中国实用医刊
中國實用醫刊
중국실용의간
CENTRAL PLAINS MEDICAL JOURNAL
2013年
11期
10-12
,共3页
李静超%楚英杰%刘晓宇%杨朝宽
李靜超%楚英傑%劉曉宇%楊朝寬
리정초%초영걸%류효우%양조관
急性非ST段抬高心肌梗死%右束支阻滞%临床预后
急性非ST段抬高心肌梗死%右束支阻滯%臨床預後
급성비ST단태고심기경사%우속지조체%림상예후
Acute non-ST elevation myocardial infarction%Right bundle branch block%Clinical outcome
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和无束支传导阻滞(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 ①931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％vs18.48％,P＜0.001,OR=1.5(95％ CI1.31～1.73)]及出院1年内长期病死率[17.07％ vs6.67％,P=0.019,OR=1.5(95％ CI 1.22 ～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.
目的 探討右束支傳導阻滯(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)患者中的髮生率及其對兩組患者臨床特徵和預後的影響.方法 收集931例急性心肌梗死(AMI)患者的臨床資料,將其分為STEMI組和NSTEMI組,且將以上兩組分彆分為RBBB和無束支傳導阻滯(NBBB)4箇亞組,追蹤隨訪1年；分析兩組中RBBB和NBBB患者之間臨床基線資料、早期治療方案、院內及齣院1年內病死率的差異；使用多自變量Logistic迴歸法篩選兩組患者院內及院外1年病死率升高的獨立預測因素.結果 ①931例患者中,急性NSTEMI患者為224例(24.06％),其中RBBB者16例(7.14％)；急性STEMI患者為707例(75.94％),其中RBBB者47例(6.65％).②與無RBBB患者相比,AMI閤併RBBB的急性心肌梗死患者男性較多、年齡更大、併存疾病比率較高、接受急診再灌註治療和急性期輔助藥物治療的比率較低.③在STEMI患者中,與NBBB患者相比,RBBB患者心肌酶峰值較高、入院心室射血分數(EF)＜40％的比率較高；RBBB是該組患者院內[53.18％vs18.48％,P＜0.001,OR=1.5(95％ CI1.31～1.73)]及齣院1年內長期病死率[17.07％ vs6.67％,P=0.019,OR=1.5(95％ CI 1.22 ～2.07)]升高的獨立預測因素.但在NSTEMI患者中,RBBB組患者的心肌酶峰值及入院EF與NBBB者差異無統計學意義,且RBBB不是院內及1年內長期病死率升高的獨立預測因素.結論 NSTEMI患者閤併RBBB併不是院內和長期病死率升高的獨立預測因素.
목적 탐토우속지전도조체(RBBB)재급성비ST단태고심기경사(NSTEMI)화급성ST단태고심기경사(STEMI)환자중적발생솔급기대량조환자림상특정화예후적영향.방법 수집931례급성심기경사(AMI)환자적림상자료,장기분위STEMI조화NSTEMI조,차장이상량조분별분위RBBB화무속지전도조체(NBBB)4개아조,추종수방1년；분석량조중RBBB화NBBB환자지간림상기선자료、조기치료방안、원내급출원1년내병사솔적차이；사용다자변량Logistic회귀법사선량조환자원내급원외1년병사솔승고적독립예측인소.결과 ①931례환자중,급성NSTEMI환자위224례(24.06％),기중RBBB자16례(7.14％)；급성STEMI환자위707례(75.94％),기중RBBB자47례(6.65％).②여무RBBB환자상비,AMI합병RBBB적급성심기경사환자남성교다、년령경대、병존질병비솔교고、접수급진재관주치료화급성기보조약물치료적비솔교저.③재STEMI환자중,여NBBB환자상비,RBBB환자심기매봉치교고、입원심실사혈분수(EF)＜40％적비솔교고；RBBB시해조환자원내[53.18％vs18.48％,P＜0.001,OR=1.5(95％ CI1.31～1.73)]급출원1년내장기병사솔[17.07％ vs6.67％,P=0.019,OR=1.5(95％ CI 1.22 ～2.07)]승고적독립예측인소.단재NSTEMI환자중,RBBB조환자적심기매봉치급입원EF여NBBB자차이무통계학의의,차RBBB불시원내급1년내장기병사솔승고적독립예측인소.결론 NSTEMI환자합병RBBB병불시원내화장기병사솔승고적독립예측인소.
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 elevation 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 appearance.Patients with left bundle branch block were excluded.The difference of baseline clinical characteristics,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 stepwise method.Results A total of 16 patients(7.14％) with NSTEMI and 47 patients(6.65％) with STEMI presented with RBBB on admission.In general,RBBB patients were older,more often had comorbidities,and less often received short-term inhospital treatment according to guidelines.In STEMI,RBBB patients had higher peak enzyme levels and lower left ventricular ejection fraction (LVEF) than patients without 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.
