[1]王晋华,李　玲,王晋丽.完全性右束支传导阻滞对住院患者全因死亡的预测价值[J].新乡医学院学报,2020,37(10):980-983.[doi:10.7683/xxyxyxb.2020.10.018]
　WANG Jinhua,LI Ling,WANG Jinli.Predictive value of complete right bundle branch block in all-cause mortality in hospitalized patients[J].Journal of Xinxiang Medical University,2020,37(10):980-983.[doi:10.7683/xxyxyxb.2020.10.018]
点击复制

完全性右束支传导阻滞对住院患者全因死亡的预测价值
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年10
页码:
980-983
栏目:
临床研究
出版日期:
2020-10-05

文章信息/Info

Title:
Predictive value of complete right bundle branch block in all-cause mortality in hospitalized patients
作者:
王晋华1; 李　玲1; 王晋丽2
（1.郑州市第九人民医院姑息治疗中心，河南　郑州　450053；2.解放军总医院第一医学中心心血管内科，北京　100853）
Author(s):
WANG Jinhua1; LI Ling1; WANG Jinli2
(1.Department of Palliative Care，the Ninth People′s Hospital of Zhengzhou,Zhengzhou 450053，Henan Province，China;
2.Department of Cardiology，the First Medical Center of PLA General Hospital，Beijing 100853，China)
关键词:
束支传导阻滞; 全因死亡; 住院患者
Keywords:
bundle branch block; all-cause mortality; hospitalized patient
分类号:
R541.7
DOI:
10.7683/xxyxyxb.2020.10.018
文献标志码:
A
摘要:
目的　观察合并完全性左束支传导阻滞（CLBBB)或完全性右束支传导阻滞（CRBBB）住院患者的临床结局差异，探讨CRBBB在院内全因死亡中的预测价值。方法　选择2007年1月至2017年1月于郑州市第九人民医院住院的合并CLBBB或CRBBB的1 556例患者为研究对象。根据合并束支传导阻滞类型分为CLBBB组和CRBBB组，比较2组患者性别、年龄及合并疾病等临床资料。根据是否发生院内死亡分为死亡组和非死亡组，比较2组患者临床疾病、束支传导阻滞类型、性别及年龄等临床指标的差异。应用logistic回归分析院内全因死亡的预测因素。结果　CLBBB组合并冠状动脉粥样硬化性心脏病（CHD）、急性心肌梗死（AMI）、扩张型心肌病（DCM）、其他心律失常患病率显著高于CRBBB组（P<0.05）；CLBBB组男性占比、合并高血压病、糖尿病（DM）患病率及病死率显著低于CRBBB组（P<0.05）；2组患者年龄、合并肿瘤和高脂血症患病率比较差异均无统计学意义（P>0.05）。院内死亡患者44例（2.8%），死亡组患者年龄大于非死亡组，合并AMI、CRBBB及肿瘤患病率均高于非死亡组（P<0.05）；2组合并CHD、DCM、高血压病、DM、高脂血症患病率比较差异均无统计学意义（P>0.05）。校正年龄、AMI和肿瘤后，CRBBB是住院患者全因死亡的独立预测因素［比值比=3.682，95%置信区间（CI）：1.249~10.865，P=0.018］。该模型用于预测院内全因死亡的受试者工作特征曲线下面积为0.833（95% CI：77.6%~88.9%，P<0.001）。结论　合并CRBBB可增加住院患者的全因死亡率，CRBBB是与AMI和年龄等传统全因死亡危险因素同等重要的心电指标，CRBBB可作为院内全因死亡的独立危险因素。
Abstract:
Objective　To observe the differential clinical outcomes of inpatients with complete left bundle branch block (CLBBB) or complete right bundle branch block (CRBBB)，and investigate the predictive value of CRBBB in all-cause death in hospitalized patients.Methods　A total of 1 556 inpatients with CLBBB or CRBBB hospitalized at the Ninth People′s Hospital of Zhengzhou from January 2007 to January 2017 were selected as research subjects.According to the bundle branch block chamber，the patients were divided into the CLBBB group and the CRBBB group.The clinical data of the patients were compared between the two groups，including gender，age and complicated diseases.And the patients were divided into the death group and the non-death group based on whether or not the death was occurred.The differences in clinical indicators of the patients between the two groups were compared，including clinical disease，type of bundle branch block，gender，age，etc.Multivariate logistic regression analysis was used to analyze the predictor of in-hospital all-cause.Results　The prevalence rate of combined coronary atherosclerotic heart disease (CHD)，acute myocardial infarction (AMI),dilated cardiomyopathy (DCM) and other arrhythmia in the CLBBB group were significantly higher than those in the CRBBB group (P<0.05).The constituent ratio of male,the prevalence rate of combined hypertension and diabetes mellitus (DM) and mortality in the CLBBB group were significantly lower than those in the CRBBB group (P<0.05).There was no significant difference in the age,prevalence rate of combined cancer and hyperlipidemia of the patients between the two groups (P>0.05).Forty-four patients (2.8%) died in the hospital.The age of the patients，prevalence rate of combined AMI，CRBBB and tumer in the death group were significantly higher than those in the non-death group(P<0.05).There was no significant difference in the prevalence rate of combined CHD,DCM，hypertension,DM,and hyperlipidemia between the two groups (P>0.05).CRBBB was an independent predictor of in-hospital all-cause death after adjusting for age，AMI and tumor ［odds ratio=3.682，95% confidence interval (CI):1.249-10.865，P=0.018］.Area under the receiver operating characteristic curve of the model used to predict in-hospital all-cause mortality was 0.833 (95% CI:77.6%-88.9%，P<0.001）.Conclusion　Combining CRBBB can increase the all-cause death of hospitalized patients.CRBBB is an indicator in ECG which is as important as traditional risk factors for all-cause death such as AMI and age.CRBBB can be used as an indepen-dent risk factor for all-cause death in the hospital.

