Held A C, Cole P L, Lipton B, Gore J M, Antman E M, Hockman J S, Corrao J, Goldberg R J, Alpert J S
University of Massachusetts Medical School, Worcester.
Am Heart J. 1988 Nov;116(5 Pt 1):1330-6. doi: 10.1016/0002-8703(88)90458-9.
Acute ventricular septal rupture in the setting of acute myocardial infarction continues to present clinicians with a difficult therapeutic dilemma. The role of surgical intervention and its timing remains unresolved. A collaborative study from three institutions was undertaken to examine various clinical outcomes in 46 patients with ventricular septal rupture. No medically treated patient survived hospitalization. Since only surgically treated patients survived, we focused our evaluation on those characteristics that might differentiate surgical survivors from surgical nonsurvivors. Systolic blood pressure, pulse, mean right atrial pressure, left ventricular systolic pressure, and cardiopulmonary bypass time were univariate predictors of hospital survival. Multivariate analysis revealed that systolic blood pressure, right atrial pressure, and cardiopulmonary bypass time were strongly predictive of survival (p less than 0.05). In addition, taken together systolic blood pressure and right atrial pressure identified a group of persons who wee much more likely to survive surgical intervention. The results of this study may prove useful in predicting the risk of surgical repair in patients with ventricular septal rupture.
急性心肌梗死背景下的急性室间隔破裂，仍然给临床医生带来了艰难的治疗困境。手术干预的作用及其时机仍未解决。来自三个机构的一项合作研究对46例室间隔破裂患者的各种临床结局进行了检查。没有接受药物治疗的患者存活至出院。由于只有接受手术治疗的患者存活下来，我们将评估重点放在那些可能区分手术幸存者和非手术幸存者的特征上。收缩压、脉搏、平均右心房压力、左心室收缩压和体外循环时间是住院生存的单因素预测指标。多因素分析显示，收缩压、右心房压力和体外循环时间是生存的强预测指标（p小于0.05）。此外，收缩压和右心房压力共同确定了一组更有可能在手术干预后存活的人群。这项研究的结果可能有助于预测室间隔破裂患者手术修复的风险。
