急性心肌梗死机械并发症的诊治

Diagnosis and treatment of mechanical complications of acute myocardial infarction

摘要:

心脏机械并发症是心肌梗死患者预后的重要决定因素。心肌梗死后早期再灌注治疗可使其机械并发症的发生率明显下降,然而,机械并发症死亡率并没有同时下降。早期诊断和治疗是改善机械并发症结局的关键。机械并发症最常发生在心肌梗死后1周内,通常首选超声心动图来确定机械并发症的类型、位置和血流动力学,外科手术是决定性的治疗,但最佳时机难确定。经皮介入治疗正在兴起,是高手术风险患者的替代治疗方案,然而尚存在临床实践不足之处。关于机械并发症的治疗,如何选择外科手术和经皮介入治疗方案的策略仍然有很多问题待解决。本文梳理机械并发症早期诊断的关键临床证据和机械并发症管理新策略,并呈现本中心机械并发症的相关统计数据,为临床诊治提供思路。

Abstract:

Cardiac mechanical complications are important determinants of prognosis in patients with myocardial infarction. Early reperfusion therapy after myocardial infarction can significantly reduce the incidence of mechanical complications, however, the mortality rate from mechanical complications does not decrease at the same time. Early diagnosis and treatment are key to improving the prognosis of mechanical complications. Mechanical complications most commonly occur within one week of myocardial infarction, and echocardiography is usually preferred to determine the type, location, and hemodynamic status of mechanical complications. Surgery is the decisive treatment, but the optimal timing is difficult to determine. Percutaneous treatment is emerging as an alternative treatment option for patients with high surgical risk, but there are still shortcomings in clinical practice. There are still many unresolved issues regarding strategies for selecting surgical and percutaneous treatment options for mechanical complications. This article summarizes the key clinical evidence for early diagnosis of mechanical complications and new strategies for the management of mechanical complications, and presents relevant statistical data on mechanical complications in our center to provide insights for clinical diagnosis and treatment.