中华灾害救援医学

目的 分析急性下壁心肌梗死合并严重房室传导阻滞（AVB）患者的临床特征以及预后影响因素。方法 选择2022年5月至2024年5月淮安市第五人民医院收治的150例急性下壁心肌梗死患者为回顾性研究对象，根据患者是否合并严重AVB分为合并严重AVB组（35例）和未合并严重AVB组（115例）。比较两组研究对象的临床基础资料、冠脉造影及经皮冠状动脉介入（PCI）参数、预后相关指标、以及并发症发生情况。结果两组患者的年龄、性别、合并高血压占比、合并高脂血症占比、合并糖尿病占比、吸烟史、饮酒史、病变血管支数、PCI开通相关血管成功率、平均每例植入支架数、住院期间死亡率均无明显差异（P>0.05）。两组患者梗死相关动脉分布相比差异明显，合并严重AVB组右冠状动脉病变占比明显高于未合并严重AVB组（P<0.05）。合并严重AVB组房室传导恢复时间明显长于未合并严重AVB组（P<0.001）。住院期间死亡率两组差异不明显（P>0.05），但随访期间合并严重AVB组的死亡率明显升高（22.86%vs. 8.70%,OR=3.12,95%CI:1.12～8.67,P<0.05）。心功能恢复情况显示，合并组以NYHA Ⅱ～Ⅲ级为主（71.43%），而未合并组以NYHA Ⅰ～Ⅱ级为主（77.40%），组间差异明显（P<0.05）。并发症方面，合并组右室心肌梗死（40.00%vs. 20.00%）、心力衰竭（48.57%vs. 24.35%）和低血压休克（28.57%vs.12.17%）的发生率均明显高于未合并组（P<0.05），但恶性心律失常发生率无统计学差异（17.78%vs. 13.91%,P>0.05）。结论 急性下壁心肌梗死合并AVB患者以右冠状动脉病变为主，且1年内死亡率、右室心肌梗死、心力衰竭及低血压休克发生率明显升高，提示此类患者需加强预后监测及并发症管理。

Objective To analyze the clinical characteristics and prognostic factors of patients with acute inferior myocardial infarction complicated by severe atrioventricular block(AVB). Methods A retrospective study was conducted on 150 patients with acute inferior myocardial infarction admitted to the Fifth People's Hospital of Huaian from May 2022 to May 2024. According to whether the patients had severe AVB, they were divided into the severe AVB group(35 patients) and the non-severe AVB group(115 patients). The clinical baseline data, coronary angiography and percutaneous coronary intervention(PCI) parameters, prognostic indicators, and complications were compared between the two groups. Results There were no significant differences between the two groups in terms of age, gender, the proportion of patients with hypertension, hyperlipidemia, diabetes, smoking history, drinking history, number of affected coronary vessels, success rate of PCI vessel opening, average number of stents implanted per case, and in-hospital mortality(P>0.05). However, the distribution of infarct-related arteries showed significant differences between the groups, with the severe AVB group having a significantly higher proportion of right coronary artery involvement compared to the non-severe AVB group(P<0.05). The recovery time for atrioventricular conduction in the severe AVB group was significantly longer than that in the non-severe AVB group(P<0.001). The in-hospital mortality rates between the two groups were not significantly different (P>0.05),but the mortality rate during follow-up was significantly higher in the severe AVB group (22.86%vs.8.70%,OR=3.12,95%CI:1.12-8.67,P<0.05).Regarding heart function recovery,the severe AVB group had a predominance of NYHA class Ⅱ-Ⅲ (71.43%),while the non-severe AVB group was mainly classified as NYHA class Ⅰ-Ⅱ (77.40%),with a significant difference between the groups (P<0.05,Cliff's delta=0.28).In terms of complications,the incidence of right ventricular myocardial infarction (40.00% vs. 20.00%),heart failure (48.57% vs. 24.35%),and hypotensive shock (22.22%vs.12.17%) was significantly higher in the severe AVB group compared to the non-severe AVB group (P<0.05),but the incidence of malignant arrhythmias showed no statistical difference(17.78%vs.13.91%,P>0.05).Conclusion Patients with acute inferior myocardial infarction complicated by AVB predominantly exhibit right coronary artery involvement.Moreover,the one-year mortality rate,as well as the incidence of right ventricular myocardial infarction,heart failure,and hypotensive shock,is significantly increased.These findings suggest that patients of this type require enhanced prognostic monitoring and comprehensive management of complications.