参考文献/References:

［1］　ZHANG Z M,RAUTAHARJU P M,PRINEAS R J,et al.Bundle branch blocks and the risk of mortality in the Atherosclerosis risk in communities study［J］.J Cardiovasc Med (Hagerstown),2016,17(6):411-417.
［2］　RABKIN S W，MATHEWSON F A，TATE R B.Natural history of left bundle-branch block［J］.Br Heart J，1980,43(2):164-169.
［3］　SCHNEIDER J F，THOMAS H E J R，KREGER B E，et al.Newly acquired left bundle-branch block:the Framingham study［J］.Ann Intern Med，1979,90(3):303-310.
［4］　ALKINDI F,EL-MENYAR A,RAFIE I,et al.Clinical presentations and outcomes in patients presenting with acute cardiac events and right bundle branch block［J］.Angiology,2020,71(3):256-262.
［5］　ALVENTOSA-ZAIDIN M,ROCA SAUMELL C,BRUGADA TERRADELLAS J.Right bundle branch block and cardiovascular morbidity and mortality in healthy patients［J］.Med Clin (Barc),2018,151(10):402-411.
［6］　SURAWICZ B,CHILDERS R,DEAL B J,et al.AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram:part III:intraventricular conduction disturbances:a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee，Council on Clinical Cardiology;the American College of Cardiology Foundation;and the Heart Rhythm Society.Endorsed by the International Society for Computerized Electrocardiology［J］.J Am Coll Cardiol,2009,53(11):976-981.
［7］　钟玉霖,陈楚玉,杨业春.2003年-2011年某院住院病人死亡病例统计分析［J］.中国病案，2013,14(4):36-37.
［8］　FOX J.Safer care for the acutely ill patient ［J］.Br J Nurs,2007,16(15):913.
［9］　MERCHANT R M,YANG L,BECKER L B,et al.Incidence of treated cardiac arrest in hospitalized patients in the United States［J］.Crit Care Med，2011，39(11):2401-2406.
［10］　SALLUH J I，SOARES M.ICU severity of illness scores:APACHE，SAPS and MPM［J］.Curr Opin Crit Care,2014,20(5):557-565.
［11］　ZIMMERMAN J E，KRAMER A A，MCNAIR D S，et al.Acute physiology and chronic health evaluation (APACHE) IV:hospital mortality assessment for today′s critically ill patients［J］.Crit Care Med,2006,34(5):1297-1310.
［12］　MORENO R P，METNITZ P G，ALMEIDA E，et al.SAPS 3-from evaluation of the patient to evaluation of the intensive care unit.Part 2:development of a prognostic model for hospital mortality at ICU admission［J］.Intensive Care Med，2005,31(10):1345-1355.
［13］　LEE Y S,CHOI J W,PARK Y H,et al.Evaluation of the efficacy of the National Early Warning Score in predicting in-hospital mortality via the risk stratification［J］.J Crit Care,2018，47:222-226.
［14］　ALVENTOSA-ZAIDIN M,GUIX FONT L,BENITEZ CAMPS M,et al.Right bundle branch block:prevalence，incidence，and cardiovascular morbidity and mortality in the general population［J］.Eur J Gen Pract,2019,25(3):109-115.
［15］　BARBARA B E，HOLST A G,JESPERSEN L,et al.Right bundle branch block:prevalence，risk factors，and outcome in the general population:results from the Copenhagen City Heart Study ［J］.Eur Heart J,2013,34(2):138-146.
［16］　NEUMANN J T,SRENSEN N A,RüBSAMEN N,et al.Right bundle branch block in patients with suspected myocardial infarction［J］.Eur Heart J Acute Cardiovasc Care,2019，8(2):161-166.
［17］　LAI L,JIANG R,FANG W,et al.Prognostic impact of right bundle branch block in hospitalized patients with idiopathic dilated cardiomyopathy:a single-center cohort study［J］.J Int Med Res,2020,48(1):300060518801478.
［18］　SAKAKURA K，KUBO N，HASHIMOTO S,et al.Determinants of in-hospital death in left main coronary artery myocardial infarction complicated by cardiogenic shock［J］.J Cardiol,2008，52(1):24-29.
［19］　XIONG Y，WANG L，LIU W,et al.The prognostic significance of right bundle branch block:a meta-analysis of prospective cohort studies［J］.Clin Cardiol,2015,38(10):604-613.
［20］　MCCULLOUGH S A,GOYAL P,KRISHNAN U,et al.Electrocardiographic findings in coronavirus disease-19:insights on mortality and underlying myocardial processes［J］.J Card Fail,2020,26(7):626-632.

更新日期/Last Update: 2020-10-05