右束支阻滞在急性心肌梗死中的意义

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

目的 了解伴随急性心肌梗死出现的右束支阻滞的临床和预后意义。 方法 将我院近5年收治的伴有新出现的持续性右束支阻滞的急性心肌梗死共 12例作为观察组 ,梗死部位均累及前间壁或前壁 ,故将同期收治的无束支阻滞的前间壁或前壁急性心肌梗死共 2 0例作为对照组 ,两组急性心肌梗死患者都在症状发生后 2 4h内收入院。分析两组的临床经过、住院病死率和随访 1年的情况。 结果 观察组血清 CK- MB平均峰值为 (2 48.2± 15 4.9) u,明显高于对照组的 (10 8.6± 6 4.2 ) u(P<0 .0 2 )。观察组 5 0 %并发室性心动过速或心室颤动 ,对照组为 2 5 %。观察组心功能受损也更严重 ,Killip平均级别为 2 .45± 0 .6 8,对照组为 (1.2 0± 0 .42 ,P<0 .0 0 5 ) ,左心室舒张末内径在观察组为 (5 6 .8± 11.0 ) mm ,对照组为 (4 7.0± 4.4) mm (P<0 .0 5 ) ,左心室射血分数在观察组为 0 .47± 0 .0 6 ,对照组为 (0 .6 5± 0 .0 9,P<0 .0 0 2 )。观察组的住院病死率为 2 5 % ,1年内因心力衰竭恶化再住院率为 44 %。

Objective To evaluate the clinical significance and prognostic value of the newly appeared persistent right bundle branch block in patients with acute anterior and septal myocardial infarction. Methods Twelve patients with acute anteroseptal or anterior myocardial infarction and newly appeared persistent right bundle branch block admitted in our hospital in the recent five years was studied as observed group.The other 20 patients admitted in the same period with acute anterior and antero septal infarction but without bundle branch block was studied as the control group.The clinical course,in hospital mortality and one year follow up study were analyzed. Results The average peak value of serum CK MB was (248 2±154 9)u in the observed group,much higher than a value of (108 6±64 2)u in the control group.The complication rate of serious ventricular arrhythmias was 50% in the studied group,but 25% in the control group,and the heart function is more severely damaged in the studied group.The average degrees of Killip stratification were 2 45±0 68 and 1 20±0 42 respectively( P <0 005).The average diameters of LVEDd were (56 8±11 0)mm and (47 0±4 4)mm respectively ( P <0 05).The average degrees of LVEF were 0 47±0 06 and 0 65±0 09 respectively ( P <0 002).The hospital moratality was 25% in the studied group.44% patients were re admitted in the period one year follow up,because of the deterioration of the heart function. Conclusion Newly appeared persistent RBBB with acute myocardial infarction is a mark of malignant clinical course and bad prognosis.