急性心肌梗死患者新出现右束支阻滞的意义

The clinical significance of new appeard right bundle branch block in patients with acute myocardial infarction

目的探讨心肌缺血事件发生时心电图新出现的右束支阻滞在急性心肌梗死中的临床意义。方法对给予经皮冠状动脉成形术的急性心肌梗死患者80例做回顾性分析,术前心电图有新出现右束支阻滞14例为观察组,无束支阻滞62例及新出现左束支阻滞4例为对照组。研究右束支阻滞出现及再灌注后持续的时间,并对其一般情况、心肌酶学(CK-MB)、心梗部位、心功能分级(Killip分级)、罪犯血管、心律失常及病死率情况分析。结果右束支阻滞出现时间为超级性期或急性期。观察组心肌酶学(CK-MB)最高值明显高于对照组1(p<0.05),然而和对照组2比较无统计学意义(p>0.05)。观察组的心功能差,和对照组1比较有统计学意义(p<0.05);右束支阻滞组恶性心律失常发生率高,和其他两组比较均无统计学意义(p>0.05)。结论心肌缺血症状>30min的患者,超急性期或急性期新出现的右束支阻滞对急性心肌梗死有一定诊断价值,且可以协助判断罪犯血管及对病情评估。

Objective To reserch the clinical significance of new appeard right bundle branch block（RBBB）in patients with acute myocardial infarction（AMI） when the accident of myocardial ischemia occurs. Methods A total of 80 hospitalized patients with acute myocardial infarction and given percutaneous coronary intervention（PCI） were retrospectively analyzed. Patients were devided into three groups based on the electrocardiogram findings before the PCI,14 patients with RBBB were studied as observed group,62 patients without bundle branch blockwere studied as control group 1,the other 4 patients with left bundle branch block（LBBB）were studied as control group 2. When did the RBBB appeard and how long did it last after the reperfusion,and also general characterstic,heart type enzyme（CK-MB）,farction location,killip grading of heart function,convict artery,arrhythmia and fatality rate were analysied. Results In observed group,RBBB appeard at hyperacute or acute phase. In observed group,the heart type enzyme（CK-MB）was significantly higher than control group1（p0.05）,however,it didn＇t have statistical significance when compared with control group 2（p0.05）. In observed group the killip grading of heart function was worse than control group1 （p0.05）; and the observed group had the higher incidence of the malignant arrhythmia,but it didn＇t have statistical significance when compared with the other control groups（p0.05）. Conciusion If the time of myocardial ischemia symptoms exceed 30 minutes and the new appeard RBBB which occurred at hyperacute or acute phase has a value in diagnosising AMI and can help judge the convict artery or clinical condition.