张晶晶.174例急性心肌梗死后心脏破裂患者的临床特点分析[J].内科急危重症杂志,2023,29(6):459-464
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| DOI：10.11768/nkjwzzzz20230605 |
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| 英文关键词: |
| 基金项目:河南省医学科技攻关计划联合共建项目（No:LHGJ20220105） |
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| 中文摘要: |
| 摘要 目的：分析急性心肌梗死（AMI）后心脏破裂（CR）患者院内死亡的危险因素。方法：回顾性收集174例AMI后CR [包括游离壁破裂(FWR)和室间隔穿孔(VSR)]患者的临床资料，将其分为死亡组（108例）和存活组（66例），比较2组基线资料特征，采用Logistic回归分析导致院内死亡的危险因素，同时比较不同破裂部位手术及死亡情况。结果：死亡组前壁心肌梗死及手术患者比例低于存活组（P=0.041或P＜0.001），SOFA评分高于存活组（P＜0.001）。VSR组的前壁心肌梗死、前降支及右冠状动脉、连续性肾脏替代治疗（CRRT）、主动脉内球囊反搏（IABP）、手术比例及存活率高于FWR组；呼吸机辅助、回旋支低于FWR组（P均＜0.05）。死亡组白细胞计数、心肌肌钙蛋白I（cTnI）、乳酸水平高于存活组，采用呼吸机辅助、CRRT及静脉-动脉体外膜肺（VA-ECMO）治疗的患者数多于存活组，而IABP支持时间低于存活组（P均＜0.05）。Logistic回归分析提示白细胞计数升高及高SOFA评分是院内死亡的独立危险因素（OR=1.142、1.572，95%CI：1.058~1.234、1.204~2.052，P均=0.001），而手术是院内死亡的独立保护因素（OR=0.008，95%CI：0.001~0.091，P＜0.001）。VSR接受手术的比例高于FWR组（P＜0.001），且存活率更高（P=0.001）。结论：白细胞计数及SOFA评分可能与患者院内死亡相关，手术治疗可改善VSR患者预后，VSR存活率高于FWR。 |
| 英文摘要: |
| Abstra Objective: To analyze the risk factors of in-hospital death in patients with cardiac rupture (CR) after acute myocardial infarction (AMI) . Method: Clinical data of 174 patients with CR (including free wall rupture and ventricular septal rupture) after AMI were retrospectively collected and divided into death group (108 cases) and survival group (66 cases). The baseline data characteristics of the two groups were compared, and the risk factors of hospital death were analyzed by Logistic regression. At the same time, the operation and death of different rupture sites were compared. Results: The proportion of patients with anterior myocardial infarction and operation in death group was lower than that in survival group (P=0.041 or P< 0.001), and SOFA score was higher than that in survival group (P<0.001). The proportions of anterior myocardial infarction,leftanterior descending and right coronary artery, continuous renal replacement therapy (CRRT), IABP, operation and survival rate in VSR group were higher than those in FWR group (all P< 0.05), and the proportions of ventilator assistance and leftcircumflex were lower than those in FWR group (all P< 0.05). The white blood cell count, cardiac troponin I (cTnI) and lactic acid levels in the death group were higher than those in the survival group, and the number of patients treated with ventilator-assisted, CRRT and veno-arterial extracorporeal membrane lung (VA-ECMO) was higher than that in the survival group, while the IABP support time was shorter than that in the survival group (all P< 0.05). Logistic regression analysis indicated that elevated white blood cell count and high SOFA score were independent risk factors for in-hospital death (OR=1.142,1.572,95%CI: 1.058-1.234,1.204-2.052,P=0.001), while surgery was an independent protective factor for in-hospital death (OR=0.008, 95%CI: 0.001-0.091, P<0.001). VSR underwent surgery at a higher rate than FWR (P<0.001) and had a higher survival rate (P=0.001). Conclusion: WBC count and SOFA score may be related to hospital death. Surgical treatment can improve the prognosis of VSR patients, and the survival rate of VSR patients is higher than that of FWR. |
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