摘要
目的探讨心肌梗死合并室间隔破裂早期死亡的危险因素及远期预后。方法回顾性分析2008年1月至2020年12月北京安贞医院收治的心肌梗死合并室间隔破裂的135例患者。根据室间隔破裂30 d内是否死亡,分为早期存活组(71例)和早期死亡组(64例),观察两组患者的临床特征差异,分析室间隔破裂患者早期死亡的危险因素,同时分析手术组(69例)和非手术组(66例)的远期预后。结果心肌梗死合并室间隔破裂患者早期死亡率为47.4%(64/135)。单因素分析显示:与早期存活组相比,年龄、女性、白细胞计数、血小板计数、C反应蛋白水平、左室舒末内径、肝功能异常、肺部感染、Killip≥3级、未手术与早期死亡相关(P均<0.05)。多因素回归分析显示,未手术(OR=16.103,95%CI:4.400~58.930,P<0.001)、Killip≥3级(OR=9.014,95%CI:2.506~32.428,P=0.001)、肝功能异常(OR=5.171,95%CI:1.388~19.264,P=0.014)是心肌梗死合并室间隔破裂患者早期死亡的独立危险因素。随访1.0~11.8(中位3.2)年发现,手术组2年和10年的累积生存率显著高于未手术组(76.7%和16.7%,P<0.001;73.1%和16.7%,P<0.001)。结论未手术、Killip≥3级和肝功能异常是心肌梗死合并室间隔破裂患者早期死亡的独立危险因素,手术治疗心肌梗死合并室间隔破裂的远期预后良好。
Objective To analysis the risk factors of early death and long-term outcomes of myocardial infarction complicated with ventricular septal rupture.Methods A total of 135 patients with myocardial infarction complicated with ventricular septal rupture in Beijing Anzhen Hospital from January 2008 to December 2020 were retrospectively analyzed.According to the survival or death within 30 days after ventricular septal rupture,the patients were divided into the early survival group(n=71)and the early death group(n=64).The clinical characteristics of the two groups were observed,and the risk factors for early death group were analyzed.The long-term outcomes of the surgery group(n=69)and the non-surgery group(n=66)was analyzed.Results The early mortality rate of patients with myocardial infarction complicated with ventricular septal rupture was 47.4%(64/135).Univariate analysis showed that age,sex,white blood cell count,platelet count,C-reactive protein level,left ventricular end-diastolic diameter,abnormal liver function,pulmonary infection,no surgery repair and Killip grade≥3 were associated with early death as compared with the early survival group(all P<0.05).Multivariate regression analysis showed that no surgery repair(OR=16.103,95%CI:4.400-58.930,P<0.001)and Killip≥3 grade(OR=9.014,95%CI:2.506-32.428,P=0.001)and abnormal liver function(OR=5.171,95%CI:1.388-19.264,P=0.014)were independent risk factors for early death in patients with myocardial infarction complicated with ventricular septal rupture.During follow-up of 1.0 to 11.8(median 3.2)years,the 2-year and 10-year cumulative survival rates were significantly higher in the surgery group than in the non-surgery group(76.7%vs.16.7%,P<0.001;73.1%vs.16.7%,P<0.001).Conclusions No surgical repair,Killip grade≥3 and abnormal liver function are independent risk factors for early death in patients with myocardial infarction complicated with ventricular septal rupture.The long-term outcomes of surgical treatment for myocardial infarction complicated with ventricular septal rupture is good.
作者
付威
董然
郑居兵
张魁
穆军升
Fu Wei;Dong Ran;Zheng Jubing;Zhang Kui;Mu Junsheng(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2022年第5期517-522,共6页
Chinese Journal of Geriatrics
基金
国家自然科学基金 (81870181)。
关键词
心肌梗死
室间隔破裂
危险因素
预后
Myocardial infarction
Ventricular septal rupture
Risk factors
Prognosis
