完全性房室阻滞在急性下壁心肌梗死合并及不合并右室梗死病人的预后意义  

Prognostic significance of complete atrioventricular block in patients with acute inferior myocardial infarction with and without right ventricular involvement.

作　　者：贾佳[1] 祁芳[1] 李宗浩[1] 樊琨[1] 耿聆[1] 

机构地区：[1]北京急救中心,100031

出　　处：《临床心电学杂志》1999年第4期205-209,共5页Journal of Clinical Electrocardiology

摘　　要：　目的　确定完全性房室阻滞（ＣＡＶＢ）对急性下壁心肌梗死（ＡＩＭＩ）伴有或不伴有右室梗死（ＲＶＩ）病人预后的影响。方法　分析２６５ 例ＡＩＭＩ病人临床资料，２２２ 例无合并ＲＶＩ的病人（Ⅰ组），４３例合并ＲＶＩ病人（Ⅱ组），根据住院期间有无合并ＣＡＶＢ再将其分为两个亚组（无合并ＣＡＶＢ组（Ⅰａ、Ⅱａ组）及合并ＣＡＶＢ组（Ⅰｂ、Ⅱｂ 组））。选择临床及实验室资料进行比较。结果　（１）ＡＩＭＩ合并ＣＡＶＢ明显增加心脏并发症的发生率，Ｐ＜ ０．０１；ＡＭＩ合并ＲＶＩ虽有增高趋势，但无显著性差异；（２）溶栓治疗显著降低ＡＩＭＩ住院期间死亡率，特别是ＡＩＭＩ同时合并ＲＶＩ和ＣＡＶＢ的病人，Ｐ＜ ０．０５；（３）与ＣＡＶＢ、ＲＶＩ并存的ＡＩＭＩ以心脏合并症及ＣＫ峰值居高，住院死亡率显著为特点。结论　ＡＩＭＩ合并ＣＡＶＢ及ＲＶＩ表现出极高的心脏合并症发生率及住院死亡率可能是梗面积较大的结果，但是ＲＶＩ及ＣＡＶＢ的协同作用可能是影响ＡＩＭＩ预后的另外因素。Objective To determine the prognostic effect of complete atrioventricular block(CAVB) in patients with acute inferior myocardial infarction(AIMI) with and without right ventricular involvement(RVI).Methods Date were analyzed in 265 patients with AIMI.222 patients had no signs of RVI(group Ⅰ),whereas 43 patients had AIMI with RVI(gruop Ⅱ).patients were divided into groups depending on the presence or absence of CAVB during hospital stay (groups Ⅰa and Ⅱa without CAVB and groups Ⅰb and Ⅱb with CAVB). Selected clinical and laboratory variables were compared for each group.Results (1)Patients of AIMI with CAVB had higher complication rates of heart P <0 01,AIMI with RVI did not have varance even thought it seems higher than AIMI without RVI;(2)thrombolytic therapy had decreased mortality rate of AIMI, espescialy in patients who had AIMI with CAVB and RVI, P <0 05.(3)AIMI with CAVB and RVI had characterized by higher CK lever,in-hospital complication and mortality rate.Conclusion Excessively high in-hospital mortality and complication rate in patients who have AIMI infarction with RVI and CAVB could be the consequence of greater infarct size,but the synergistic influence of RVI and CAVB could be the other factor that influences outcome.

关 键 词：急性 房室阻滞 预后 心肌梗塞 

分 类 号：R542.220.7[医药卫生—心血管疾病]