摘要
目的 观察急性心肌梗死(AMI)合并室间隔穿孔(VSR)患者的临床特征及分析影响短期预后的相关因素.方法 纳入空军军医大学第一附属医院 2010年 1月～2023年 6月因急性心肌梗死合并室间隔穿孔住院患者87例,根据不同标准将研究对象划分为好转组(n=46)与死亡组(n=41)或药物保守组(n=70)与手术干预组(n=17).对其临床资料进行回顾性分析,对比院内生存组及死亡组,分析影响短期预后的因素.结果 与好转组比较,死亡组男性比例低(P<0.05)、吸烟史比例低(P<0.05)、穿孔大小数值低(P<0.05)、谷草转氨酶数值高(P<0.01)、谷丙转氨酶数值高(P<0.05)、肌酐数值高(P<0.05)、肌钙蛋白I数值高(P<0.01)、NT-proBNP数值高(P<0.05)、住院时间长(P<0.01)、合并心源性休克比例高(P<0.01),且外科手术比例低(P<0.05).手术干预组与药物保守组比较,明显改善短期预后情况:好转率高,死亡率低,两组比较有统计学意义(P<0.05).Logistic回归分析显示心源性休克是VSR患者发生短期内死亡的独立危险因素.结论 急性心肌梗死合并室间隔穿孔患者多数预后不良,女性、多脏器功能衰竭者死亡率高.心源性休克是VSR患者发生短期内死亡的独立危险因素,适时选择手术能改善短期预后.
Abstract
AIM To observe the clinical data of patients with ventricular septal rupture(VSR)after acute myocardial infarction(AMI),and to analyze short-term prognosis and related factors of these patients.METHODS 87 hospitalized patients with acute myocardial infarction complicated with ventricular septal perforation were included in the First Affiliated Hospital of Air Force Military Medical University from January 2010 to June 2023.According to different criteria,the study subjects were divided into an improvement group(n=46)and a death group(n=41),or a drug conservative group(n=70)and a surgical intervention group(n=17).Retrospective analysis of clinical data,comparison of in-hospital survival and death groups,and analysis of factors affecting short-term prognosis.RESULTS Compared with the improvement group,the proportion of males in the death group was lower(P<0.05),the proportion of smoking history was lower(P<0.05),the perforation size value was lower(P<0.05),the aspartate aminotransferase value was higher(P<0.01),the alanine aminotransferase value was higher(P<0.05),the creatinine value was higher(P<0.05),the troponin I value was higher(P<0.01),the NT proBNP value was higher(P<0.05),the length of hospital stay was longer(P<0.01),and the proportion of concomitant cardiogenic shock was higher(P<0.01),And the proportion of surgical operations is low(P<0.05).Compared with the drug conservative group,the surgical intervention group significantly improved the short-term prognosis:the improvement rate was high,the mortality rate was low,and the comparison between the two groups was statistically significant(P<0.05).Logistic regression analysis shows that cardiogenic shock is an independent risk factor for short-term mortality in VSR patients.CONCLUSION Most patients with acute myocardial infarction and ventricular septal rupture have a poor prognosis,and women and patients with multiple organ failure have high mortality.Cardiogenic shock is an independent risk factor for short-term mortality in VSR patients,and timely selection of surgery can improve short-term prognosis.
基金项目
咸阳市科技局项目(2021ZDYF-SF-045)
NETL
NSTL
万方数据