112例急性ST段抬高型心肌梗死后心脏破裂患者的临床特点分析

发布时间：2018-05-31 15:18

本文选题：急性ST段抬高型心肌梗死 + 心脏破裂　；参考：《吉林大学》2017年硕士论文

【摘要】：目的分析急性ST段抬高型心肌梗死(ST-elevation myocardial infarction,STEMI)患者并发心脏破裂(cadiac rupture,CR)的临床特点,探索STEMI后CR的危险因素,探究临床防治措施。方法连续入选于2014年1月至2016年12月期间就诊于吉林大学第一医院心血管疾病诊疗中心并诊断为STEMI并发CR患者共112例,定义为破裂组,按照1:3匹配原则,匹配条件为相同性别及年龄±1岁,随机选取与CR组同年入院且未发生心脏破裂的336例STEMI患者作为非破裂组,记录入选患者在院期间一般资料、检验检查结果、病情变化、冠脉造影情况以及治疗情况,对STEMI后CR患者临床特点进行总结,利用统计学分析发现STEMI后CR的危险因素。结果1、3年间ST段抬高型心肌梗死患者共6007例,并发CR患者共112例,STEMI后CR发病率为1.9%,其中FWR共82例(71.9%),VSR共31例(27.2%),PMR共1例(0.9%),两例患者在院期间先后发生VSR、FWR。112例STEMI合并CR患者平均年龄为(68.9±9.74)岁,其中男性52人,女性60人。2、STEMI患者发生CR前常常存在诱因,包括用力排大小便,剧烈恶心、呕吐,情绪激动,反复胸痛等。3、CR多发生在STEMI起病1周内,本研究中91%的CR发生在STEMI起病一周内。其中24小时内发生CR患者共61人,占总人数54%,3~5天发生CR患者共25人,占总人数22%。4、STEMI并发CR患者中,急性前壁心肌梗死患者共63例,其中出现FWR共52例(81.2%),出现VSR共12例(18.8%),1例患者同时发生FWR、VSR。急性下壁心肌梗死患者共35例,其中出现FWR共21例(60%),出现VSR共13例(37.1%),出现pmr共1例(2.9%)。急性前壁心肌梗死合并下壁心肌梗死患者共9例,其中出现fwr共4例(40%),出现vsr共6例(60%),1例患者同时发生fwr、vsr。急性侧壁心肌梗死患者共5例,均为fwr。5、两组单因素分析中,(1)基本资料方面,心脏破裂组与非心脏破裂组性别比例相同、年龄相近。cr组患者既往高血压病史、糖尿病病史、脑卒中病史的比例高于非cr组(p0.05),既往心肌梗死病史、吸烟史比例低于非cr组(p0.05)。(2)入院后常规检验方面,cr组患者白细胞计数、中性粒细胞计数、中性粒细胞百分比、单核细胞计数、随机血糖、凝血酶原时间、门冬氨酸氨基转移酶、丙氨酸氨基转移酶、γ-谷氨酰转肽酶、总胆红素、直接胆红素、空腹血糖水平高于对照组(p0.05),而嗜酸性粒细胞计数、淋巴细胞百分比、血清钠离子水平低于对照组(p0.05)。(3)心肌梗死相关情况方面,cr患者入院收缩压低于对照组(p0.05),cr组患者入院后心率、肌钙蛋白i峰值、d-二聚体、bnp、前壁心肌梗死比例、killip分级iii级~iv级比例、心肌梗死后反复胸痛比例高于对照组(p0.05)。(4)冠脉造影结果方面,非cr组有较好的侧支循环(p0.05)。(5)治疗方面,非cr组使用指南推荐药物及直接经皮冠状动脉介入治疗(primarypercutaneouscoronaryintervention,ppci)均较cr组更加完善(p0.05)。6、应用条件logistic进行多因素分析,结果显示入院低收缩压(or=0.984,95%ci:0.975~0.994)、入院心率快(or=1.021,95%ci:1.007~1.037)、心肌梗死后反复胸痛(or=11.947,95%ci:3.639~39.218)、白细胞计数升高(or=1.105,95%ci:1.03~1.185)、中性粒细胞百分比升高(or=17.089,95%ci:1.216~240.221)是stemi患者并发cr的独立危险因素。结论1、stemi后cr的发病率为1.9%,并不多见,其中左室游离壁破裂比较常见。2、cr多发生在stemi起病1周内,其中两个高发时间分别为起病24小时内及起病后3~5天。3、stemi并发cr的危险因素包括入院低收缩压、心率快、心肌梗死后反复胸痛、白细胞计数升高、中性粒细胞百分比升高。
[Abstract]:Objective to analyze the clinical characteristics of cardiac rupture (cadiac rupture, CR) in patients with acute ST segment elevation myocardial infarction (ST-elevation myocardial infarction, STEMI), to explore the risk factors of CR in STEMI after STEMI, and to explore the clinical prevention and treatment measures. Methods to be selected from January 2014 to December 2016 to visit the cardiovascular system of No.1 Hospital of Jilin University. The center of disease diagnosis and treatment was diagnosed as 112 cases of STEMI complicated with CR, defined as the rupture group. According to the 1:3 matching principle, the matching conditions were the same sex and age of 1 years, and 336 cases of STEMI patients who were admitted to the same year with the CR group without rupture of the heart were selected as the non rupture group, and the general data of the hospitalized patients were recorded and the results were tested. The clinical features of patients with CR after STEMI were summarized, and the risk factors of CR after STEMI were analyzed by statistical analysis. Results there were 6007 cases of ST segment elevation myocardial infarction in 1,3, 112 cases with CR patients and 1.9% of CR incidence after STEMI, of which 82 cases (71.9%) were FWR, 27.2% (27.2%), 27.2% (27.2%). 