急性心肌梗死并发房室传导阻滞的临床分析

目的探讨急性心肌梗死(AMI)患者发生房室传导阻滞(AVB)的临床特点。方法采用非创伤性心电监测法监测122例心肌梗死患者AVB的发生率及其对药物治疗反应、演变过程和最终预后。结果 122例AMI患者中20例发生AVB(16.4%)。17例发生于下/后心肌梗死者,3例发生于前壁/广泛前壁心肌梗死者。按AVB发生的不同时期分为早发组(发病8 h内,n=8)和晚发组(发病8 h后,n=12),晚发组并发症显著高于早发组(25﹪vs 83.3﹪,P<0.05);早发组对阿托品或山莨菪碱治疗反应较好(P<0.05);早发组Ⅲ度AVB 7例、Ⅱ度AVB 1例,持续时间短。晚发组Ⅰ度AVB 5例、Ⅱ度AVB 6例、Ⅲ度AVB 1例,持续时间长;早发组住院期间死亡1例、晚发组死亡5例,有显著差异(P<0.05)。结论 AMI病人中下/后壁心肌梗死易并发AVB;8 h之内发生的AVB以Ⅲ度AVB为主,早期发生的AVB患者预后好。

Clinical analysis of acute myocardial infarction complicated by atrioventricular block

Objective To investigate the clinical features of acute myocardial infarction （AMI） with atrioventricular block （AVB）. Methods Non-invasive ECG monitoring method was used for monitoring the incidence of AVB , it＇s re- sponse to drug treatment in 122 cases of myocardial infarction. Results Among 122 patients with AMI, 20 patients had AVB （ 16.4% ）. 17 cases occurred in the infero/post-myocardial infarction, 3 cases occurred in the anterior Ⅰ extensive anterior wall myocardial infarction. According to the different periods of AVB occerrence, patients were divided in early-on- set group（ disease within 8 hours, n = 8） and late-onset group（ disease after 8 hours,n = 12）, and compared to early-onset group, the occurrence of complications of late-onset group was higher （ P 〈0. 05）. There was significant difference in the occurrence of combined heart failure in two groups（P 〈 0.05 ） ;There was significant difference in the effect of two groups after treatment with atropine or anisodamine（P 〈 0.05） ; Early-onset group mainly showed Ⅲ degree AVB in 7 patients and Ⅱ degree AVB in 1 patients, short duration, however, late-onset group showed I degree AVB in 5 patients, Ⅱ degree AVB in 6 patients, followed by .Ⅲ degree AVB in 1 patients, long duration, 1 patient died during hospitalization in earlyonset group, 5 patients died during hospitalization in late-onset group. There was significant difference in two-hospital mortality of the two groups （P 〈 0. 05 ）. Conclusion It is easy to occur infarction complicated by AVB in the infero or posterior wall for patients with AMI; early-onset group mainly showed m degree AVB, the prognosis of AVB occurred in the early is good.