老年慢性全心衰竭合并左束支传导阻滞患者r波递增不良新概念  

New concept of poor r-wave progression in elderly patients with chronic whole heart failure complicated with left bundle branch block

作　　者：陈灼焰 胡永烁 CHEN Zhuoyan;HU Yongshuo(Department of Cardiology ,the First Hospital of Fuzhou Affiliated to Fujian Medical University ,Fuzhou 350009 ,China)

机构地区：[1]福建医科大学附属福州市第一医院心内科

出　　处：《中华实用诊断与治疗杂志》2019年第7期682-684,共3页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的探讨心电图r波递增不良新概念“掉头延迟”及“掉头迟钝”与老年慢性全心衰竭合并左束支传导阻滞的关系。方法老年慢性全心衰竭合并左束支传导阻滞患者22例,心电图表现符合“掉头延迟”和/或“掉头迟钝”,均给予标准抗心力衰竭治疗。比较治疗前、临床症状缓解时体质量、血清脑钠肽及左室射血分数;记录治疗过程中液体出入量负平衡。结果 22例患者中4例在治疗第3天临床症状缓解,8例在治疗第4天临床症状缓解,10例在治疗第5天临床症状缓解,临床症状缓解时间为(4.27±0.77)d;临床症状缓解时脑钠肽[(420.8±142.9)ng/L]、体质量[(63.6±8.3)kg]均低于治疗前[(1 763.8±428.3)ng/L、(68.9±11.1)kg],左室射血分数[(40.1±11.6)%]高于治疗前[(35.2±8.7)%](P<0.05);临床症状缓解时,8例“掉头延迟”得到纠正,6例“掉头迟钝”得到纠正,6例“掉头延迟”及“掉头迟钝”均得到纠正,2例“掉头延迟”及“掉头迟钝”均未得到纠正;随液体出入量负平衡(累计)增加,“掉头延迟”和/或“掉头迟钝”现象纠正者逐渐增加,出入量负平衡>3 000 mL时,“掉头延迟”现象纠正8例,“掉头迟钝”现象纠正6例,“掉头延迟”和“掉头迟钝”现象均纠正6例。结论老年慢性全心衰竭合并左束支传导阻滞患者随容量超负荷的改善,“掉头”现象可能被纠正。Objective To explore the relationship of "U-turn delay" and "U-turn slow" in the ECG new concepts of poor r-wave progression with chronic whole heart failure complicated with left bundle branch block in elderly patients. Methods Twenty-two elderly patients with chronic whole heart failure complicated with left bundle branch block were conformed to ECG "U-turn delay" and "U-turn slow" and were treated with standard anti-heart failure therapy. The body mass, the level of brain natriuretic peptide and left ventricular ejection fraction were recorded before treatment and when the clinical symptoms were relieved. The negative balance of fluid intake and outlet during treatment was recorded. Results In 22 patients, the clinical symptoms were relieved in 4 patients on the third day, in 8 on the fourth day, and in 10 on the fifth day, averagely (4. 27±0. 77) d. The levels of brain natriuretic peptide and body mass were significantly lower and left ventricular ejection fraction was significantly higher when the clinical symptoms were relieved ((420. 8± 142. 9) ng/L,(63. 6 ±8.3) kg,(40. 1 ± 11. 6)%) than those before treatment (( 1 763. 8 ± 428.3) ng/L,(68.9 ± 11. 1) kg,(35. 2±8.7)%)(PV0. 05). In 22 patients,"U-turn delay" was corrected in 8 patients,"U-turn slow" was corrected in 6 patients*, both "U-turn delay" and "U-turn slow" was corrected in 6, and neither "U-turn delay" nor "U-turn slow" was corrected in 2. With the increase of negative balance of fluid intake and outlet,"U-turn delay" and/or "U-turn slow" were corrected in more patients. When the negative balance of fluid intake and outlet exceeded 3 000 mL,"U-turn delay" was corrected in 8 patients,"U-turn slow" was corrected in 6, and both wU-turn delay" and"U-turn slow" was corrected in 6. Conclusion With the improvement of volume overload,"U-turn delay" and "U-turn slow" might be corrected in patients with chronic whole heart failure complicated with left bundle branch block.

关 键 词：慢性全心衰竭 左束支传导阻滞 心电图 "掉头"现象 R波递增不良 

分 类 号：R541.6[医药卫生—心血管疾病]