急性心肌梗死合并Ⅲ度房室传导阻滞的临床特征及死亡相关因素分析  

Clinical characteristics and risk factors related to in-hospital mortality of patients with acute myocardial infarction complicated by complete atrioventricular block.

作　　者：孙超[1] 葛堪忆[1] 郭静萱[1] 毛节明[1] 陈明哲[1] 高炜[1] 

机构地区：[1]北京大学第三医院心内科,北京100083

出　　处：《中国综合临床》2006年第9期772-774,共3页Clinical Medicine of China

摘　　要：目的探讨急性心肌梗死合并Ⅲ度房室传导阻滞(AVB)的临床特征及死亡相关因素。方法选择急性心肌梗死合并Ⅲ度AVB患者51例(Ⅲ度AVB组),选择与Ⅲ度AVB组每例患者前后相继入院的急性心肌梗死患者2例,共102例构成对照组,比较2组临床特征及治疗的差异。Ⅲ度AVB组排除合并全身疾患病例2例,根据住院期间转归分为死亡组(14例)和存活组(35例),比较2组基线临床特征、并发症及治疗的差异。结果与对照组比较,Ⅲ度AVB组发病年龄较大,下壁、右心室梗死比例高,前壁梗死较少,住院期间死亡、心室颤动、低血压、心源性休克、心功能KillipⅣ级发生率高,起搏治疗比例较高,差异有显著性。与Ⅲ度AVB存活组比较,死亡组前壁梗死、低血压、心源性休克、心功能KillipⅣ级较多,12h内再灌注治疗病例较少,差异有显著性。结论急性心肌梗死合并Ⅲ度AVB预后差,住院期间病死率高。前壁梗死、低血压、心源性休克、KillipⅣ级心功能、12h内有无再灌注治疗是Ⅲ度AVB死亡相关因素。采取更为积极的血运重建措施可能改善Ⅲ度AVB预后。Objective To investigate the clinical characteristics and risk factors related to in-hospital mortality in patients with acute myocardial infarction （ AMI ） complicated by complete atrioventricular block （ CAVB ）. Methods 51 consecutive patients with CAVB complicated by AMI were selected and compared with those of 102 AMI patients without CAVB （control group} ,each case in control group was admitted just before or after hospital admission of the corresponding CAVB patient. The differences in clinical course were analyzed and compared between groups. AVB group were divided into death group （ n = 14 ） and survival group （ n = 35 ） except two cases complicated by other diseases, for the comparison of the clinical characteristics, complications and treatment. Results Compared with patients without CAVB ,the patients with CAVB were older and with a greater proportion complicated with inferi. or or right ventrical infarction. There was a higher incidence of hospital mortality,ventricular fibrillation （VF） ,low blood pressure, cardiogenic shock, Killip class Ⅳ and cardiac pacing in patients with CAVB, than those without CAVB. More CAVB patients who dead had anterior infarction or experienced low blood pressure ,cardiogenic shock or Killip class Ⅳ and less patients received coronary reporfusion therapy within 12 hours of symptoms onset than CAVB survivors did. No differences in the risk of developing VF were found between CAVB survivors and those who died during hospital stay. Conclusion Patients with CAVB complicated by AMI have a significant worse prognosis than those without CAVB. Anterior infarction,low blood pressure, cardiogenic shock, Killip class Ⅳ and lack of coronary repcrfusion therapy within 12 hours of symptoms onset are clinical factors related to in-hospital mortality. It is likely to improve the prognosis of AVB by active reconstruction of blood transportation.

关 键 词：急性心肌梗死 房室传导阻滞 

分 类 号：R542.22[医药卫生—心血管疾病]