老年急性前壁心肌梗死并发房室传导阻滞患者临床研究
心肌梗死；,传导阻滞；,老年人,1资料与方法,2结果,3讨论,参考文献
【摘要】 目的 探讨老年急性前壁心肌梗死(AWMI)伴完全性房室传导阻滞(CAVB)患者的临床特点。 方法 回顾性分析急性AWMI或下壁心肌梗死(IWMI)并CAVB老年患者的临床特点，根据入院时心电图ST段抬高部位将患者分为2组：IWMI合并CAVB组共17例,AWMI合并CAVB组共8例。比较2组患者主要危险因素、临床表现和冠状动脉病变特点的差别。 结果 ①AWMI患者在呼吸困难、CK最大值、晕厥、病死率、需要经静脉起搏治疗、QRS宽度和室性心动过速较IWMI患者明显增高，Killp心功能分级差。②10例IWMI的患者进行急诊PCI治疗，所有患者梗死相关动脉(IRCA)均为右冠状动脉(RCA)且均累及房室结动脉；有4例AWMI的患者进行急诊PCI治疗，所有患者IRCA均为前降支(LAD)近段病变且均累及高位间隔支，其中有3例患者合并RCA病变且均累及房室结的供血。 结论 与IWMI合并CAVB患者相比较，AWMI合并CAVB的患者IRCA为LAD近段病变累及高位间隔支，且多同时合并有房室结动脉的缺血，梗死面积大，心功能差，室性心动过速发生率高，病死率高。【主题词】 心肌梗死； 传导阻滞； 老年人
Clinical characteristics of elderly patients with acute anterior wall myocardial infarction and complete atrioventricular block
ZHAN Zhongqun, WANG Wei, WANG Chongquan, DANG Shuyi, HE Chaorong.
Department of cardiology, Taihe Hospital Affiliated to Yunyang Medical College, Shiyan 442000 China
【Abstract】 Objective To evaluate the clinical characteristics of elderly patients with acute anterior wall myocardial infarction(AWMI) and complete atrioventricular block(CAVB). Methods Twentyfive elderly patients with inferior wall myocardial infarction (IWMI) or AWMI accompanied by CAVB were randomly divided into two groups: Group A, 17 patients with IWMI; Group B, 8 patients with AWMI. The differences of the main risk factors, clinical manifestation and coronary artery lesions between the two groups were analyzed. Resukts ①Dyspnea, syncope, mortality, transvenous pacemaker(P<001) and ventricular tachycardia(P<005) were more common in patients with AWMI and CAVB than those in patients with IWMI and CAVB. QRS duration(P<001) and peak CK level (P<005)were higher while Killip cardiac function class was poorer in patients with AWMI and CAVB than that in patients with IWMI and CAVB. ②Infarction related coronary artery(IRCA) was right coronary artery, which involved atrioventricular nodal artery in 9 patients with IWMI and CAVB who performed direct PCI. IRCA was proximal anterior descending coronary artery (LAD) which involved the high septal branches in 4 patients with AWMI and CAVB who performed direct PCI and 3 patients with lesions involving the artery to AV node. Conckusions Compared with elderly patients with IWMI and CAVB, infarction size is large, and cardiac function is poor, and ventricular tachycardia and mortality are high in the elderly patients with AWMI and CAVB. ......
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