摘要
目的:分析急性心肌梗死(AMI)患者发生心室游离壁破裂的临床特点,探讨此类疾病的预防及治疗经验。方法:回顾性分析我院近5年收治确诊为AMI患者5420例,确诊游离壁破裂51例患者的临床资料。结果:48例AMI患者为急性ST段抬高型心肌梗死,其中前壁和广泛前壁AMI 26例。76.5%的患者在心肌梗死1周内出现破裂,平均(4.7±3.4)d。临床表现为突然的意识丧失、呼吸停止以及心包填塞,用力排便、频繁呕吐、情绪激动有可能诱发心脏破裂。常见合并症有心力衰竭、心律失常、心肌梗死后心绞痛或再发心肌梗死的发生率分别为64.7%、41.2%、29.4%。高龄(≥70岁)、女性是心脏破裂常见高危因素,超敏C反应蛋白为心脏破裂独立预测因子。早期成功再灌注治疗能有效降低破裂风险。正性肌力药物增加破裂风险,而β-受体阻滞剂和ACEI可降低心脏破裂危险。所有患者均接受非手术治疗,病情好转2例,死亡49例。结论:AMI合并心室游离壁破裂发生率0.94%,病死率96.1%。正确识别高危人群、早期诊断、及时外科手术治疗能有效降低心脏破裂的病死率。
Objective ： To analyze the clinical characteristics of ventricular free wall rupture （ cardiac rupture, CR） in patients with acute myocardial infarction （AMI） , and to explore the experiences for prevention and treatment of the dis- ease. Methods： Clinical data of 51 cases diagnosed with AMI complicated with CR in recent 5 years were analyzed retro- spectively. Results ： Forty-eight of the cases were diagnosed as ST-elevated myocardial infarction （ STEMI）, 26 of those were with anterior and extensive anterior infarction. 76.5 % of CR occurred within a week after AMI, with average of （4.7 ± 3.4）d. The common clinical manifestations included sudden loss of consciousness, respiratory arrest and cardiac tam- ponade. Forced defecation, frequent vomiting, agitation were likely to induce CR. Heart failure, arrhythmias, angina after AMI or recurrent myocardial infarction were common complications, with the incidence of 64.7%, 41.2%, 29.4%. The aged （ ≥70 years）, female were the common risk factors and predictors. Hypersensitive C reactive protein （hsCRP） was the independent predict factor of CR. Early reperfusion of the myocardium could reduce the incidence of CR. Patients treated with thrombolysis had a higher incidence of CR, while B-blocks and ACEI may reduce the risk of CR. All patients received non-surgical treatments, among them 2 survived and 49 died. Conclusions ： The incidence of AMI who complicated with CR was 0.94% , and with mortality rate of 96.1%. Recognizing the high-risk group, early diagnosis, and surgical operation on time might decrease the mortality of CR.
出处
《内科急危重症杂志》
2013年第4期202-204,共3页
Journal of Critical Care In Internal Medicine
关键词
急性心肌梗死
心脏破裂
Acute myocardial infarction Cardiac rupture
