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目的了解升主动脉夹层累及冠状动脉导致急性心肌梗死的临床特征及治疗转归。方法选取2012年3月—2016年3月武汉市中心医院收治的升主动脉夹层患者100例,其中累及冠状动脉导致急性心肌梗死患者8例。术前对患者进行常规检查,并检测血肌酐(Scr)水平和估算肾小球滤过率(e GFR)。根据患者冠状动脉病变范围及类型,给予其冠状动脉旁路移植(CABG)术或修补术。术后转送监护室进行进一步治疗,并记录患者的急性肾衰竭(ARF)发生率和病死率。结果 8例发生急性心肌梗死的患者中,术后存活4例,死亡4例,病死率为50.0%。术后死亡患者的血Scr水平高于存活患者,e GFR低于存活患者,ARF发生率高于存活患者(P<0.05)。92例未发生急性心肌梗死的患者中,存活81例,死亡11例。发生急性心肌梗死患者的病死率高于未发生患者(P<0.05)。结论升主动脉夹层累及冠状动脉导致急性心肌梗死患者的病死率较高,术前肾功能检查可有效指导并改善其转归。
Objective To investigate the clinical characteristics and treatment outcome of ascending aortic dissection involving coronary artery leading to acute myocardial infarction. Methods From March 2012 to March 2016, 100 patients with ascending aortic dissection were treated in Wuhan Central Hospital, including 8 patients with acute myocardial infarction involving the coronary artery. Patients were routinely examined preoperatively, and serum creatinine (Scr) levels and estimated glomerular filtration rate (e GFR) were measured. According to the extent and type of coronary artery lesions in patients with coronary artery bypass grafting (CABG) surgery or repair. The patient was transferred to the care unit for further treatment and the incidence of acute renal failure (ARF) and mortality were recorded. Results Among the 8 patients with acute myocardial infarction, 4 patients survived and 4 patients died, with a mortality rate of 50.0%. The level of Scr in postoperative death patients was higher than those in survivors, and the eGFR was lower than those in survivors. The incidence of ARF was higher than that in survivors (P <0.05). Of the 92 patients without acute myocardial infarction, 81 survived and 11 died. Patients with acute myocardial infarction mortality was higher than no patient (P <0.05). Conclusion The mortality of patients with acute myocardial infarction due to coronary artery involvement in ascending aortic dissection is high. Preoperative renal function tests can effectively guide and improve the prognosis.