非特异性室内阻滞临床分析

Clinical analysis of non-specific intraventricular block

目的探讨非特异性室内阻滞的临床特征及其发生机制。方法选取非特异性室内阻滞患者28例作为观察组(A组),完全性左束支阻滞患者30例作为对照组1(B组)、完全性右束支阻滞患者62例作为对照组2(C组),观察患者的一般临床资料、心功能、心电图及24 h动态心电图检查结果、心脏超声心动图结果的特征表现。结果 NYHA心功能≥Ⅲ级、QRS波时限及≥4种室性早搏(室早)、≥2种特宽型室早和Lown法分级≥4B的室早患者的例数3组间比较,差异均有统计学意义(P均<0.01)。QRS波时限比较,B组与A、C组差异均有统计学意义(P均<0.01);≥4种室早的例数3组之间比较,差异有统计学意义(P <0.01);≥2种特宽型室早的例数比较,A组与B、C组差异均有统计学意义(P均<0.01);Lown法分级≥4B的室早例数A、B组与C组比较,差异均有统计学意义(P均<0.01)。左室射血分数、左室内径、左室壁运动异常例数3组比较,差异均有统计学意义(P均<0.01),A、B组与C组差异均有统计学意义(P <0.05)。结论非特异性室内阻滞患者的心功能较单纯束支阻滞患者更差,发生室性心律失常的概率更高,因此有效鉴别非特异性室内阻滞与一般束支阻滞具有重要的临床意义。

Objective To investigate the clinical features and mechanism of non-specific intraventricular block.Methods We selected 28 patients with non-specific intraventricular block as the observation group(group A),30 patients with complete left bundle branch block as the control group 1(group B)and 62 patients with complete right bundle branch block as the control group 2(group C).We observed their general clinical data,cardiac function,and characteristic manifestations of ECG,24-hour ambulatory electrocardiographic and cardiac echocardiographic examination results.Results There are statistically significant differences of the number of patients with NYHA cardiac function grading ofⅢor above,QRS duration,and the number of patients with over 4 kinds of premature ventricular contractions(PVCs),over two types of extra wide PVCs and Lown grading of 4 B or above among the three groups(P<0.01).There is statistically significant difference of QRS duration between group B and group A or C(P<0.01).The number of patients with over 4 kinds of PVCs varies significantly among the three groups(P<0.01).There is statistically significant difference of the number of patients with over two types of extra wide PVCs between group A and group B or C(P<0.01).The number of patients with Lown grading of 4 B or above varies significantly between group A,B and group C(P<0.01).The left ventricular ejection fraction,left ventricular diameter and the number of patients with abnormalities of left ventricular wall motion are significantly different among the three groups(P<0.01),and between group A or B and group C(P<0.05).Conclusion Patients with non-specific intraventricular block is poorer in cardiac functions than those with simple bundle branch block,and the former are high risky of ventricular arrhythmia.Therefore,it is clinically significant to effectively distinguish non-specific intraventricular block from general bundle branch block.