右束支传导阻滞非ST段抬高型急性冠状动脉综合征的心电图表现、临床特征及预后影响对比

Comparison of electrocardiogram, clinical features and prognosis of right bundle branch block non-ST-elevation acute coronary syndrome

目的对比研究右束支传导阻滞(RBBB)非ST段抬高型急性冠状动脉综合征的心电图表现、临床特征及预后影响。方法选择非ST段抬高型急性心肌梗死患者80例,其中男性51例,女性29例;年龄53～74岁,平均年龄64.26岁。按照有无RBBB,分为研究组(RBBB)和对照组(无RBBB)。研究组40例,其中男性28例,女性12例;年龄53～72岁,平均年龄62.40岁。对照组40例,其中男性23例,女性17例;年龄58～74岁,平均年龄66.56岁。分析两组患者心电图ST-T改变、QRS波群时限、Tp-Te值、心率等心电指标,心功能Killip分级,以及心律失常、心肌梗死再发、心肌梗死后心绞痛等并发症发生率。结果研究组ST段压低发生率及T波异常发生率与对照组相比(92.5%vs 90.0%,77.5%vs75.0%),差异均无统计学意义(χ~2=0.157、0.069,P> 0.05);而ST段压低程度较对照组显著(1.72 mV±0.37 mV vs 1.58 mV±0.22 mV;t=2.057,P <0.05)。研究组QRS波群时限较对照组长(133.26 s±9.65 s vs 129.47 s±5.67 s),Tp-Te值较对照组高(105.72 ms±13.65 ms vs 99.28 ms±7.97 ms),心率较对照组快(87.84次/分±6.55次/分vs 81.76次/分±6.01次/分),差异均具有统计学意义(t=2.142、2.577、4.326,P<0.05)。研究组心功能平均级别及心功能Ⅲ级以上者均高于对照组(2.25±1.21 vs 1.88±0.99,65.0%s 27.5%),差异具有统计学意义(t=1.757,χ~2=4.713,P<0.05)。研究组患者并发症发生率显著高于对照组(30.0%vs 10.0%),差异具有统计学意义(χ~2=5.000,P<0.05)。结论 RBBB非ST段抬高型急性冠状动脉综合征提示患者心功能较差,病情危险,易发生预后不良,需要高度重视。

Objective To compare the electrocardiogram, clinical features and prognosis of non-ST-elevation acute coronary syndrome with right bundle branch block(RBBB). Methods A total of 80 patients with non-ST-segment elevation acute myocardial infarction were enrolled, which included 51 males and 29 females, aged 53-74 years old with mean age of 64.26 years old. According to with or without RBBB, all patients were divided into study group(n = 40, including 28 males and 12 females;aged 53-72 years old with mean age of 62.40 years old) and control group(n = 40, including 23 males and 17 females;aged 58-74 years old with mean age of 66.56 years old). The ST-T changes of electrocardiogram, QRS duration, Tp-Te value, heart rate, heart function Killip grading, and complications including arrhythmia, myocardial infarction recurrence, angina after myocardial infarction were analyzed. Results There was no significant difference in incidence of ST segment depression and T wave abnormality between study group and control group(χ^2 = 0.157, 0.069, P > 0.05), while ST segment depression of study group was significantly higher than that of control group(1.72 mV ± 0.37 mV vs 1.58 mV ± 0.22 mV;t= 2.057, P < 0.05).The QRS duration in study group was longer than that of control group[(133.26 ± 9.65) seconds vs(129.47 ± 5.67) seconds],Tp-Te value was higher than that of control group(105.72 ms ± 13.65 ms vs 99.28 ms ± 7.97 ms), and heart rate was faster than that of control group[(87.84 ± 6.55) times/minute vs(81.76 ± 6.01) times/minute], the differences were statistically significant(t =2.142, 2.577, 4.326;P< 0.05). The mean cardiac function level and cardiac function above grade Ⅲ in study group were higher than those in control group(2.25 ± 1.21 vs 1.88 ± 0.99, 65.0 % vs 27.5 %), and difference was statistically significant(t =1.757,χ^2= 4.713, P < 0.05). The complication incidence in study group was significantly higher than that in control group(30.0 % vs 10.0 %;χ^2= 5.000, P < 0.05). Conclusion It is demonstrated that patients with RBBB non-ST-elevation acute coronary syndrome suggested that the patients with poor cardiac function, worse clinical prognosis and poor prognosis,who need highly attention.