摘要
目的 分析急性心肌梗死（AMI）合并心脏破裂（CR）患者的临床特征,探讨影响AMI合并CR存活时间的危险因素.方法 回顾性分析2009年4月至2015年3月广东省人民医院75例确诊为AMI合并左室游离壁破裂（FWR）、室间隔穿孔（VSR）患者的临床资料,将患者按存活时间分为〈30 d组（42例）和≥30 d组（33例）.分析两组患者的临床特征;绘制受试者工作特征曲线（ROC曲线）,分析各指标对患者30 d存活时间的预测价值.结果 存活时间〈30 d组女性患者数（25例比0）及未合并糖尿病患者数（36例比21）明显多于存活时间≥30 d组（均P〈0.05）.所以女性、未合并糖尿病为AMI后CR近期死亡的危险因素.存活时间≥30 d组罪犯血管为右冠状动脉（RCA）并及时行经皮冠脉介入治疗（PCI）术的患者数明显多于存活时间〈30 d组（11例比4例,P〈0.05）.所以罪犯血管为RCA及时行PCI术是近期存活的保护因素.ROC曲线分析显示,AMI女性、合并糖尿病和罪犯血管为RCA对患者存活时间有一定的预测价值,其ROC曲线下面积（AUC）及95%可信区间（95%CI）分别为0.798（0.696-0.899）、0.592（0.542-0.743）和0.647（0.500-0.794）,敏感度、特异度分别为34.6%、16.1%及42.3%、12.9%,均P〈0.05.结论 女性、未合并糖尿病为AMI并发CR近期死亡的危险因素,而AMI并发CR时罪犯血管为RCA者,应尽早行PCI,可提高患者30 d存活率.
Objective To investigate the clinical characteristics of patients with acute myocardial infarction （AMI） complicated with cardiac rupture （CR） and to explore the risk factors for the survival time of AMI combined with CR. Methods A retrospective study was conducted. The clinical data of 75 hospitalized patients with the confirmed diagnosis of AMI combined with free wall rupture （FWR） or ventricular septal rupture （VSR） admitted to Guangdong General Hospital from April 2009 to March 2015 were collected. They were divided into a survival ＆lt; 30-day group （42 cases） and a survival ≥ 30-day （33 cases） group, and their clinical characteristics were analyzed. Receiver operating characteristic curve （ROC curve） was drawn, and the predictive value of each indicator for the patient＆#39;s 30-day survival time was analyzed. Results The number of female patients （25 cases vs. 0 case） and the number of patients without diabetes （36 cases vs. 21 cases） in the survival 〈30-day group were significantly higher than those in survival ≥ 30-day group （all P〈 0.05）. Therefore, both female and without diabetes were risk factors for the recent death of AMI complicated with CR. In the survival ≥ 30-day group, the number of patients with right coronary artery （RCA） lesions and immediately undergoing early percutaneous coronary intervention therapy （PCI） was significantly higher than that in survival ＆lt; 30-day group （11 cases vs. 4 cases, P〈0.05）. Therefore, the RCA lesion and immediately undergoing early PCI therapy was a recent survival protective factor. ROC curve analysis showed that AMI female and combined with diabetes and lesions in RCA had a certain predictive value for survival time of the patients, the area under ROC curve （AUC） and 95% confidence interval （95%CI） were 0.798 （0.696-0.899）, 0.592 （0.542-0.743） and 0.647 （0.500-0.794） respectively, sensitivity and specificity were 34.6%, 16.1% and 42.3% and 12.9% respectively, all P〈 0.05. Conclusions Women and without diabetes are the risk factors of recent death of AMI complicated by CR, and in patients with AMI complicated with CR and the involved lesion being RCA, PCI therapy should be performed as early as possible that may elevate the 30-day survival rate for the patients.
作者
吕明芳
薛凌
杨雪苹
陈少辉
符传东
陈纪言
Lyu Mingfang Xue Ling Yang Xueping Chen Shaohui Fu Chuandong Chen Jiyan(Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China Department of Cardiology, The Eighth People＇s Hospital of Guangzhou, Guangzhou 510060, Guangdong, China Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou 510440, Guangdong China）.)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2017年第5期477-480,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
广东省广州市科技计划项目（201300000180）.
关键词
心肌梗死
急性
心脏破裂
临床特征
诊断价值
Acute myocardial infarction
Cardiac rupture
Clinical characteristics
Diagnostic value
