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目的分析急性心肌梗死(AMI)后并发心脏破裂(CR)患者的一般资料、临床特征、早期诊断、防治方法以及预后等,以期寻找预防CR的有效手段。方法选取2011年8月至2015年12月解放军306医院心血管内科收治的AMI患者1 639例为研究对象。其中,经超声证实为CR的患者15例设为A组,其余1 624例非CR患者设为B组,比较并分析两组患者的一般资料、治疗情况等。结果 CR女性患者的发生率高于男性(P<0.05);CR患者70岁以上比例明显高于70岁以下者(P<0.05);CR患者体质量指数(BMI)<19 kg/m~2者高于BMI>19 kg/m~2者(P<0.05);合并高血压、糖尿病的患者较易发生CR。CR患者中左心室游离壁破裂者13例(86.7%),室间隔穿孔者2例(13.3%);15例患者中诊断为急性非ST段抬高型心肌梗死者1例(6.7%),急性ST段抬高型心肌梗死者14例(93.3%),其中,以前壁以及广泛前壁心肌梗死10例(66.7%)、下壁+正后壁(或同时合并右室)4例(26.7%)。结论 CR是AMI在临床中致命性的并发症,抢救成功率低;高龄、低体质量、女性、前壁心肌梗死等均是CR的易发因素;床旁心动超声图有助于早期诊断,积极的再灌注治疗是预防CR的有效手段。
Objective To analyze the general information, clinical features, early diagnosis, prevention and treatment and prognosis of patients with acute myocardial infarction (AMI) complicated with heart rupture (CR) in order to find an effective means of preventing CR. Methods A total of 1 639 AMI patients admitted to Department of Cardiology, 306 Hospital of PLA from August 2011 to December 2015 were selected as the study objects. Among them, 15 cases were confirmed as CR by ultrasound group A, the other 1 624 non-CR patients were set as group B, the two groups were compared and analyzed the general information, treatment and so on. Results The incidence of CR in women was higher than that in men (P <0.05). The proportion of patients with CR over 70 years old was significantly higher than those under 70 years old (P <0.05). The body mass index (BMI) Were higher than BMI> 19 kg / m ~ 2 (P <0.05); patients with hypertension and diabetes were more likely to develop CR. In CR patients, 13 cases (86.7%) had ruptured left ventricular free wall and 2 cases (13.3%) had ventricular septal perforation. One case (6.7%) of 15 patients were diagnosed as acute non ST-segment elevation myocardial infarction There were 14 cases (93.3%) of acute ST-segment elevation myocardial infarction, including 10 cases (66.7%) of anterior wall and extensive anterior myocardial infarction, 4 cases of inferior wall + posterior wall combined with right ventricle (26.7 %). Conclusion CR is a fatal complication of AMI in clinical practice. The success rate of rescue is low. Elderly, low body weight, female and anterior myocardial infarction are all risk factors for CR. Bedside echocardiography is helpful for early diagnosis, Active reperfusion therapy is an effective means of preventing CR.