Zeng C W, Li X M, Zhou Y, Dai Y, Liu N
Center of Cardiac Intensive Care, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Zhonghua Wai Ke Za Zhi. 2020 Feb 1;58(2):142-146. doi: 10.3760/cma.j.issn.0529-5815.2020.02.013.
To examine the mortality rate and relative factors associate with ventricular septal rupture in myocardial infarction patients. A total of 51 patients who suffered from myocardial infarction complicating with ventricular septal rupture received operative procedures between January 2005 and December 2018 in Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, were retrospectively analyzed. There were 34 males and 17 females, with an age of (63±8) years (range: 44 to 82 years). The time between ventricular septal rupture and surgical procedure was (44±39) days (range: 3 to 187 days). The test and χ(2) test were used for univariate analysis, Logistics regression model was used for multivariate analysis of in-hospital mortality relative factors. There were 8 patients dead in hospital, 43 patients survived, the overall mortality rate was 15.7% in hospital. The post-operation mortality rate was 2/3 of who suffered ventricular septal rupture and underwent operation within 1 week, but it's markedly decreased to 6.5% if the time over 4 weeks. Univariate analysis showed that renal failure before operation, creatinine before operation, left ventricular ejection fraction, cardiac function (New York Heart Association) grade Ⅳ, severe tricuspid regurgitation, dialysis post-operation, creatinine of the first day of post-operation, the time between and operation more than 4 weeks were in-hospital mortality relative factors. Multivariate analysis reflected that advanced age (1.32, 95: 1.05 to 1.75, 0.033), cardiac function grade Ⅳ (2.25, 95: 1.62 to 2.82, 0.003), severe tricuspid regurgitation ( 1.82, 95: 1.31 to 2.43, 0.001), renal failure before operation (1.78, 95: 1.26 to 2.32, 0.015), the time between ventricular septal rupture and operation less than 1 week (2.50, 95: 1.52 to 2.98, 0.012), were independent in-hospital mortality relative factors. The surgery operation is an effective way to deal with ventricular septal rupture combined with myocardial infarction. The independent relative factors of in-hospital mortality are advanced age, cardiac function grade Ⅳ, renal failure before operation, severe tricuspid regurgitation, the time between ventricular septal rupture and operation less than 1 week.
为研究心肌梗死患者室间隔破裂的死亡率及相关因素。回顾性分析2005年1月至2018年12月在首都医科大学附属北京安贞医院心脏外科接受手术治疗的51例心肌梗死合并室间隔破裂患者。其中男性34例，女性17例，年龄（63±8）岁（范围：44至82岁）。室间隔破裂至手术时间为（44±39）天（范围：3至187天）。采用t检验和χ²检验进行单因素分析，应用Logistic回归模型对院内死亡相关因素进行多因素分析。8例患者院内死亡，43例存活，院内总死亡率为15.7%。术后死亡率在室间隔破裂后1周内接受手术的患者中为2/3，但如果时间超过4周则显著降至6.5%。单因素分析显示术前肾衰竭、术前肌酐、左心室射血分数、心功能（纽约心脏病协会）Ⅳ级、重度三尖瓣反流、术后透析、术后第1天肌酐、室间隔破裂至手术时间超过4周是院内死亡相关因素。多因素分析表明高龄（1.32，95%：1.05至1.75，P = 0.033）、心功能Ⅳ级（2.25，95%：1.62至2.82，P = 0.003）、重度三尖瓣反流（1.82，95%：1.31至2.43，P = 0.001）、术前肾衰竭（1.78，95%：1.26至2.32，P = 0.015）、室间隔破裂至手术时间小于1周（2.50，95%：1.52至2.98，P = 0.012）是独立的院内死亡相关因素。手术是治疗心肌梗死合并室间隔破裂的有效方法。院内死亡的独立相关因素为高龄、心功能Ⅳ级、术前肾衰竭、重度三尖瓣反流、室间隔破裂至手术时间小于1周。
