Westaby S, Parry A, Ormerod O, Gooneratne P, Pillai R
Oxford Heart Centre, John Radcliffe Hospital, Headington, England.
J Thorac Cardiovasc Surg. 1992 Dec;104(6):1506-9.
We studied all patients with postinfarction ventricular septal rupture referred to the Oxford Heart Centre for operation over a 4 1/2-year period. Twenty one women and 8 men were admitted to the Centre, 13 of whom had received streptokinase and 16 of whom had not. The median interval between symptomatic onset of myocardial infarction and the development of septal rupture was 24 hours for those treated by early thrombolysis (all streptokinase) and six days for those who were not. Of the 26 patients who underwent surgical repair, three were operated on less than 36 hours after streptokinase infusion, in one case within 12 hours of thrombolytic treatment. Macroscopic observation of the disintegrating myocardium showed muscle bundles dissected by blood rendered incoagulable by thrombolytic treatment, together with the histologic features of reperfusion injury. The overall surgical mortality rate for the streptokinase group was 33% and for the others 21%. The patient operated on within 12 hours of thrombolytic treatment recovered uneventfully. Six of seven surgical deaths were caused by left ventricular or biventricular failure and one by gastrointestinal hemorrhage. All survivors were in New York Heart Association classes II or III between 2 weeks and 4 1/2 years after operation. We conclude that thrombolysis leads to early breakdown of the interventricular septum after acute myocardial infarction but does not preclude early repair.
我们研究了在4年半的时间里转诊至牛津心脏中心接受手术的所有心肌梗死后室间隔破裂患者。该中心收治了21名女性和8名男性，其中13人接受了链激酶治疗，16人未接受。对于早期溶栓治疗（均为链激酶）的患者，从心肌梗死症状发作到室间隔破裂发生的中位间隔时间为24小时，而未接受溶栓治疗的患者为6天。在接受手术修复的26例患者中，3例在输注链激酶后不到36小时接受手术，其中1例在溶栓治疗后12小时内接受手术。对正在解体的心肌进行宏观观察发现，肌束被溶栓治疗后无法凝固的血液分割，同时伴有再灌注损伤的组织学特征。链激酶治疗组的总体手术死亡率为33%，其他组为21%。在溶栓治疗后12小时内接受手术的患者顺利康复。7例手术死亡中有6例是由左心室或双心室衰竭引起，1例由胃肠道出血引起。所有幸存者在术后2周 至4年半的时间里心功能均为纽约心脏协会II级或III级。我们得出结论，溶栓治疗会导致急性心肌梗死后室间隔早期破裂，但并不妨碍早期修复。
