心肌梗死急性期心包摩擦音的发生频率及临床意义

Frequency and clinical significance of pericardial friction rubs in the acute phase of myocardial infarction.

作者信息

Dubois C, Smeets J P, Demoulin J C, Pierard L, Henrard L, Preston L, Kulbertus H E

出版信息

Eur Heart J. 1985 Sep;6(9):766-8. doi: 10.1093/oxfordjournals.eurheartj.a061938.

DOI:10.1093/oxfordjournals.eurheartj.a061938

Abstract

An early pericardial friction rub was noted in 23.4% of a population of 1264 consecutive patients admitted with acute myocardial infarction. The incidence of the rub did not vary with age, sex or past cardiac history. The pericardial rub, however, was more often a complication of Q- than non-Q-wave infarcts (25.5% vs 10.5%, P greater than 0.001) and of anterior than inferior infarcts (35.3% vs 20.8%, P greater than 0.001). In comparing the 297 patients with a pericardial rub to the 967 others, we noted that the former group had a higher CK peak (1706 +/- 1110 UI l-1 vs 1189 +/- 1038 UI l-1, P greater than 0.001) and a higher incidence of Killip class greater than 1 (47.5% vs 33.2%, P greater than 0.001), atrial flutter or fibrillation (22.2% vs 9.3%, P greater than 0.001), second or third degree atrioventricular blocks (16.8% vs 9.4%, P greater than 0.001) and complete bundle branch block (14.5% vs 7.1%, P greater than 0.001). In spite of this, the development of a pericardial rub did not increase the in-hospital mortality (10.8% in patients with pericardial rub; 11.3% in those without).

摘要

在连续收治的1264例急性心肌梗死患者中，23.4%的患者出现了早期心包摩擦音。摩擦音的发生率与年龄、性别或既往心脏病史无关。然而，心包摩擦音更常发生于Q波梗死而非非Q波梗死（25.5%对10.5%，P>0.001），以及前壁梗死而非下壁梗死（35.3%对20.8%，P>0.001）。在将297例有心包摩擦音的患者与967例其他患者进行比较时，我们发现前一组患者的肌酸激酶（CK）峰值更高（1706±1110 UI l-1对1189±1038 UI l-1，P>0.001），Killip分级大于1级的发生率更高（47.5%对33.2%，P>0.001），房扑或房颤的发生率更高（22.2%对9.3%，P>0.001），二度或三度房室传导阻滞的发生率更高（16.8%对9.4%，P>0.001），以及完全性束支传导阻滞的发生率更高（14.5%对7.1%，P>0.001）。尽管如此，心包摩擦音的出现并未增加住院死亡率（有心包摩擦音的患者为10.8%；无心包摩擦音的患者为11.3%）。