發(fā)布時(shí)間：2018-05-31 15:18

  本文選題：急性ST段抬高型心肌梗死 + 心臟破裂�。� 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的分析急性ST段抬高型心肌梗死(ST-elevation myocardial infarction,STEMI)患者并發(fā)心臟破裂(cadiac rupture,CR)的臨床特點(diǎn),探索STEMI后CR的危險(xiǎn)因素,探究臨床防治措施。方法連續(xù)入選于2014年1月至2016年12月期間就診于吉林大學(xué)第一醫(yī)院心血管疾病診療中心并診斷為STEMI并發(fā)CR患者共112例,定義為破裂組,按照1:3匹配原則,匹配條件為相同性別及年齡±1歲,隨機(jī)選取與CR組同年入院且未發(fā)生心臟破裂的336例STEMI患者作為非破裂組,記錄入選患者在院期間一般資料、檢驗(yàn)檢查結(jié)果、病情變化、冠脈造影情況以及治療情況,對(duì)STEMI后CR患者臨床特點(diǎn)進(jìn)行總結(jié),利用統(tǒng)計(jì)學(xué)分析發(fā)現(xiàn)STEMI后CR的危險(xiǎn)因素。結(jié)果1、3年間ST段抬高型心肌梗死患者共6007例,并發(fā)CR患者共112例,STEMI后CR發(fā)病率為1.9%,其中FWR共82例(71.9%),VSR共31例(27.2%),PMR共1例(0.9%),兩例患者在院期間先后發(fā)生VSR、FWR。112例STEMI合并CR患者平均年齡為(68.9±9.74)歲,其中男性52人,女性60人。2、STEMI患者發(fā)生CR前常常存在誘因,包括用力排大小便,劇烈惡心、嘔吐,情緒激動(dòng),反復(fù)胸痛等。3、CR多發(fā)生在STEMI起病1周內(nèi),本研究中91%的CR發(fā)生在STEMI起病一周內(nèi)。其中24小時(shí)內(nèi)發(fā)生CR患者共61人,占總?cè)藬?shù)54%,3~5天發(fā)生CR患者共25人,占總?cè)藬?shù)22%。4、STEMI并發(fā)CR患者中,急性前壁心肌梗死患者共63例,其中出現(xiàn)FWR共52例(81.2%),出現(xiàn)VSR共12例(18.8%),1例患者同時(shí)發(fā)生FWR、VSR。急性下壁心肌梗死患者共35例,其中出現(xiàn)FWR共21例(60%),出現(xiàn)VSR共13例(37.1%),出現(xiàn)pmr共1例(2.9%)。急性前壁心肌梗死合并下壁心肌梗死患者共9例,其中出現(xiàn)fwr共4例(40%),出現(xiàn)vsr共6例(60%),1例患者同時(shí)發(fā)生fwr、vsr。急性側(cè)壁心肌梗死患者共5例,均為fwr。5、兩組單因素分析中,(1)基本資料方面,心臟破裂組與非心臟破裂組性別比例相同、年齡相近。cr組患者既往高血壓病史、糖尿病病史、腦卒中病史的比例高于非cr組(p0.05),既往心肌梗死病史、吸煙史比例低于非cr組(p0.05)。(2)入院后常規(guī)檢驗(yàn)方面,cr組患者白細(xì)胞計(jì)數(shù)、中性粒細(xì)胞計(jì)數(shù)、中性粒細(xì)胞百分比、單核細(xì)胞計(jì)數(shù)、隨機(jī)血糖、凝血酶原時(shí)間、門冬氨酸氨基轉(zhuǎn)移酶、丙氨酸氨基轉(zhuǎn)移酶、γ-谷氨酰轉(zhuǎn)肽酶、總膽紅素、直接膽紅素、空腹血糖水平高于對(duì)照組(p0.05),而嗜酸性粒細(xì)胞計(jì)數(shù)、淋巴細(xì)胞百分比、血清鈉離子水平低于對(duì)照組(p0.05)。(3)心肌梗死相關(guān)情況方面,cr患者入院收縮壓低于對(duì)照組(p0.05),cr組患者入院后心率、肌鈣蛋白i峰值、d-二聚體、bnp、前壁心肌梗死比例、killip分級(jí)iii級(jí)~iv級(jí)比例、心肌梗死后反復(fù)胸痛比例高于對(duì)照組(p0.05)。(4)冠脈造影結(jié)果方面,非cr組有較好的側(cè)支循環(huán)(p0.05)。(5)治療方面,非cr組使用指南推薦藥物及直接經(jīng)皮冠狀動(dòng)脈介入治療(primarypercutaneouscoronaryintervention,ppci)均較cr組更加完善(p0.05)。6、應(yīng)用條件logistic進(jìn)行多因素分析,結(jié)果顯示入院低收縮壓(or=0.984,95%ci:0.975~0.994)、入院心率快(or=1.021,95%ci:1.007~1.037)、心肌梗死后反復(fù)胸痛(or=11.947,95%ci:3.639~39.218)、白細(xì)胞計(jì)數(shù)升高(or=1.105,95%ci:1.03~1.185)、中性粒細(xì)胞百分比升高(or=17.089,95%ci:1.216~240.221)是stemi患者并發(fā)cr的獨(dú)立危險(xiǎn)因素。結(jié)論1、stemi后cr的發(fā)病率為1.9%,并不多見,其中左室游離壁破裂比較常見。2、cr多發(fā)生在stemi起病1周內(nèi),其中兩個(gè)高發(fā)時(shí)間分別為起病24小時(shí)內(nèi)及起病后3~5天。3、stemi并發(fā)cr的危險(xiǎn)因素包括入院低收縮壓、心率快、心肌梗死后反復(fù)胸痛、白細(xì)胞計(jì)數(shù)升高、中性粒細(xì)胞百分比升高。
[Abstract]:Objective to analyze the clinical characteristics of cardiac rupture (cadiac rupture, CR) in patients with acute ST segment elevation myocardial infarction (ST-elevation myocardial infarction, STEMI), to explore the risk factors of CR in STEMI after STEMI, and to explore the clinical prevention and treatment measures. Methods to be selected from January 2014 to December 2016 to visit the cardiovascular system of No.1 Hospital of Jilin University. The center of disease diagnosis and treatment was diagnosed as 112 cases of STEMI complicated with CR, defined as the rupture group. According to the 1:3 matching principle, the matching conditions were the same sex and age of 1 years, and 336 cases of STEMI patients who were admitted to the same year with the CR group without rupture of the heart were selected as the non rupture group, and the general data of the hospitalized patients were recorded and the results were tested. The clinical features of patients with CR after STEMI were summarized, and the risk factors of CR after STEMI were analyzed by statistical analysis. Results there were 6007 cases of ST segment elevation myocardial infarction in 1,3, 112 cases with CR patients and 1.9% of CR incidence after STEMI, of which 82 cases (71.9%) were FWR, 27.2% (27.2%), 27.2% (27.2%). 