在患有心脏性休克和心脏骤停的患者中,右和左捆分支块的影响
Jonas Rusnak1, Tobias Schupp1, Kathrin Weidner1
1Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Critical care medicine
|October 29, 2024
概括
右束分支阻塞 (RBBB) 与左束分支阻塞 (LBBB) 不同,右束分支阻塞 (RBBB) 在心脏性休克 (CS) 患者中显著增加了30天的死亡率. 这一发现甚至适用于经历心脏骤停的CS患者.
科学领域:
- 心脏病学 心脏病学
- 密集护理医学 密集护理医学
- 电子生理学 电子生理学
背景情况:
- 捆绑分支块 (BBB),包括右捆绑分支块 (RBBB) 和左捆绑分支块 (LBBB),已知会影响心力衰竭患者的预后.
- 特别是在心脏性休克 (CS) 的背景下,RBBB和LBBB的预后意义需要进一步阐明.
研究的目的:
- 研究RBBB和LBBB对心脏性休克 (CS) 患者30天全因死亡率的预后影响.
- 为了比较CS患者的RBBB,LBBB和没有BBB的结果.
主要方法:
- 在德国一家高等学术医院的ICU进行了前性注册表研究.
- 被诊断为CS的成年患者被纳入研究队列.
- 评估的主要结局是30天全因死亡率,使用日志等级测试和多变量考克斯回归分析.
主要成果:
- 该研究包括248名CS患者. RBBB与30天死亡率最高 (72.5%) 相关,其次是LBBB (52.9%) 和没有BBB (50.0%).
- 这些死亡率差异在入院时心脏骤停的CS患者小组中持续存在 (RBBB 90.0%,LBBB 73.3%,没有BBB 62.2%).
- 多变量分析证实RBBB是30天死亡率 (HR,1.807) 的独立负预后因素,而LBBB没有显著影响. 乳酸盐,热素I和急性生理学得分也预测了死亡率.
结论:
- 右捆支部阻塞 (RBBB) 独立地与心脏性休克 (CS) 患者的30天全因死亡率增加有关,无论心脏骤停状态如何.
- 左捆分支区块 (LBBB) 在这个CS队列中没有对30天死亡率产生显著的预后影响.
- 诸如急性生理学评分,乳酸和热波水平等因素也是CS患者死亡率的关键预测因素.
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