急性心肌梗死伴右束支传导阻滞的临床意义

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

目的探讨急性心肌梗死(AMI)患者伴发右束支传导阻滞(RBBB)的临床意义及预后。方法将我院近5年来收治的AMI患者共240例分为AMI伴RBBB组和不伴RBBB组。根据RBBB发生的时间、持续间期以及是否合并左束支分支阻滞将前者分为新发生RBBB、陈旧性RBBB、持续性RBBB、短暂性RBBB、双束支阻滞和单纯性RBBB 6个亚组,观察各组的临床经过和住院病死率。结果240例AMI伴发RBBB 26例,占10.8% ,与不伴RBBB比较,其磷酸肌酸激酶(CK)峰值、恶性室性心律失常发生率、心功能不全发生率、住院病死率均显著增高(P < 0.01)。RBBB组高发的心功能不全发生率和住院病死率并非源自陈旧性RBBB和单纯性RBBB,而是来源于新发生RBBB和双束支阻滞。新发生的持续性RBBB住院病死率最高,为50%, 短暂性RBBB为11.1% , 而持续性RBBB的再灌注治疗率较短暂性RBBB明显降低(25% vs 88.9%, P < 0.05)。结论AMI患者伴发RBBB提示预后不良。再灌注治疗可改善预后。

ObjectiveTo evaluate the clinical significance and prognosis of right bundle branch block (RBBB) in patientswith acute myocardial infarction (AMI). Methods240 patients with AMI confirmed in our hospital in five years weredivided into two groups: AMI with RBBB group and without RBBB group. According to the time of appearance of RBBB,duration and whether association with left fascicular block , the AMI with RBBB group was further divided into six subgroups: new RBBB, old RBBB , persistent RBBB, transient RBBB, bifascicular block and isolated RBBB. The clinical course, in-patient mortality in all groups were analyzed.ResultsAmong 240 patients, RBBB was found in 26 patients (10.8%). Thepeak values of serum creatine kinase(CK), the severe ventricular arrhythmia rate, heart failure rate and in-patient mortalityin the with RBBB group were much higher than those in without RBBB group (P<0.01).The higher heart failure rate and in-patient mortality were determined in new RBBB and bifascicular block rather than in old RBBB and isolated RBBB.The in-patient mortality was 50% in new persistent RBBB , but 11.1% in transient RBBB. The reperfusion therapy rate in persistentRBBB was 25% , less than that 88.9% in transient RBBB (P<0.05) .ConclusionsAMI with RBBB indicates poor prognosis.Reperfusion therapy can improve the prognosis.