影响急性心肌梗死合并室间隔穿孔30天内生存状况的相关因素

张显贵; 赵舟; 高卿; 范桄溥; 张国栋; 陈彧; 刘刚; 陈生龙

doi:10.13201/j.issn.1001-1439.2021.02.013

影响急性心肌梗死合并室间隔穿孔30天内生存状况的相关因素

- 北京大学人民医院心脏中心心脏外科(北京, 100044)
基金项目:
北京大学人民医院研究与发展基金(科研)(No:RDY2019-32)

详细信息

通讯作者: 赵舟,E-mail:zhaozhou8@126.com

中图分类号: R542.22

收稿日期: 2020-07-15

Analysis of the related factors which affect the survival status of patients with ventricular septal rupture complicating acute myocardial infarction within 30 days

- Department of Cardiac Surgery, Heart Center, People's Hospital of Peking University, Beijing, 100044, China

More Information

Corresponding author: ZHAO Zhou, E-mail: zhaozhou8@126.com

Received Date: 15 July 2020

摘要

摘要: 目的:通过分析急性心肌梗死(AMI)合并室间隔穿孔(VSR)患者的临床资料,探讨影响其30 d内生存状况的相关因素。方法:回顾性分析2006年1月—2019年11月北京大学人民医院心外科收治的29例AMI合并VSR患者的临床资料。所有患者中共有24例(82.8%)患者接受了手术治疗修补VSR,其中18例(75%)患者同期实施冠状动脉旁路移植术(CABG)。对比生存组与死亡组病例的临床资料,分析影响患者30 d内生存状况的相关因素。结果:未接受手术的患者VSR发生后30 d内病死率显著高于接受手术的患者(100%∶33.3%,P=0.011)。死亡组患者AMI后至VSR出现的时间更短[(2.43±1.72) d∶(6.79±5.77) d,P=0.019],急诊手术比例更高(8.3%∶58.3%,P=0.027);而生存组患者同期行CABG的比例更高(93.8%∶37.5%,P=0.007),且CABG是手术患者围术期预后的独立性保护因素(OR 0.58,95%CI 0.005~0.721,P=0.027)。结论:在修补AMI后VSR的同时,实施CABG有助于改善患者的围术期预后,应尽可能地根据术前造影结果实现完全的血运重建治疗。
- 急性心肌梗死 /
- 室间隔穿孔 /
- 冠状动脉旁路移植
Abstract: Objective: To analyze the clinical data of patients with ventricular septal rupture(VSR) and acute myocardial infarction(AMI), and to explore the related factors that affect survival status of them within 30 days.Methods: We analyzed retrospectively the clinical data of 29 patients diagnosed with VSR after AMI at department of cardiac surgery in Peking University People's Hospital from January 2006 to November 2019. Among 29 cases, 24(82.8%) patients underwent surgical repair, and 18(75%) patients underwent coronary artery bypass grafting(CABG) at the same time. The clinical data of patients in the survival group and the death group were compared to analyze the relevant factors which affect survival status of patients within 30 days.Results: This study found that patients with surgical repair had a significantly higher 30-day mortality rate than patients without surgical repair after the occurrence of VSR(100% vs 33.3%, P=0.011). The time from AMI to VSR was shorter(2.43 ± 1.72) days vs(6.79 ± 5.77) days, P=0.019, and the proportion of emergency surgery was higher(8.3% vs 58.3%, P=0.027) in the death group. While the proportion of patients who underwent concomitant CABG was higher in the survival group(93.8% vs 37.5%, P=0.007), and CABG is an independent protective factor for perioperative prognosis of surgical patients(OR, 0.58; 95%CI, 0.005-0.721, P=0.027).Conclusion: While repairing the VSR, the concomitant CABG can improve the perioperative prognosis of patients. In the meanwhile, it is supported to complete revascularization based on preoperative angiographic results.
- acute myocardial infarction /
- ventricular septal rupture /
- coronary artery bypass grafting

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参考文献(23)

