急性前壁心肌梗死伴发新出现的完全性右束支传导阻滞32例临床分析

目的通过对急性前壁心肌梗死（AMI）伴发新出现的完全性右束支传导阻滞（CRBBB）32例患者的临床资料分析,评估AMI伴发新出现的CRBBB的临床意义。方法选取2003年2月至2007年6月在本院心脏科住院的AMI患者105例,分为两组,AMI伴发新出现的CRBBB患者32例为观察组,单纯AMI患者73例为对照组,对两组患者的肌钙蛋白（cTNI）滴度、血清肌酸激酶同工酶（CK-MB）、左室射血分数（LVEF）、心功能Killip分级、严重恶性心律失常发生率及住院病死率等临床资料进行对比性分析并做统计学处理。结果AMI伴发新出现的CRBBB患者发生快速或缓慢心律失常的比例、心功能Killip分级≥Ⅲ级的比例、心源性休克比例、cTNI滴度及早期病死率均显著高于单纯AMI患者（P〈0.05）,而LVEF、溶栓再通率显著〈单纯AMI患者。结论AMI伴发新出现的持续性CRBBB,提示临床病情凶险,预后不良,可作为AMI患者病情恶化的一个很有价值的预测指标。

Clinical analysis of 32 cases of acute anterior wall myocardial infarction combined with complete right bundle branch block

Objective To evaluate the clinical significance of acute anterior wall myocardial infarction combined with complete right bundle branch block.Methods 105 cases of acute anterior wall myocardial infarction of our hospital from Feb,2003 to Jun,2007 were divided into two groups,32 cases with acute anterior wall myocardial infarction combined with complete right bundle branch block（CRBBB）were of observing group and 73 cases of acute anterior wall myocardial infarction alone were of control group.Treponin titre（cTNI）,serum creatine kinase isozyme（CK-MB）,left ventricular ejection fraction（LVEF）,Killip grading of heart function,incidence rate of severe arrhythmogenesis and case-fatality rate were compared and statistically analyzed.Results The incidence rate of tachyarrhythmia or bradyarrhythmia,the rate of Killip grading≥Ⅲ,the incidence rate of cardiac shock,cTNI and early mortality was higher in were significantly higher in observing group than those in control group（P〈0.05）.The LVEF and recanalization rate after thrombolysis were significantly lower in observing group than those in control group.Conclusions Acute anterior wall myocardial infarction combined with CRBBB suggests the severity of disease and the poor prognosis,which could be a valuable prediction of aggravation in patients with acute anterior wall myocardial infarction.