摘要
目的探讨右束支传导阻滞（RBBB）在急性非sT段抬高心肌梗死（NSTEMI）和急性sT段抬高心肌梗死（STEMI）患者中的发生率及其对两组患者临床特征和预后的影响。方法收集931例急性心肌梗死（AMI）患者的临床资料，将其分为STEMI组和NSTEMI组，且将以上两组分别分为RBBB和无柬支传导阻滞（NBBB）4个亚组，追踪随访1年；分析两组中RBBB和NBBB患者之间临床基线资料、早期治疗方案、院内及出院1年内病死率的差异；使用多自变量Logistic回归法筛选两组患者院内及院外1年病死率升高的独立预测因素。结果@931例患者中，急性NSTEMI患者为224例（24．06％），其中RBBB者16例（7．14％）；急性STEMI患者为707例（75．94％），其中RBBB者47例（6．65％）。②与无RBBB患者相比，AMI合并RBBB的急性心肌梗死患者男性较多、年龄更大、并存疾病比率较高、接受急诊再灌注治疗和急性期辅助药物治疗的比率较低。③在STEMI患者中，与NBBB患者相比，RBBB患者心肌酶峰值较高、入院心室射血分数（EF）〈40％的比率较高；RBBB是该组患者院内[53．18％vsl8．48％，P〈0．001，OR=1．5（95％凹1．31—1．73）I及出院1年内长期病死率I17．07％vs6．67％，P=0．019，OR=1．5（95％C11．22—2．07）]升高的独立预测因素。但在NSTEMI患者中，RBBB组患者的心肌酶峰值及入院EF与NBBB者差异无统计学意义，且RBBB不是院内及1年内长期病死率升高的独立预测因素。结论NSTEMI患者合并RBBB并不是院内和长期病死率升高的独立预测因素。
Objective To evaluate the incidence and clinical impact of right bundle branch block （RBBB） in patients with non-ST elevation myocardial infarction（NSTEMI） and patients with ST el- evation myocardial infarction（STEMI）. Methods Nine hundred and thirty-one patients with AMI were divided into STEMI team and NSTEMI group, each group was sub divided into right bundle branch block （RBBB） group and none bundle branch block （NBBB） group furtherly according to the ECG appear- ance. Patients with left bundle branch block were excluded. The difference of baseline clinical character- istics, short-term inhospital treatment, in hospital and one-year mortality between RBBB group and NBBB groups were analyzed. Independent predictors of raised mortality was screened by Logistic regression step- wise method. Results A total of 16 patients（7. 14% ） with NSTEMI and 47 patients（6. 65% ） with STE- MI presented with RBBB on admission. In general, RBBB patients were older, more often had comorbidi- ties, and less often received short-term inhospital treatment according to guidelines. In STEMI, RBBB pa- tients had higher peak enzyme levels and lower left ventricular ejection fraction （LVEF） than patients with- out BBB. Right bundle branch block in STEMI was associated with an increased inhospital and long-term mortality. However, peak enzyme levels and LVEF were similar in both groups with and without BBB in NSTEMI. Right bundle branch block in NSTEMI was not independently associated with a worse outcome. Conclusions Unlike RBBB in STEMI, RBBB in NSTEMI is not an independent predictor of inhospital and long-term mortality.
出处
《中国实用医刊》
2013年第11期10-12,共3页
Chinese Journal of Practical Medicine
关键词
急性非ST段抬高心肌梗死
右束支阻滞
临床预后
Acute non-ST elevation myocardial infarction
Right bundle branch block
Clinical outcome
