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目的:探讨急性ST段抬高心肌梗死(STEMI)患者早期24h内死亡的原因。方法:对STEMI523例患者中24h内死亡17例的死亡病因、梗死部位、治疗方法、临床特征等临床资料进行分析。结果:死因为心脏破裂12例,占总病死率70.6%;心力衰竭合并心源性休克4例,占23.5%;恶性心律失常1例,占5.9%;心脏破裂的病死率高于心力衰竭合并心源性休克、恶性心律失常(P<0.01)。心脏破裂死亡的12例中溶栓9例,未溶栓2例,急诊介入术1例。结论:心脏游离壁破裂是STEMI患者早期24h内死亡的主要病因;静脉溶栓治疗可能增加心脏破裂的发生率,尤其对于老年STEMI患者,宜尽早行急诊介入术或冠状动脉搭桥术以减少心脏破裂的发生。
Objective: To investigate the causes of early death in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: The clinical data of 17 death cases, infarct sites, treatment methods and clinical features in 5 of STEMI523 patients were analyzed. Results: The cause of death was cardiac rupture in 12 cases, accounting for 70.6% of the total. Heart failure combined with cardiogenic shock in 4 cases (23.5%), malignant arrhythmia in 1 case (5.9%), heart failure rate higher than in heart failure Cardiogenic shock, malignant arrhythmia (P <0.01). Among the 12 patients who died of heart rupture, 9 were thrombolysis, 2 were not thrombolysis and 1 was emergency intervention. Conclusion: Cardiac wall rupture is the main cause of death in early stage of STEMI. Intravenous thrombolysis may increase the incidence of heart rupture. Especially for elderly patients with STEMI, emergency intervention or coronary artery bypass grafting should be performed to reduce heart rupture happened.