急性心肌梗死早期合并完全性右束支传导阻滞的临床与预后

Clinical characteristics and prognostic significance of complete right bundle-branch block in early acute myocardial infarction patients

目的对288例无合并或同时合并完全性右束支传导阻滞(RBBB)的急性心肌梗死(AM I)患者的临床特点及预后指标作回顾性分析,评估AM I早期合并RBBB的临床意义。方法非右束支传导阻滞AM I(NRBBB-AM I)组236例,RBBB-AM I组52例。观察AM I患者住院期间与RBBB发生的相关临床及预后指标,包括新发生的RBBB、双束支传导阻滞、短暂或持续状态、溶栓治疗患者比例、溶栓再通率、各种恶性心律失常发生率、左室射血分数(LVEF)、心功能K illip分级患者比例、早期死亡率等,并作对比性分析。结果合并完全性RBBB的AM I患者,特别是合并双束支传导阻滞者,大面积心肌梗死患者的比例显著高于无合并RBBB患者(P<0.05),而接受溶栓治疗的患者比例显著低于无RBBB的患者(P<0.01),合并RBBB患者发生快速或缓慢心律失常的比例、K illip分级≥Ⅲ的患者比例、心源性休克比例及早期死亡率均显著高于无合并RBBB患者(P<0.05或P<0.01),而射血分数(EF)、溶栓再通率低于或显著低于无RBBB患者。结论完全性RBBB在AM I早期提示预后不良,尽早血管重建如溶栓治疗对改善AM I合并RBBB患者的临床预后有积极的影响。

Objective Reviewed the clinical characteristics and prognostic targets of complete right bundle -branch block （RBBB） in 288 patients of acute myocardial infarction （ AMI） in early. Methods In 236 AMI patients with none bundle -branch -block （NRBBB - AMI） and 52 AMI patients with RBBB（RBBB -AMI） all clinical characteristics and prognostic targets included new or old RBBB, Bifascicular or isolated RBBB, transient or Permanent RBBB, Percentage in patients received thrombolytic therapy, and the reperfusion rate after thromholysis in clinical index, atrial or ventricular arrhythmias status, LVEF, the rate in patients with heart function in KiUip classy≥Ⅲ, and the early mortality in hospital. Result In RBBB patients of AMI, also included bifascicular, the rate associated with a greater extent of infartion in which S -T elevatted in 〉3 leads had a higher percentage than NRBBB patients （P 〈0. 05）. The rate in patients received thromholystie therapy had a significantly lower percentage than NRBBB patients（P 〈0. 01 ）. The patients with RBBB had a higher percentage in all other index＇s included morbidity of atria or ventricular arrhythmias, heart failure with heart function in Killip claas≥Ⅲ,carcinogenic shock and early mortality in hospital ,all P 〈0. 01, however, patients with RBBB had a lower percentage in LVEF and reperfusion after thrombolytic therapy than those with NRBBB. Conclusion Complete right bundle -branch -block should be an independent predictor for early mortality and represents an additional contribution to the poor outcome. Early revascularization included early thromholytic therapy, can establish a possible benefit in morbidity of RBBB and the clinical prognosis in patients with AMI.