THE AGEING OF CARDIAC INFARCTS, AND ITS INFLUENCE ON CARDIAC RUPTURE
THE AGEING OF CARDIAC INFARCTS, AND ITS INFLUENCE ON CARDIAC RUPTURE
复制标题
心肌梗塞的衰老及其对心脏破裂的影响
DOI：
10.1136/hrt.13.1.37
复制
发表时间：
1951
影响因子：
--
通讯作者：
I. Lodge
中科院分区：
文献类型：
--
作者：
I. Lodge
在最近发生的致死性心肌梗死的尸检病例中，约有9%发现心包积血是一种并发症（Edmondson和Hoxie, 1942； Diaz-Rivera和Miller, 1948； Friedman和White， 1944）。心脏破裂实际上局限于梗塞后的前三周，尽管它偶尔发生在心脏动脉瘤的晚期。破裂后通常不会立即死亡，但间隔数小时后死亡，可能是由于心脏填塞引起的循环衰竭。当心梗已被确认，且患者在医院休息时，破裂发生的频率较低；更常见的是，在我们的9个案例中至少有5个，灾难发生在治疗不完善的病人到达医院时，要么奄奄一息，要么已经死亡。在这方面，Jetter和White（1944）发现，在精神病院的一个小系列（27例）患者中，最近心肌梗死破裂的发生率不少于73%，这一点很有趣；他们没有抱怨疼痛，因此没有得到治疗。在缺乏临床证据的情况下，作者根据Mallory -et al.（1939）的组织学标准估计梗死的年龄。由于显微镜检查可能是估计病变年龄的唯一方法，因此在没有明确梗死发病史的情况下，这些标准可能具有医学法律意义。本报告的目的是重新检查心肌组织变化的顺序在最近的梗死，并据此估计心包可能发生的时间。从本院进行尸检的216例近期梗死病例中，选取了18例无破裂并发症的病例，依据是明确的发病史和充分的组织学准备。这些案例提供了一天以后的材料，但第三天除外，因为第三天没有代表性章节。然后将本研究结果与Mallory et al.（1939）的研究结果进行比较。216例中合并心包积血19例（8.8%）。其中10例因组织学准备不充分或存在一些复杂因素（如梅毒性大动脉炎或结节性多动脉炎）而被放弃。在破裂发生的时间估计，在剩余的，根据从研究中获得的组织学标准18例简单的。
In about 9 per cent of necropsies upon cases of fatal recent cardiac infarction hemopericardium is found as a complication (Edmondson and Hoxie, 1942; Diaz-Rivera and Miller, 1948; Friedman and White, 1944). Rupture of the heart is practically confined to the first three weeks after infarction although it occasionally occurs at later stages with cardiac aneurysm. Death is not usually immediate upon rupture, but follows at an interval of several hours, being probably due to circulatory failure caused by cardiac tamponade. Rupture occurs less frequently when cardiac infarction has been recognized, and the patient is at rest in hospital; more often, and in at least five of our nine cases, the catastrophe has occurred in an imperfectly treated patient arriving at hospital either moribund or dead. In this connection it is of interest that Jetter and White (1944) found that rupture of recent cardiac infarcts occurred in no fewer than 73 per cent of a small series (27) of patients in mental institutions; they had made no complaint of pain and therefore had not been treated. In the absence of clinical evidence the authors estimated the age of the infarcts by the histological criteria of Mallory -et al. (1939). Such criteria may thus assume medico-legal importance in the absence ofa clear history of the onset of infarction, since microscopical examination may be the only method of estimating the age of the lesion. The purpose of this report is to re-examine the sequence of histological changes in the myocardium in recent infarction, and to estimate accordingly the period at which hwmopericardium is likely to supervene. From a total of 216 cases of recent infarction that came to necropsy in this Institute a series of 18 cases uncomplicated by rupture was selected on the strength of a clear history of the onset being available, together with adequate histological preparations. The cases provided material dating from one day onwards, with the exception of the third day, when no representative sections were available. The results of this study were then compared with those of Mallory et al. (1939). Nineteen of the 216 cases (8.8%) were complicated by hemopericardium. Of these 10 were discarded on account either of the inadequacy of the histological preparations, or from the presence ofsome complicating factor such as syphilitic aortitis or polyarteritis nodosa. The period at which rupture occurred was estimated, in the remainder, on the basis of the histological criteria acquired from study of the 'uncomplicated 18 cases.