急性心肌梗死伴右束支传导阻滞的临床意义

Clinical significance of right bundle branch block in patients with acute myocardial infarction

目的 :评价急性心肌梗死 ( AMI)患者并发右束支传导阻滞 ( RBBB)的临床意义及预后。方法 :观察了 1995年 1月～ 1998年 5月 133例 AMI患者血清肌酸激酶 ( CK)及其同工酶 ( CK-MB)水平、严重并发症及死亡率。结果 :2 9例 AMI并发 RBBB(占 2 1.8% )者预后明显差于未并发RBBB者。表现为 CK及 CK- MB浓度更高 ,与心脏事件相关的并发症 (心力衰竭、完全性房室传导阻滞、心源性休克、心律失常 )发生率及死亡率均增高 ,经统计学处理 ,两组有极显著性差异 ( P <0 .0 0 5 )。结论 :AMI并发 RBBB可能是大面积梗死、心肌坏死严重的表现 ,可以作为一个预示危险的标志 ,对这些患者进行积极的介入性治疗 ,重建血管 ,可改善预后。

Objective:To evaluate the clinical significance and prognosis of right bundle branch block(RBBB) in patients with acute myocardial infarction (AMI). Method:The clinical informations of 133 patients with AMI were analysed.Result:Among these patients,29 cases complicated RBBB ( 21.8 %),and their prognoses were worse.They had higher serum level of creatine kinase(CK) and isoenzyme mb(CK mb), more severe complications(heart failure,arrhythmia,cardiogenic shock) and much higher mortality rate than those without RBBB. There was significant difference between two groups (P< 0.005 ).Conclusion:In patients with AMI, RBBB might be a predictive sign of larger and severer infarction,active intervention would improve their prognosis.