合并右束支阻滞的冠心病患者临床及冠状动脉造影特点分析

目的分析合并完全性右束支传导阻滞Fightbundlebranchblock，RBBB）冠心病患者的临床以及冠状动脉造影特点。方法189例心电图显示右束支传导阻滞的患者，为本院2002年1月-2008年1月收入院，并接受冠状动脉造影检查的病例。最小年龄38岁，最大年龄86岁，平均年龄（61±10）岁，其中男性154例，女性35例。完全性右束支传导阻滞由心电图分析确定。采用Judkins法进行选择性冠状动脉及右心室造影检查，通过计算机图像处理系统测定右心室射血分数。所有资料采用SAS软件处理，P〈0．05认为差异有统计学意义。结果在189例患者中根据造影检查结果，确诊为冠心病者134例，其中男性116例，女性18例，平均年龄（62±9）岁。排除冠心病者55例，其中男性38例，女性17例，平均年龄（57±10）岁。与不合并冠心病者相比，冠心病合并RBBB者，年龄较大，男性多见，糖尿病、高血压、既往心肌梗死发生率较高；冠状动脉造影显示：单支、双支和三支病变分别占35％、24％和40％。病变部位：前降支受累者最多见，占85．1％，其次为右冠状动脉占62．7％，回旋支受累者57．5％，累及右主干者11．9％。多变量分析结果显示：经冠状动脉造影确诊的合并RBBB的冠心病患者，其独立预测因素包括：男性、年龄增加，合并高血压、糖尿病、既往心肌梗死者与冠心病发生密切相关，危险因素越多，冠状动脉造影诊断的冠心病发生率越高。结论大多数合并RBBB的冠心病患者，其临床特征包括：高龄、男性、多合并糖尿病或／和高血压，既往有心肌梗死史。当右束支传导阻滞伴不明原因胸痛或心电图异常难以解释时，冠状动脉造影有助于确定缺血性心脏病及病因诊断。

Clinical Significance and Characteristics of Coronary Angiography of Coronary Artery Disease in Patients with Complete Right Bundle Branch Block

Objective To analysis the characteristics of coronary angiography of coronary artery disease （CAD） in patients with complete right bundle branch block （RBBB）. Methods 189 patients with electrocardiographic findings of RBBB had been subjected to coronary angiographic study. The age range from 38 to 86 years old （mean 60±9 years）. There were 154 men and 35 women. The diagnosis of RBBB was based upon electrocardiography. Patients underwent selective coronary angiography and right ventriculography by use of the Judkins technique. Statistical analysis was performed using SAS software. Results of the 189 patients, 71% had CAD. Compared with the patients without CAD, the patients with CAD were older; more likely to be men; more likely to have previous myocardial infarction, diabetes mellitus and hypertension. Coronary angiogram revealed that single vessel disease, double vessels disease and triple vessels disease were 35%, 24% and 40% respectively. Left anterior descending lesion was most. Independent predictors of the multivariable analysis are male gender, increasing age, diabetes mellitus and hypertension. Conclusions Most of the subjects with RBBB and concomitant CAD are likely to have certain clinical characteristics, the patients with CAD were older; more likely to be men; more likely to have previous myocardial infarction, diabetes mellitus and hypertension. When right bundle branch block was associated with chest pain of uncertain etiology, or unexplained electrocardiographic abnormality, coronary angiogram was helpful to confirm ischemic heart disease and etiology.