左束支阻滞伴心功能不全者QRS波时限及冠心病等变化研究

目的 探究左束支阻滞伴心功能不全患者的QRS波时限及冠心病、高血压等疾病变化特点.方法 选取2015年6月至2018年12月我院住院患者诊断为左束支阻滞伴心功能不全74例与不伴心功能不全70例进行比较,观察两组在QRS波时限、RV1振幅<0.1mV例数和冠心病、高血压等疾病例数的差异.将观察组74例按左束支阻滞特征分成真性与假性组,以QRS波时限大于、等于和小于150ms分成两组并分别进行比较.结果 伴心功能不全组QRS波时限(143.14±19.55)ms大于不伴组(131.29±13.55)ms(P<0.001).伴心功能不全组冠心病(55/74比24/70,P<0.001)、心肌梗死(12/74比3/70,P=0.019)、心肌病(21/74比0/70,P<0.001)的例数均高于不伴组.两组高血压(52/74比52/70)、糖尿病(24/74比30/70)的例数较高,两组在高血压、糖尿病、冠状动脉旁路移植、支架置入和RV1振幅<0.1 mV的例数之间无差异(P>0.05).对伴心功能不全者的第二种分组中,除真性左束支阻滞在心功能Ⅲ级(25/43比8/31,P=0.010)、假性在心功能Ⅳ级(16/31比11/43,P=0.019)和冠心病例数方面(27/31比28/43,P=0.013)较高外,其余所有的比较均无差异(P>0.05).结论 当患者左束支阻滞伴心功能不全时,QRS时限明显增宽,临床上更多见于冠心病、心肌梗死和心肌病者,上述特点可为此类患者的临床诊断和治疗提供参考和帮助.

Study on the changes of QRS duration and coronary heart disease in patients with left bundle branch block and cardiac insufficiency

Objective To investigate the changes of QRS duration and coronary heart disease in patients with left bundle branch block and cardiac insufficiency.Methods 74 left bundle branch block patients with cardiac insufficiency and 70 patients without cardiac insufficiency in our hospital from 2015.6-2018.12 were enrolled.The changes and differences between the two groups in the QRS time limit,RVi amplitude<0.1mV cases,coronary heart disease and hypertension were observed.The observation group was divided into the true and false groups by QRS wave time limit.Results The QRS time limit(143.14±19.55)ms vs.(131.29±13.55)ms,P<0.001 and cases of coronary heart disease(55/74 vs.24/70,P<0.001),myocardial infarction(12/74 vs.3/70,P=0.019)and cardiomyopathy(21/74vs.0/70,P<0.001)were all higher in the group with cardiac insufficiency than that without cardiac insufficiency.There were no differences between the two groups in the cases of hypertension,diabetes,coronary artery bypass grafts,stent implantation and the RVj amplitude<0.1 mV.The cases of coronary heart disease wwere higher in true left bundle branch block with grade ID heart function.The coronary heart disease incidence was higher in the false group with grade IV heart function.Conclusion The QRS time limit is widened in patients with LBBB and cardiac insufficiency and it is more common in the patients with coronary heart disease,myocardial infarction and cardiomyopathy;these features can provide reference and help for the clinical diagnosis and treatment of such patients.