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目的探讨新发右束支阻滞(RBBB)在急性下壁心肌梗死(MI)中的发生率、临床特征及院内预后价值。方法收集863例前壁及下壁急性心肌梗死(AMI)患者,分别将其分为RBBB组及无RBBB组;比较两组间的基线资料,临床特征及院内预后。应用Logistic回归分析下壁AMI患者院内死亡的独立危险因素。结果 RBBB在下壁AMI中发生率为11.7%,与其在前壁AMI中的发生率(13.3%)相比无统计学差异。下壁AMI中RBBB组与非RBBB组相比,RBBB组患者年龄较大、CK-MB峰值较高、肺淤血发生率、院内死亡率及MACE发生率较高(P<0.05);Logistic回归分析结果提示新发持续RBBB为下壁AMI患者院内死亡的独立预测因素[RR=5.79(95%CI:1.15-29.13),P<0.05]。结论新发RBBB在下壁AMI患者中发生率与前壁AMI并无明显差异,新发持续的RBBB的意义与前壁AMI患者一样,预示院内预后较差。
Objective To investigate the incidence, clinical characteristics and prognosis of newly diagnosed right bundle branch block (RBBB) in acute inferior myocardial infarction (MI). Methods 863 AMI patients were divided into two groups: RBBB group and no RBBB group. Baseline data, clinical characteristics and in-hospital prognosis were compared between the two groups. Logistic regression analysis was used to analyze the independent risk factors for nosocomial death in patients with inferior wall AMI. Results The incidence of RBBB in the inferior wall AMI was 11.7%, which was not statistically different from its incidence in the anterior wall AMI (13.3%). Compared with non-RBBB group, RBBB group had higher age, higher peak of CK-MB, lower incidence of pulmonary congestion, hospital mortality and MACE (P <0.05) in RBBB group than in non-RBBB group. Logistic regression analysis The results suggest that persistent new RBBB is an independent predictor of in-hospital mortality in patients with inferior AMI [RR = 5.79 (95% CI: 1.15-29.13), P <0.05]. Conclusions The incidence of newly diagnosed RBBB in inferior wall AMI is not significantly different from that of anterior wall AMI. The significance of new RBBB persistent is the same as that of AMI in the anterior wall, which indicates the poor in-hospital prognosis.