摘要
目的分析心肌梗死后室间隔穿孔（PI-VSD）患者临床特点，总结经导管介入封堵术治疗效果及预后。方法回顾性分析2009年11月至2013年10月在上海长海医院确诊为PI-VSD患者的临床特征及预后。结果10例PI-VSD患者平均年龄（66．6＋8．51）岁，男女各有5例；伴发高血压病6例，2型糖尿病2例，慢性肾功能不全1例：均有心功能不全表现。7例患者穿孔时间明确，为1-15d不等，中位时间10d：穿孔直径3。19mm。6例患者成功完成介入封堵，其中5例随访期间存活，1例因肺部感染死亡：4例患者未介入封堵，其中3例因心源性休克死亡。介入封堵患者术前、术后平均美国纽约心脏病协会（NYHA）心功能水平分别为3．17±0．75、2．67±0．82，平均左室射血分数分别为（52．0±7．07）％、（61．0±7．72）％，差异均无统计学意义（P=0．296、P=0．062）。结论PI—VSD患者药物治疗预后仍较差，经导管介入封堵术治疗安全可行，有改善患者心功能趋势并降低死亡率，可成为除外科手术外另一选择。
Objective To analyze the clinical features of patients with post-infarction ventricular septal defect （PIVSD）, to summarize the therapeutic effect of transcatheter closure, and to analyze the prognosis. Methods A total of 10 patients with confirmed PIVSD, who were admitted to authors＇ hospital during the period from November 2009 to October 2013, were enrolled in this study. The clinical data, including the clinical features and prognosis, were retrospectively analyzed. Results The mean age of the 10 patients （5 males and 5 females） was （66.6±8.51） years. Hypertension was accompanied in 6 patients, type II diabetes in 2 patients and chronic renal insufficiency in one patient; and signs of cardiac dysfunction were seen in all 10 patients. The onset time of ventricular septal perforation was clear in 7 patients, ranging from one to 15 days, with a median time of 10 days. The diameter of perforation was 3-19 mm. Successful interventional closure therapy was accomplished in 6 patients, among them 5 was survival during follow-up period and one died of pulmonary infection. Four patients did not receive interventional closure therapy, among them 3 died of cardiogenic shock. According to New York heart disease association criteria, the preoperative and postoperative heart function scores and the mean left ventricular ejection fraction in patients who received interventional closure therapy were （3.17±0.75） and （2.67±0.82）, （0.52±7.07）% and （0.61±7.72）% res- pectively. The differences were statistically significant （P=0.452 and P=0.062 respectively）. Conclusion The prognosis of patients with PIVSD who receive medication treatment is poor. For the treatment of PIVSD, transcatheter closure is safe and reliable; this therapy can improve cardiac function and reduce mortality, andit may become an alternative treatment option for surgery.
出处
《介入放射学杂志》
CSCD
北大核心
2016年第2期102-105,共4页
Journal of Interventional Radiology
关键词
急性心肌梗死
室间隔破裂
预后
acute myocardial infarction
ventricular septal rupture
prognosis
