右室心肌梗死对急性下壁心肌梗死临床特征和预后的影响

Influence of right ventricular infarction on the clinical manifestations and prognosis of left inferior myocardial infarction/

目的:分析右室心肌梗死(心梗)对急性下壁心梗临床特征和预后的影响。方法:比较急性单纯性下壁心梗(第一组)和急性下壁心梗合并右室心梗(第二组)两组患者的临床特征和院内病死率。结果:共176例患者符合入选条件,第一组115例,第二组61例。第一组低血压、快速心律失常(包括阵发性室上性心动过速,阵发性心房颤动,频发室性早搏,室性心动过速,心室纤颤等)、缓慢心律失常(包括窦性心动过缓,房室传导阻滞)、心功能不全的发生率和院内病死率显著低于第二组(P<0.05)。静脉溶栓、急诊PTCA和未行再灌注治疗的院内病死率在第一组的分别为3.23％,3.33％和29.17％,在第二组分别为9.z5％,13.04％和82.35％。结论:当急性下壁心梗合并右室心梗时,患者的临床表现更为严重,院内病死率增高。积极行溶栓或急诊PTCA治疗,可显著降低其院内病死率。

Objective: To investigate the influence of right ventricular infarction (RVI) on the clinical features and prognosis of left inferior myocardial infarction. Methods: The patients with inferior AMI admitted in 24 hours during last 5 years were retrospectively studied. The patients with inferior AMI were grouped as group 1 (115 cases), and the patients with inferior AMI and RVI as group 2 (61 cases). The clinical manifestations and in-hospital mortality were compared between group 1 and group 2. Results: The incidence of hypotension, tachyarrhythmia (including paroxysmal supraventricular tachycardia, paroxysmal atrial fibrillation, frequent ventricular ectopic beats and ventricular tachycardia, ventricular fibrillation etc.), brady-arrhythmias (including sinus bradycardia and atrio-ventricular block), cardiac dysfunction, and in-hospital mortality in group 1 was higher than those of group 2 (P< 0.05). The in-hospital mortality with intravenous thrombolysis, direct PTC A, and no reperfusion therapy was 3.23%, 3.33%, 29.17% in group 1, and 9. 25%, 13.04%, 82. 35% in group 2. Conclusion: Inferior AMI with RVI show complicated clinical manifestation and present a worse prognosis. Reperfusion therapy can significantly decrease its in-hospital mortality.