目的:总结急性心肌梗死(AMI)合并室间隔穿孔(VSR)患者的临床特点及预后.方法:我院2002-01到2010-09间收治的AMI患者共12 354例,其中合并VSR患者 70例占收治AMI患者的0.57%,其中男33例(47.1%),女37(52.9%),平均年龄(68.1±8.5)岁.对这70例AMI合并VSR患者的临床资料进行回顾性分析.结果:70例AMI合并VSR患者,继发于前壁心肌梗死者54例(77.1%).VSR患者30天死亡率为55.7%,1年死亡率为64.3%;保守治疗49例,30天死亡率为77.6%,1年死亡率为87.8%;手术治疗21例,30天死亡率为4.8%,1年死亡率为9.5%;接受手术治疗患者的30天及1年死亡率均显著优于接受保守治疗患者(P<0.005).仅1例AMI后6天行急诊手术治疗的患者于围术期死亡,所有AMI后2周以上行外科手术治疗的患者均好转出院.结论:VSR是AMI少见但严重的并发症,手术治疗的近期及远期预后均显著优于保守治疗,AMI后2周以上行外科手术治疗成功率高,对于强化内科保守治疗后仍出现血流动力学不稳定、预计不能存活至AMI后4~6周的危重患者,可适当提前外科手术时间,以挽救更多患者的生命.%Objective: To summarize the clinical characteristics and prognosis in patients of acute myocardial infarction (AMI) combined with ventricular septal rupture (VSR).rnMethods: There were 12354 AMI patients treated in our hospital from January 2002 to October 2010, and 70 (0.57%) of them combined with VSR including 33 (47.1%) male and 37 (52.9%) female, with the mean age of ( 68.1 ± 8.5 ) years. We retrospectively analyzed those 70 patients for their clinical characteristics.rnResults: There was 54/70 (77.1%) VSR patients followed by acute anterior myocardial infarction. The overall 30-day mortality in VSR patients was 55.7%, and 1-year mortality was 64.3%. There were 49 patients received conservative treatment, and their 30-day mortality was 77.6%, 1-year mortality was 87.8%. 21 patients had surgical treatment, and their 30-day mortality was 4.8%, 1-year mortality was 9.5%. The patients with surgical treatment presented much better mortality than those with conservative treatment, P<0.005. 1 patient died at peri-operative period who received emergency surgery at 6 days after AMI. All patients with the surgery at 2 weeks after AMI were getting better and discharged.rnConclusion: VSD is an infrequent but devastating complication of AMI. Surgical repair had better outcome than conservative treatment; the higher success rate might be obtained by surgery at 2 weeks after AMI. The earlier operation could be performed in high risk patients for saving more live.
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