27.2% PMR 1 cases (0.9%), two patients had VSR during the hospital, and the average age of FWR.112 STEMI combined with CR was (68.9 + 9.74) years old, of which 52 men and 60 women were.2, and STEMI patients were often induced before CR, including severe bowel movement, severe nausea, vomiting, emotional excitement, repeated chest pain and.3, CR more occurring in STEMI 1 weeks. Within this study, 91% of the CR occurred within one week of the onset of STEMI. Among them, 61 were CR patients in 24 hours, the total number was 54%, and CR patients were 25, accounting for 22%.4, and 63 cases of acute anterior wall myocardial infarction in STEMI complicated with CR patients. There were 52 cases (81.2%) with FWR, 12 cases in 18.8% (18.8%), and 1 patients simultaneously FW. There were 35 cases of acute lower wall myocardial infarction in R and VSR., of which there were 21 cases of FWR (60%), 13 cases (37.1%) and 1 cases of PMR (2.9%). There were 9 cases of acute anterior wall myocardial infarction combined with inferior wall myocardial infarction, of which there were 4 cases of FWR (40%), 6 (60%) occurred in VSR, FWR in 1 cases, and acute side wall myocardial infarction in vsr. patients. For example, fwr.5, two groups of single factor analysis, (1) basic data, the heart rupture group and the non heart rupture group had the same sex ratio. The history of hypertension, the history of diabetes and the history of stroke were higher than that of the non CR group (P0.05). The history of myocardial infarction was lower than that of the non CR group (P0.05). (2) admission to hospital. (2) admission to hospital. In the routine test, the leukocyte count, neutrophils count, neutrophils percentage, mononuclear cell count, random blood sugar, prothrombin time, aspartate aminotransferase, alanine aminotransferase, gamma glutamyl transpeptidase, total bilirubin, direct bilirubin, and fasting blood glucose level were higher than those of the control group (P0.05) in the CR group. The level of acid granulocyte count, lymphocyte percentage and serum sodium ion were lower than that of the control group (P0.05). (3) the systolic pressure of Cr patients was lower than that of the control group (P0.05). The heart rate, the peak of cardiac troponin I, the d- two polymer, the proportion of BNP, the anterior wall myocardial infarction, the III grade ~iv grade ratio of Killip classification, the myocardial infarction in the CR group were lower than the control group (P0.05). The proportion of postoperative recurrent chest pain was higher than that of the control group (P0.05). (4) the results of coronary angiography, non CR group had better collateral circulation (P0.05). (5) the treatment, non CR guidelines recommended drugs and direct percutaneous coronary intervention (primarypercutaneouscoronaryintervention, PPCI) were more perfect than the CR group (P0.05).6, the application of logistic. Multifactor analysis showed low systolic pressure (or=0.984,95%ci:0.975~0.994), fast hospitalization heart rate (or=1.021,95%ci:1.007~1.037), repeated chest pain (or=11.947,95%ci:3.639~39.218) after myocardial infarction, increased leukocyte count (or=1.105,95%ci:1.03~1.185), and increased neutrophil percentage (or=17.089,95%ci:1.216~240.221) was ste. Conclusion the incidence of Cr in MI patients was 1, and the incidence of Cr after STEMI was 1.9%. The left ventricular wall rupture was common.2 and Cr occurred more than 1 weeks in the onset of STEMI, and two of the high onset times were 24 hours of onset and 3~5 days after onset respectively. The risk factors for STEMI and Cr were low systolic pressure and fast heart rate. Repeated chest pain after myocardial infarction increased white blood cell count and increased neutrophil percentage.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R542.22

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