成人房间隔缺损发生右束支阻滞的影响因素分析

The factors influencing right bundle branch block in adults with atrial septal defect

目的:探讨成人继发孔型房间隔缺损(ASD)患者发生右束支阻滞(RBBB)的影响因素。方法:选择ASD患者132例,根据心电图将患者分为RBBB和非RBBB两组,对两组资料进行比较,筛选影响因素并纳入Logistic回归模型确定RBBB的危险因素。结果:RBBB组男性比例高于非RBBB组(P<0.05),活动时气促症状更多见(P<0.05)。RBBB组右房内径、右室舒末内径均大于非RBBB组(P<0.001),ASD亦大于非RBBB组(P<0.05)。RBBB组平均肺动脉压和Qp/Qs均高于非RBBB组(P<0.05和P<0.001)。Logistic回归显示:RBBB的发生与右房中-重度增大(OR 6.8,P<0.01)、右室增大(OR 1.1,P<0.05)和高Qp/Qs(OR 2.7,P<0.05)密切相关。结论:较大的分流量和右心增大是成人继发孔型ASD患者发生RBBB的危险因素。

Objective: To explore the relevant factors causing right bundle branch block(RBBB)in adults with secundum atrial septal defect(ASD). Methods: A total of 132 ASD adults were enrolled in present study. Then according to electrocardiogram, these patients were divided into two groups of RBBB and non-RBBB, the data between the two groups were compared to screen the relevant factors of RBBB. The risk factors of RBBB were determined by analyzing the related factors using binary Logistic regression model. Results: The male proportion of group RBBB was higher than that of non-RBBB group(P<0.05)and the symptoms of shortness of breath during activity were more common in group RBBB than that in non-RBBB group(P< 0.05). The right atrial diameter and right ventricular end diastolic diameter of group RBBB were larger than those of non-RBBB group(P<0.001), as well as the ASD size(P<0.05). In addition, the mean pulmonary arterial pressure and Qp/Qs of group RBBB were both higher than those of non-RBBB group(P<0.05 and P<0.001). Logistic regression showed that RBBB was closely related to the moderately to severely increasing right atrium(OR 6.8, P<0.01), the enlarging right ventricle(OR 1.1, P<0.05)and high Qp/Qs(OR 2.7, P<0.05). Conclusion: The increasing shunt volume and enlarging right-sided heart are risk factors for presence of RBBB in adults with secundum ASD.