The success rate of interventional surgery was 84.2%(32/38),and the postoperative survival rate was 91.4%(32/35).The survival rate of drug therapy was 7.7%(2/26).The analysis of related factors of survival rate showed that survival rate was related to stable condition,which was statistically significant(P<0.001).Conclusions According to the results of this study,minimally invasive transcatheter closure of ventricular Septal perforation af ter myocardial infarction is safe,effective and with less invasive and associated with lower mortality.