27.2% PMR 1 cases (0.9%), two patients had VSR during the hospital, and the average age of FWR.112 STEMI combined with CR was (68.9 + 9.74) years old, of which 52 men and 60 women were.2, and STEMI patients were often induced before CR, including severe bowel movement, severe nausea, vomiting, emotional excitement, repeated chest pain and.3, CR more occurring in STEMI 1 weeks. Within this study, 91% of the CR occurred within one week of the onset of STEMI. Among them, 61 were CR patients in 24 hours, the total number was 54%, and CR patients were 25, accounting for 22%.4, and 63 cases of acute anterior wall myocardial infarction in STEMI complicated with CR patients. There were 52 cases (81.2%) with FWR, 12 cases in 18.8% (18.8%), and 1 patients simultaneously FW. There were 35 cases of acute lower wall myocardial infarction in R and VSR., of which there were 21 cases of FWR (60%), 13 cases (37.1%) and 1 cases of PMR (2.9%). There were 9 cases of acute anterior wall myocardial infarction combined with inferior wall myocardial infarction, of which there were 4 cases of FWR (40%), 6 (60%) occurred in VSR, FWR in 1 cases, and acute side wall myocardial infarction in vsr. patients. For example, fwr.5, two groups of single factor analysis, (1) basic data, the heart rupture group and the non heart rupture group had the same sex ratio. The history of hypertension, the history of diabetes and the history of stroke were higher than that of the non CR group (P0.05). The history of myocardial infarction was lower than that of the non CR group (P0.05). (2) admission to hospital. (2) admission to hospital. In the routine test, the leukocyte count, neutrophils count, neutrophils percentage, mononuclear cell count, random blood sugar, prothrombin time, aspartate aminotransferase, alanine aminotransferase, gamma glutamyl transpeptidase, total bilirubin, direct bilirubin, and fasting blood glucose level were higher than those of the control group (P0.05) in the CR group. The level of acid granulocyte count, lymphocyte percentage and serum sodium ion were lower than that of the control group (P0.05). (3) the systolic pressure of Cr patients was lower than that of the control group (P0.05). The heart rate, the peak of cardiac troponin I, the d- two polymer, the proportion of BNP, the anterior wall myocardial infarction, the III grade ~iv grade ratio of Killip classification, the myocardial infarction in the CR group were lower than the control group (P0.05). The proportion of postoperative recurrent chest pain was higher than that of the control group (P0.05). (4) the results of coronary angiography, non CR group had better collateral circulation (P0.05). (5) the treatment, non CR guidelines recommended drugs and direct percutaneous coronary intervention (primarypercutaneouscoronaryintervention, PPCI) were more perfect than the CR group (P0.05).6, the application of logistic. Multifactor analysis showed low systolic pressure (or=0.984,95%ci:0.975~0.994), fast hospitalization heart rate (or=1.021,95%ci:1.007~1.037), repeated chest pain (or=11.947,95%ci:3.639~39.218) after myocardial infarction, increased leukocyte count (or=1.105,95%ci:1.03~1.185), and increased neutrophil percentage (or=17.089,95%ci:1.216~240.221) was ste. Conclusion the incidence of Cr in MI patients was 1, and the incidence of Cr after STEMI was 1.9%. The left ventricular wall rupture was common.2 and Cr occurred more than 1 weeks in the onset of STEMI, and two of the high onset times were 24 hours of onset and 3~5 days after onset respectively. The risk factors for STEMI and Cr were low systolic pressure and fast heart rate. Repeated chest pain after myocardial infarction increased white blood cell count and increased neutrophil percentage.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22

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