对不同传导阻滞表现的急性心肌梗死患者心功能的临床研究

Clinic study of heart function in the patients with acute myocardial infarction having different conduction block

目的研究入院时心电图呈不同传导阻滞表现急性心肌梗死患者的心功能。方法选择2006~2008年在本院住院的急性心肌梗死患者90例,根据入院时心电图发现的不同传导阻滞分组,分为房室传导阻滞组（A组）,束支传导阻滞组（B组）,房室传导阻滞合并束支传导阻滞组（C组）,心肌梗死后第24小时查BNP浓度和心脏超声（测定左室舒张末内径,EF值）,并所有入院患者行Swan-Ganzs漂浮导管置管术,并记录入院后第24小时的肺毛细血管楔嵌压（PCWP）和中心静脉压力（CVP）。结果 A组BNP,PCWP,CVP和LVEDD的水平[（560±26.3）pg/ml,（18±1.53）mm-Hg,（12±1.23）mmHg,（46±4.2）mm],低于B组[（1250±105.8）pg/ml,（25±2.36）mmHg,（18±1.58）mmHg,（51±5.1）mm],低于C组[（2563±235.6）pg/ml,（32±3.68）mmHg,（22±2.36）mmHg,（63±6.2）mm],B组低于C组,EF值A组（42±4.8）%,高于B组（36±3.6）%和C组（28±2.7）%,B组高于C组（P〈0.05）。结论各组间随着传导阻滞的严重程度,BNP浓度随之升高,肺毛细血管楔嵌压和中心静脉压力随之增加,EF值随之减少,束支传导阻滞对心功能的影响大于房室传导阻滞。

Objective To study heart function in the patients with acute myocardial infarction having different conduction block.Methods 90 patients who had been diagnosed of acute myocardial infarction were selected,by the kind of conduction block,they were grouped into atrioventricular conduction block group（A group）,bundle branch block group（B group）,atrioventricular conduction block and bundle branch block group（C group）,the concentration of serum BNP was detected,left ventricle diastole inner diameter,ejection fraction,the PCWP and CVP were measured in the first 24h from in hospital.Results The level of BNP,PCWP,CVP and LVED of group A[（560±26.3）pg/ml,（18±1.53）mmHg,（12±1.23）mmHg,（46±4.2）mm]were lower than which of group B[（1250±105.8）pg/ml,（25±2.36）mmHg,（18±1.58）mmHg,（51±5.1）mm],the latter was lower than which of group C[（2563±235.6）pg/ml,（32±3.68）mmHg,（22±2.36）mmHg,（63±6.2）mm],the level of EF,group A（42±4.8）%was higher than group B（36±3.6）%,the latter was higher than which of group C（28±2.7）%.Conclusion The conduction block in the patients with acute myocardial infarction if more severity,the level of BNP,left ventricle end diastole inner diameter,ejection fraction,the PCWP and CVP are higher,the level of EF is more lower.To the damage of heart fuction,bundle branch block is singnificant than atrioventricular conduction block.