右束支阻滞对急性心肌梗死预后的判断

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

目的 :观察并发右束支阻滞的急性心肌梗死 (AMI)患者的临床预后。方法 :将该院近 7年收治的2 39例AMI患者分为两组 :对照组 ,无新发的右束支阻滞 ;观察组 ,为伴有新出现的右束支阻滞。后者又根据右束支阻滞持续时间长短及是否并发其他传导阻滞分为 4个亚组。分析各组并发心功能不全、恶性室性心律失常及住院病死率的情况。结果 :观察组恶性室性心律失常的发生率、心功能受损及住院病死率分别为 19.0 %、4 7.6 %、30 .0 % ,较对照组相应的 3.0 %、19.8%、17.3%有显著增加 (P <0 .0 5 ) ;但后二者并非源自于单纯右束支阻滞 ,而与并发的其他传导阻滞有显著相关性 (P <0 .0 5 ) ;右束支阻滞持续时间周期对心功能受损及住院病死率的影响亦有明显相关性 (P <0 .0 5 )。结论

Objective:To evaluate the clinical course and prognosis of the newly appeared right bundle branch block (RBBB)in patients with acute myocardial infarction(AMI).Method:Two hundred and thirty nine patients with AMI admitted to our hospital in the recent seven years were divided into two groups: the control group without newly appeared RBBB and the observed group with newly appeared RBBB. According to RBBB duration and whether complicated with fascicular block, the observed group was further divided into four subgroups. Heart failure, serious arrhythmias and in hospital mortality in all groups were analyzed. Result:Heart failure, serious arrhythmias and in hospital mortality rate in the observed group were 19.0 %, 47.6 % and 30.0 % respectivly, whereas in the control group, these parametevs were 3.0 %, 19.8 % and 17.3 % respectively, which showed significant difference between observed and control group. (P< 0.05 for all). In particular, the higher arrhythmias and in hospital mortality rate were determined by the bifascicular RBBB rather than by isolated RBBB. Permanent and transient RBBB had different prognosis (P< 0.05 ). Conclusion:Newly appeared RBBB in AMI makes patients have a bad prognosis.