上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (5): 632-.doi: 10.3969/j.issn.1674-8115.2011.05.022

• 论著（临床研究） • 上一篇    下一篇

急性前壁心肌梗死合并完全性房室传导阻滞的临床特点

储 光, 张国兵, 张 锋, 张 治, 孙宝贵, 戴秋艳, 刘少稳   

  1. 上海交通大学附属第一人民医院心内科, 上海 200080
  • 出版日期:2011-05-28 发布日期:2011-05-27
  • 通讯作者: 戴秋艳, 电子信箱: qiuyand@yahoo.com。
  • 作者简介:储 光（1975—）, 男, 主治医师, 硕士；电子信箱: chu943106@yahoo.com.cn。

Clinical characteristics of acute anterior myocardial infarction complicated by complete atrioventricular block

CHU Guang, ZHANG Guo-bing, ZHANG Feng, ZHANG Zhi, SUN Bao-gui, DAI Qiu-yan, LIU Shao-wen   

  1. Department of Cardiology, the First People's Hospital, Shanghai Jiaotong University, Shanghai 200080, China
  • Online:2011-05-28 Published:2011-05-27

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摘要：

目的 观察急性前壁心肌梗死合并完全性房室传导阻滞（CAVB）的临床特点。方法 2004—2009年上海交通大学附属第一人民医院心内科共收治急性前壁心肌梗死患者885例，分为合并新发CAVB组（n=19，2.1%），无CAVB组（n=866，97.9%），分别观察肌酸激酶及同工酶峰值、脑钠肽水平、心功能Killip分级、左室射血分数、冠状动脉病变特点及住院病死率，并分析发生CAVB的发病因素及对预后的影响。结果 新发CAVB组较无CAVB组肌酸激酶峰值和同工酶峰值明显升高[（1 804.5±65.4）U/L vs（1 251.3±46.7）U/L，（155.8±25.6）U/L vs（104.3±19.1）U/L，均P<0.05]；脑钠肽峰值水平更高[（1 254.4±55.3）pg/mL vs（432.4±78.5）pg/mL，P<0.05]；心功能Killip分级较差（P<0.05）；左室射血分数明显降低[（40.5±4.6）% vs（51.2±6.9）%，P<0.05]；冠状动脉病变更为严重（P<0.05）；住院病死率显著升高（63.2% vs 2.4%，P<0.05）。结论 急性前壁心肌梗死合并新发CAVB患者冠状动脉病变严重，心肌坏死面积大，心功能差，住院病死率极高。

关键词: 心肌梗死, 房室传导阻滞, 脑钠肽

Abstract:

Objective To investigate the clinical characteristics of acute anterior myocardial infarction complicated by complete atrioventricular block (CAVB). Methods A total of 885 patients with acute anterior myocardial infarction were enrolled, and were divided into CAVB group (complicated by CAVB, n=19, 2.1%) and non-CAVB group(not complicated by CAVB, n=866, 97.9%). The serum peak levels of creatine kinase and its isoenzyme, BNP level, left ventricular ejection fraction (LVEF), Killip heart performance stage, coronary artery lesion feature and hospital mortality were observed, and pathological factors of CAVB and their impact on prognosis were analysed. Results Compared with patients in nonCAVB group, those in CAVB group had significantly higher serum peak levels of creatine kinase and its isoenzyme [（1 804.5±65.4）U/L vs （1 251.3±46.7）U/L，（155.8±25.6）U/L vs （104.3±19.1）U/L，P<0.05 for both], significantly higher BNP level [（1 254.4±55.3）pg/mL vs （432.4±78.5）pg/mL，P<0.05], poorer Killip heart performance stage （P<0.05）, significantly lower LVEF [（40.5±4.6）% vs （51.2±6.9）%，P<0.05], more severe coronary artery lesions （P<0.05）and significantly higher hospital mortality （63.2% vs 2.4%，P<0.05）. Conclusion Patients with acute anterior myocardial infarction complicated by CAVB may have more severe coronary artery lesions, more extensive infarction area, worse heart performance and higher in hospital mortality.

Key words: myocardial infarction, atrioventricular block, brain natriuretic peptide