右束支阻滞在急性心肌梗死中的意义

Significance of Right Bundle Branch Block in Patients with Acute Myocardial Infarction

目的 了解伴随急性心肌梗死 (AMI)出现的右束支传导阻滞 (RBBB)的临床和预后意义。方法 将我院 5年收治的伴有新出现的持续性RBBB的AMI共 2 0例作为观察组 ,梗死部位均累及前间壁或前壁。将同期收治的无束支传导阻滞的前间壁或前壁AMI共 3 0例作为对照组 ,两组AMI患者在症状发生后 2 4小时收入院。分析两组的临床经过、住院病死率及一年随访。结果 观察组血清CK MB平均峰值为 2 46.2± 14 6.8U ,明显高于对照组的 10 6.2± 5 8.6U (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 %。观察组心功能受损更严重 ,Killip平均级别为 2 .46± 0 .65 ,对照组为 1.2 0± 0 .3 8(P <0 .0 5 ) ,左心室舒张末内径观察组为 5 6.6± 10 .0mm ,对照组为 46.0± 4.6mm (P <0 .0 5 ) ,左心室射血分数观察组为 0 .46± 0 .0 4,对照组为 0 .66± 0 .0 8(P <0 .0 0 2 )。观察组的住院病死率为 2 5 % ,对照组住院病死率为 3 %。结论 伴随AMI新出现的持续RBBB是临床预后不良的标志。

Objective To evaluate the clinical significance and prognostic value of the newly appeared persistent right bundle branch block(RBBB) accompanied with acute anterior and septal myocardial farction(AMI).Method 20 patients with acute anteroseptal or anterior myocardial infarction and newly appeared persistent RBBB admitted in our hospital in recent five years were studied as observation group.30 patients with anterior or antero septal AMI but without bundle branch block admitted in the same period served as the control group.All patients were hospitalizated within 24 hours after the attack.The clinical course and inhospital mortality in two groups and one year follow up study were analyzed.Results The average peak value of serum CK MB was 246.2±146.8U in the observation group,which was much higher than that in the control group(106.2±58.6U).The complication rate of serious ventricular arrhythmias was 50% in the observation group,but 25% in the control group.The heart function was damaged more severly in the observation group,the average degress of killip stratification was 2.46±0.65 and 1.20±0.38 respectively( P <0.05).The average diameters of LVEDs were 56.6±10.0mm and 46.0±4.6mm respectively( P< 0.05).The average LVEF were 0.46±0.04 and 0.66±0.08 respectively( P <0.002).The hospital moratality was 25% in the observation group,but 3% in the control group.Conclusion Newly appeared persistent RBBB accompanied with AMI is a mark of bad clinical course and prognosis.