急性心肌梗死后心脏破裂的发生机制及危险因素

Pathogenesis and risk factors of cardiac rupture after acute myocardial infarction

急性冠状动脉综合征(acute coronary syndrome,ACS)是缺血性心脏病(ischaemic heart disease,IHD)的一种急性表现,具有很高的死亡风险,而急性心肌梗死(acute myocardial infarction,AMI)是其中的主要类型。心脏破裂(cardiac rupture,CR)是AMI的一种严重并发症,具有病情危重、难以及时预测和无有效救治方法等特点,其病死率极高。本综述从AMI后CR的发生机制、临床表现、相关检测手段、危险因素等方面总结CR的防治方法,主要从基线数据、生化指标、临床特点、血运重建情况、既往史等信息并结合现有的研究所提出的风险预测模型,提出分别利用年龄、性别、心率、心肌梗死部位、血红蛋白数量、白细胞数量、入院时间等预测AMI患者CR。其主要危险因素有:高龄女性、基础心率>80次/min、前壁心肌梗死、血红蛋白<120 g/L、白细胞>1×10~9/L、入院时间>12 h等,这些指标更易引起CR,此外,原发性经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)治疗有助于降低CR的风险,而溶栓则可能增加CR的风险。运用风险预测模型及相关检查手段,从机制和源头出发及时预测CR的发生,可明显降低病死率并为高危患者治疗及预后提供指导。CR具有突发性、高致死性,是临床中的棘手问题,因此通过早期预测因素,并建立一系列风险预测模型评估CR,以便早期识别CR的发生,积极采取预防措施,尽早防治CR显得尤为重要。

Acute coronary syndrome(ACS)is an acute manifestation of ischemic heart disease(IHD),with a high risk of death.Acute myocardial infarction(AMI)is the main type of acute myocardial infarction.Cardiac rupture(CR)is a serious complication of AMI,which is difficult to predict in time and has no effective treatment.The mortality rate was very high.In this review,we summarized the prevention and treatment of CR in terms of its mechanism,clinical manifestations,relevant detection methods,risk factors and so on.Based on baseline data,biochemical indicators,clinical characteristics,blood revascularization,past history,and combined with the risk prediction model put forward by existing research,we put forward the use of age,sex,heart rate and myocardial infarction site,respectively.It was suggested that CR in patients with AMI could be predicted by hemoglobin count,leukocyte count,admission time,etc.The main risk factors are elderly women,basal heart rate>80 times/min,anterior wall myocardial infarction.Hemoglobin<120 g/L,white blood cell>10~9/L,admission time>12 h,these indexes are more likely to cause cardiac rupture.In addition,primary PCI treatment can reduce the risk of CR,while thrombolysis may increase the risk of CR.Using risk prediction model and relevant inspection methods,we can predict the occurrence of CR timely from mechanism and source.CR is a difficult problem in clinical practice because of its sudden and high mortality.Therefore,a series of risk prediction models are established to evaluate CR,through early prediction factors.For early recognition,it is important to take preventive measures to prevent heart rupture as early as possible.