[1]	Topaz O,Taylor AL.Interventricular septal rupture complicating acute myocardial infarction:from pathophysiologic features to the role of invasive and noninvasive diagnostic modalities in current management[J].Am J Med,1992,93(6):683-688.
[2]	Hutchins GM.Rupture of the interventricular septum complicating myocardial infarction:pathological analysis of 10 patients with clinically diagnosed perforations[J].Am Heart J,1979,97(2):165-173.
[3]	Pohjola-Sintonen S,Muller JE,Stone PH,et al.Ventricular septal and free wall rupture complicating acute myocardial infarction:experience in the Multicenter Investigation of Limitation of Infarct Size[J].Am Heart J,1989,117(4):809-818.
[4]	Moore CA,Nygaard TW,Kaiser DL,et al.Postinfarction ventricular septal rupture:the importance of location of infarction and right ventricular function in determining survival[J].Circulation,1986,74(1):45-55.
[5]	Radford MJ,Johnson RA,Daggett WM Jr,et al.Ventricular septal rupture:a review of clinical and physiologic features and an analysis of survival[J].Circulation,1981,64(3):545-553.
[6]	Thygesen K,Alpert JS,Jaffe AS,et al.Fourth universal definition of myocardial infarction(2018)[J].J Am Coll Cardiol,2018,72(18):2231-2264.
[7]	匡建梅,徐全民.血液检验指标在无症状心肌缺血患者诊断中的价值[J].临床血液学杂志,2020,33(2):93-96.
[8]	Banka VS,Agarwal JB,Bodenheimer MM,et al.Interventricular septal motion:biventricular angiographic assessment of its relative contribution to left and right ventricular contraction[J].Circulation,1981,64(5):992-996.
[9]	Cooley DA,Belmonte BA,Zeis LB,et al.Surgical repair of ruptured interventricular septum following acute myocardial infarction[J].Surgery,1957,41(6):930-937.
[10]	Birnbaum Y,Fishbein MC,Blanche C,et al.Ventricular septal rupture after acute myocardial infarction[J].N Engl J Med,2002,347(18):1426-1432.
[11]	李汉美,项理,许建屏,等.急性心肌梗死后合并室间隔穿孔外科修复105例:阜外医院16年随访结果[J].中国胸心血管外科临床杂志,2019,26(5):451-456.
[12]	Cerin G,Di Donato M,Dimulescu D,et al.Surgical treatment of ventricular septal defect complicating acute myocardial infarction.Experience of a north Italian referral hospital[J].Cardiovasc Surg,2003,11(2):149-154.
[13]	Menon V,Webb JG,Hillis LD,et al.Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction:a report from the SHOCK Trial Registry.SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK?[J].J Am Coll Cardiol,2000,36(3 Suppl A):1110-1116.
[14]	French JK,Hellkamp AS,Armstrong PW,et al.Mechanical complications after percutaneous coronary intervention in ST-elevation myocardial infarction(from APEX-AMI)[J].Am J Cardiol,2010,105(1):59-63.
[15]	Shapira I,Isakov A,Burke M,et al.Cardiac rupture in patients with acute myocardial infarction[J].Chest,1987,92(2):219-223.
[16]	Papalexopoulou N,Young CP,Attia RQ.What is the best timing of surgery in patients with post-infarct ventricular septal rupture?[J].Interact Cardiovasc Thorac Surg,2013,16(2):193-196.
[17]	Jeppsson A,Liden H,Johnsson P,et al.Surgical repair of post infarction ventricular septal defects:a national experience[J].Eur J Cardiothorac Surg,2005,27(2):216-221.
[18]	Arnaoutakis GJ,Zhao Y,George TJ,et al.Surgical repair of ventricular septal defect after myocardial infarction:outcomes from the Society of Thoracic Surgeons National Database[J].Ann Thorac Surg,2012,94(2):436-443.
[19]	陈同峰,孙子瑞,蒋亚鹏,等.28例心肌梗死后室间隔穿孔介入封堵患者主动脉内球囊反搏应用分析[J].临床心血管病杂志,2020,36(5):423-428.
[20]	Park BS,Lee WY,Lim JH,et al.Delayed repair of ventricular septal rupture following preoperative awake extracorporeal membrane oxygenation support[J].Korean J Thorac Cardiovasc Surg,2017,50(3):211-214.
[21]	Cox FF,Plokker HW,Morshuis WJ,et al.Importance of coronary revascularization for late survival after postinfarction ventricular septal rupture.A reason to perform coronary angiography prior to surgery[J].Eur Heart J,1996,17(12):1841-1845.
[22]	Barker TA,Ramnarine IR,Woo EB,et al.Repair of post-infarct ventricular septal defect with or without coronary artery bypass grafting in the northwest of England:a 5-year multi-institutional experience[J].Eur J Cardiothorac Surg,2003,24(6):940-946.
[23]	Huang SM,Huang SC,Wang CH,et al.Risk factors and outcome analysis after surgical management of ventricular septal rupture complicating acute myocardial infarction:a retrospective analysis[J].J Cardiothorac Surg,2015,10:66.