【摘要】 目的:探讨急性心肌梗死(AMI)后发生室间隔穿孔(VSR)的临床特征、治疗方法及其预后。方法:对20例AMI并发VSR患者的临床资料进行回顾性分析。结果:20例患者中,男12例,女8例,平均年龄(65.5±19.5)岁,14例有原发性高血压,8例有吸烟史;所有患者均无陈旧性心肌梗死病史,16例无心绞痛病史,17例有前壁心肌梗死;15例VSR发生于心肌梗死后1周内,其中3例发生在溶栓后,1例发生在PCI术后第1天;所有病例均经超声心动图证实,穿孔直径范围6～28mm,17例位于室间隔近心尖部;12例前壁心肌梗死患者施行了冠状动脉造影,其中2例未见明显狭窄,其余10例前降支闭塞或重度狭窄;20例患者均给予药物治疗,12例药物治疗的同时给予主动脉内球囊反搏(IABP)支持,3例行介入封堵术,2例行外科手术治疗,均存活,余15例死亡。结论:AMI并发室间隔破裂并不常见,但一旦发生多数迅速发展至心源性休克,内科治疗病死率很高,常规药物治疗联合IABP支持维持患者血流动力学稳定2～3周后再行介入或手术治疗,可提高生存率。更多还原

【Abstract】 Objective:To explore the clinical features,treatment and outcomes in patients with ventricular septal rupture(VSR)complicating acute myocardial infarction(AMI).Method:The clinical experience and data of 20 post-infarct VSR patients were retrospectively anlysed.Result:Among the 20patients,12(60%)were males and 6(40%)were females,average aged was(65.5±19.5).Fourteen(70%)cases had hypertention and 8(40%)had smoking history.All patients had not myocardial infarction history,and 16(80%)had not angina pectoris history.Anterior wall infarction was in 17(85%).The majority(75%)of ventricular septal ruture occurred within the first seven days.Coronary angiography were performed in 12patients with anterior acute myocardial infarction.Ten patients had LAD occlusion.Surgery or transcatheter closure was respectively performed in 5patients,and all were survival.Last 15(70%)patients died.Conclusion:VSR complicating AMI is uncommon.The mortality remains extremely high in patients with medical therapy.Surgery treatment(repair or transcatheter closure) after maintaining the patients′hemodynamic stable for 2～3weeks by medical therapy and the support of IABP,can improve the survival rate.更多还原