急性右室梗死治疗策略的探讨

Investigation of treatment in the patients with acute right ventricular myocardial infarction

目的 探讨急性右室梗死治疗策略。方法 随机连续选择资料相对完整的 32 3例因首次急性下壁心梗住我院心内科病人 ,其中 98例是右室梗死 (V4R导联ST段上移 >0 1mV)。回顾性对比分析两组一般性资料及治疗措施。结果 右室梗死组 (A组 ,98例 )与下、后壁梗死组 (B组 ,2 2 5例 )比较硝普钠加多巴胺、β -受体阻滞剂 (β -b)、血管紧张素转换酶抑制剂 (ACEI)两组分布无差异 (P >0 0 5 ) ,消心痛A组多于B组 (P =0 0 4 ) ,钙拮抗剂 (CCB)A组明显少于B组 (P =0 0 0 1) ;A组心脏性死亡发生率多于B组 (2 5 %vs 5 % ,P =0 0 0 1)。结论 在无禁忌症情况下 ,治疗右室梗死急性期适时适量应用血管扩张剂、β -b、ACEI是安全有益的 ,没有增加死亡率。

Objective To investigate the treatment methods for the patients with acute right ventricular myocardial infarction.Methods All 323 patients with acute inferior myocardial infarction were divided into two groups and reviewed restrospectively their treatment methods,who were first admitted into cardiovascular wards of the First Affiliated Hospital of Harbin Medical University and in one group there were 98 cases with acute right ventricular myocardial infarction(ST segment elevation in V4R lead≥1 mV).Results There was no difference between the group A 98 cases with RVMI and the group B 225 cases with inferior and posterior MI in the administration of natroprusside with dopamine,β-blocker,ACEI(P>0.05).The administration of isosorbide dinitrate was more in group A than in group B(P=0.04),but CCB was less in group A than in group B on the contrary(P=0.001).The cardiac mortality in group A was greatly superior to in group B (25% vs 5%,P=0.001).Conclusion Under no contraindication,it is safe that the vasodilator,β-blocker and ACEI were moderately administrated in the RVMI.