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目的:对急性右室心肌梗死(RVI)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:将46例RVI患者按有无右心衰竭及心原性休克进行危险分层:A组为无右心衰竭组(32例),接受溶栓处理与直接经皮介入治疗(PCI);B组为右心衰竭或同时合并心原性休克组(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RVI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组分别各有1例在住院期间发生再梗,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,右心衰竭合并心原性休克、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:RVI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疗效在降低RVI特别是合并右心衰竭或心原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, the outcome of reperfusion and the prognosis of acute right ventricular myocardial infarction (RVI) .Methods: Forty-six patients with RVI were divided into two groups based on risk of right heart failure and cardiogenic shock In group A, patients without right heart failure (n = 32) received thrombolytic therapy and direct percutaneous intervention (PCI); group B received right heart failure (n = 14) Direct interventional therapy by percutaneous coronary intervention.Multi-factor regression model was used to analyze the relationship between adverse cardiovascular events and in-hospital mortality and risk factors such as age, gender, hypertension, diabetes, smoking.Results: Forty-six patients with RVI Coronary angiography, angiography showed that the right coronary artery infarction (IRA) in 35 cases, IRA in 9 cases of gynecological branch, IRA in anterior descending artery in 2 cases; 15 cases of single-vessel disease, double-vessel disease in 21 cases , Three / = multi-branch disease in 10 cases; during hospitalization in 11 cases of angina pectoris, of which 9 cases of direct PCI group were heavier three lesions; thrombolytic therapy group and direct PCI group were There was one case of re-infarction occurred during hospitalization, both underwent emergency PCI intervention; hospitalized during the death of 3 cases, its 1 in the thrombolytic group and 2 in the direct PCI group. The incidence and mortality of adverse cardiovascular events during the hospital stay in group B were higher than those in group A. Multivariate regression analysis showed that right ventricular failure and cardiogenic shock, Multiple lesions were both independent predictors of adverse cardiovascular events and death during hospitalization.Conclusion: RVI has adverse cardiovascular events and mortality, and has a significant impact on the severity of cardiac function, age, gender and vascular disease. PCI is superior to thrombolytic therapy in reducing in-hospital mortality in patients with RVI, particularly those with right heart failure or cardiogenic shock.