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目的对急性右室心肌梗死的临床特征、再灌注治疗结果及近期预后等方面的问题进行探讨。方法作者将1999年至2002年间收住的46例急性右室心肌梗死患者按有无右心衰及心源性休克进行危险分层:A组为无右心衰组(32例),接受溶栓处理与直接经皮介入治疗(PCI);B组为右心衰或同时合并心源性休克组(14例),均接受直接经皮介入治疗;运用多因素回归模型对不良心血管事件及住院死亡率与年龄、性别、高血压、糖尿病、吸烟等危险因素的关系作回归分析。结果46例急性右室心肌梗死病人中42例作了冠脉造影检查,造影显示梗死相关血管(IRA)为右冠状动脉者35例,IRA为回旋支者9例,IRA为前降支者2例;单支病变者15例,双支病变者21例,三支/多支病变者10例;住院期间有11例发生心绞痛,其中行直接PCI组9例,均为较重的三支病变患者;住院期间溶栓治疗组与直接PCI组各有1例在住院期间发生再梗死,均行紧急PCI干预;住院期间死亡3例,其中溶栓组1例,直接PCI组2例;B组患者住院期间不良心血管事件发生率及死亡率高于A组;多因素回归分析显示,右心衰合并心源性休克、女性、年龄、多支病变均为住院期间不良心血管事件及死亡发生的独立预测因子。结论急性右室心肌梗死不良心血管事件及死亡率较高,心脏功能、年龄、性别及血管病变严重性对其具有重要影响;直接PCI在降低急性右室心肌梗死特别是合并右心衰或心源性休克患者的住院死亡率方面优于溶栓疗法。
Objective To investigate the clinical characteristics of acute right ventricular myocardial infarction, the results of reperfusion therapy and the recent prognosis. METHODS: Forty-six patients with acute right ventricular infarction admitted between 1999 and 2002 were stratified for risk by right-heart failure and cardiogenic shock: group A, right-heart failure-free group (n = 32) Thrombectomy and direct percutaneous interventional therapy (PCI). Group B was treated with right heart failure or with cardiogenic shock (n = 14), and received direct percutaneous intervention. Multivariate regression analysis was used to evaluate adverse cardiovascular events and In-hospital mortality and age, gender, hypertension, diabetes, smoking and other risk factors for regression analysis. Results Of the 46 patients with acute right ventricular myocardial infarction, 42 patients underwent coronary angiography. Angiography showed that the infarct-related vessels (IRA) were right coronary artery in 35 patients, IRA in 9 cases, IRA in anterior descending artery 2 Cases of single-vessel disease in 15 cases, double-vessel disease in 21 cases, three / multi-vessel disease in 10 cases; during hospitalization in 11 cases of angina pectoris, of which 9 cases were direct PCI group, were severe three lesions Patients were hospitalized during the thrombolytic therapy group and the direct PCI group, one case of re-infarction occurred during hospitalization, were underwent emergency PCI intervention; hospitalized during the death of three cases, including thrombolysis in 1 case, 2 cases of direct PCI group; B group The incidence of adverse cardiovascular events and mortality during hospitalization were higher in group A than in group A. Multivariate regression analysis showed that right heart failure complicated with cardiogenic shock, female, age, and multi-vessel disease were both adverse cardiovascular events and death during hospitalization Independent predictors. Conclusions Adverse cardiovascular events and mortality in patients with acute right ventricular infarction are high, and the severity of cardiac function, age, sex and vascular disease have an important influence on it. Direct PCI can reduce acute right ventricular myocardial infarction, especially with right heart failure or heart failure Outpatient mortality in patients with source shock is superior to thrombolytic therapy.