急性心肌梗死合并室间隔穿孔及并发心原性休克患者的临床特点及外科治疗预后

发布时间：2018-06-23 23:43

本文选题：心肌梗死 + 室间隔破裂　；参考：《中国循环杂志》2017年09期

【摘要】：目的:本研究探索急性心肌梗死(AMI)后合并室间隔穿孔(VSR)及并发心原性休克患者的临床特点及外科治疗预后。方法:回顾性分析我院外科2005-01至2015-05 AMI后VSR接受外科手术的患者77例,将患者分为休克组(52例),非休克组(25例),分析两组患者间临床特点及休克组患者的随访结果。结果:两组患者均合并室壁瘤多发(73.0%,68.0%),VSR到手术时间分别为(34.4±18.6)天和(8.7±50.3)天,同期行冠状动脉旁路移植术占比分别为73.1%、72.0%;休克组较非休克组患者VSR开口大([16.16±6.73)mm vs(11.86±4.62)mm],穿孔部位位于后室间隔的患者多(48.0%vs 24.0%),左心室射血分数较低[(45.0±8.8)%vs(47.9±12.3)%];休克组术前使用主动脉球囊反搏者(34.6%vs 0)、血管活性药物(96.2%vs 28.0%)和急诊手术患者均较多(42.3%vs 8.0%),择期手术的患者少(57.7%vs 92.0%),差异均有统计学意义(P0.05)。休克组患者住院死亡3例,平均随访(4.5±3.1)年,随访期间死亡2例。结论:VSR较大及部位在后室间隔的患者易发生休克,外科治疗术后存活患者中期预后好。
[Abstract]:Objective: to investigate the clinical features and surgical outcome of patients with ventricular septal perforation (VSR) and cardiogenic shock after acute myocardial infarction (AMI). Methods: 77 patients undergoing VSR surgery after AMI from January 2005 to May 2015 in our hospital were retrospectively analyzed. The patients were divided into shock group (52 cases) and non-shock group (25 cases). The clinical characteristics of the two groups and the follow-up results of shock group were analyzed. Results: the time from VSR to operation was (34.4 卤18.6) days and (8.7 卤50.3) days, respectively. The ratio of coronary artery bypass grafting was 73.1% and 72.0 mm respectively, the opening of VSRs in shock group was larger than that in non-shock group (16.16 卤6.73) mm vs (11.86 卤4.62 mm), the perforation location was in posterior ventricular septum (48.0%vs 24.0%), and the left ventricular ejection fraction (LVEF) was lower [(45.0 卤8.8) vs (47.9 卤12.3)%]. There were more balloon counterpulsators (34.6%vs 0), vasoactive drugs (96.2%vs 28.0%) and emergency surgery (42.3%vs 8.0%), but less selective surgery (57.7%vs 92.0%), the difference was statistically significant (P0.05). In shock group, 3 patients died in hospital, the average follow-up was (4.5 卤3.1) years, and 2 patients died during the follow-up period. Conclusion the patients with greater VSR and location in the posterior ventricular septum are prone to shock, and the survival patients after surgical treatment have a good medium-term prognosis.
【作者单位】：中国医学科学院北京协和医学院国家心血管病中心阜外医院成人外科中心;
【分类号】：R541.64;R542.22

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