王学文,钟建利,鄢华,蔡建华,宋丹,苏晞

• 1:武汉亚洲心脏病医院心内科
• 2:武汉亚洲心脏病医院急诊科

摘要(Abstract)：

目的比较介入封堵及外科手术治疗两种方法在急性心肌梗死合并室间隔穿孔(PIVSR)患者中应用的效果,探索最佳治疗方法及手术时机。方法回顾2012年1月至2018年12月武汉亚洲心脏病医院PI-VSR的患者资料,分析介入封堵与外科手术治疗的疗效。结果共纳入PI-VSR患者66例,其中18例为介入封堵组,2例因位置或破口面积太大不适合封堵,改行外科手术;22例为外科手术组;26例为药物治疗组。66例患者平均年龄(66.48±9.91)岁,其中男37例(57.8%),女29例(42.2%)。造影提示:左前降支闭塞58例,右冠状动脉闭塞8例。介入封堵组与外科手术组比较:术后穿孔大小[(0.4±0.1)cm比(0.5±0.2)cm,P=0.816];穿孔至手术时间[(20.8±5.4)d比(29.9±4.9)d,P=0.524],急性心肌梗死(AMI)至手术时间[(20.4±5.0)d比(31.6±4.8)d,P=0.061],入院至手术时间[(16.4±5.1)d比(18.6±1.6)d,P=0.675],术后住院时间[(10.8±7.9)d比(16.6±2.7)d,P=0.653];主动脉内球囊反搏(IABP)使用率(50.0%比68.2%,P=0.135),IABP使用时间[(7.1±7.3)d比(12.9±2.7)d,P<0.001]。术前左心室射血分数(LVEF)[(41.2±5.6)%比(41.9±5.0)%,P=0.002],术后LVEF[(45.6±4.4)%比(42.2±6.5)%,P=0.264]。介入封堵组患者与药物治疗组患者有效率比较(88.9%比7.7%,P<0.001),外科手术组患者与药物治疗组患者有效率比较(86.4%比7.7%,P<0.001),差异均有统计学意义;但是介入封堵组患者与外科手术组患者有效率比较(88.9%比86.4%,P=0.598),差异无统计学意义。结论介入封堵治疗与外科手术治疗相比,介入封堵治疗PI-VSR是安全、有效的,创伤较小,住院时间明显减少。药物治疗效果较差。因此,积极的介入封堵治疗或者外科手术治疗,可降低死亡率,改善预后。

关键词(KeyWords)： 急性心肌梗死合并室间隔穿孔;介入封堵治疗;外科手术;室间隔封堵

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 王学文,钟建利,鄢华,蔡建华,宋丹,苏晞

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