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中华妇幼临床医学杂志(电子版) ›› 2016, Vol. 12 ›› Issue (06) : 699 -704. doi: 10.3877/cma.j.issn.1673-5250.2016.06.015

所属专题： 文献；

论著

儿童与成年人心电图右束支传导阻滞的临床分析
刘童1, 秦方1, 郑志洁2, 乔莉娜3, 卢永义3, 魏丽3,†()   
  1. 1. 610041成都市第一人民医院心内科
    2. 610041成都，四川大学华西第四医院心电图室
    3. 610041成都，四川大学华西第二医院儿科
  • 收稿日期:2016-03-09 修回日期:2016-11-04 出版日期:2016-12-01
  • 通信作者: 魏丽

Clinical analysis of right bundle branch block pattern for children and adults electrocardiogram

Tong Liu1, Fang Qin1, Zhijie Zheng2, Lina Qiao3, Yongyi Lu3, Li Wei3,†()   

  1. 1. Department of Cardiology, Chengdu First People′s Hospital, Chengdu 610041, Sichuan Province, China
    2. Department of Electrocardiogram, West China Fourth Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
    3. Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2016-03-09 Revised:2016-11-04 Published:2016-12-01
  • Corresponding author: Li Wei
  • About author:
    Corresponding author: Wei Li, Email:
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引用本文：

刘童, 秦方, 郑志洁, 乔莉娜, 卢永义, 魏丽. 儿童与成年人心电图右束支传导阻滞的临床分析[J]. 中华妇幼临床医学杂志(电子版), 2016, 12(06): 699-704.

Tong Liu, Fang Qin, Zhijie Zheng, Lina Qiao, Yongyi Lu, Li Wei. Clinical analysis of right bundle branch block pattern for children and adults electrocardiogram[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2016, 12(06): 699-704.

目的

探讨儿童与成年人心电图右束支传导阻滞(RBBB)的年龄、病因、合并阻滞类型分布及心电图QRS波宽的差异。

方法

选择2013年1月至12月于成都市第一人民医院、四川大学华西第二医院及四川大学华西第四医院心电图室门诊或住院确诊为RBBB的830例患者为研究对象。根据其年龄分为儿童组(n＝330，<18岁)与成年人组(n＝500，≥18岁)。统计学比较2组受试者年龄、病因、合并阻滞类型分布及心电图QRS波宽。

结果

①儿童组RBBB患者中，3～7岁者为132例，占儿童组总人数的40.0%(132/330)；成年人组RBBB患者中，50～70岁者为204例，占成年人组总人数的40.8%(204/500)。②儿童组RBBB患者中，以先天性心脏病为最主要的病因，先天性心脏病术前者占29.1%(96/330)，术后者占56.4%(186/330)。成年人组RBBB患者中，慢性肺部疾病或明确有心脏病史者占65.6%(328/500)。③儿童组与成年人组RBBB合并其他阻滞类型的发生率分别为16.4%(54/330)与50.4%(252/500)。2组患者RBBB合并其他阻滞类型的构成比比较，差异无统计学意义(χ2＝0.250，P＝0.993)。成年人和儿童RBBB均以合并左前分支传导阻滞(LAFB)最为常见。④儿童组不完全性RBBB(IRBBB)患者QRS波宽为(78.2±12.6)ms，低于成年人组IRBBB患者的(98.9±9.3)ms，二者比较，差异有统计学意义(t＝－3.193，P＝0.013)。儿童组完全性RBBB(CRBBB)患者QRS波宽为(118.4±8.9)ms，低于成年人组CRBBB患者的(148.2±21.4)ms，二者比较，差异有统计学意义(t＝－3.214，P＝0.012)。

结论

儿童与成年人RBBB患者的年龄、病因、心电图QRS波宽分布不同，但是RBBB合并其他阻滞类型比较无差异。

关键词: 束支传导阻滞, 心电描记术, 儿童, 成年人
Objective

To analyze the age, etiologic distribution, combined type of block and the QRS wave width of electrocardiogram in children and adults with right bundle branch block (RBBB).

Methods

A total of 830 cases of outpatients and inpatients who were diagnosed as RBBB by electrocardiogram in Chengdu First People′s Hospital, West China Second Hospital of Sichuan University and West China Fourth Hospital of Sichuan University from January to December in 2013 were selected as the subjects. According to the age, they were divided into children group (n=330, all <18 years old) and adults group (n=500, all ≥18 years old). The age, etiologic distribution, combined types of blocks, QRS width of two groups were analyzed by statistical methods.

Results

①The age of RBBB patients in children group was mainly distributed in 3 to 7 years old, accounting for 40.0% (132/330) of the total number of children group. The age of RBBB patients in adult group was mainly distributed in 50 to 70 years old, accounting for 40.8% (204/500) of the total number of adults group. ②Congenital heart disease was the most common cause of RBBB in children, preoperative and postoperative congenital heart disease patients accounted for 29.1% (96/330) and 56.4% (186/330), respectively in children group. Adults with chronic lung disease or a clear history of heart disease accounted for 65.6% (328/500) in adults group. ③The incidence of RBBB combined with other types of block in children group and adults group was 16.4% (54/330) and 50.4% (252/500), respectively. There was no significant difference in the constituent ratio of RBBB combined with other types of blocks in children and adults group (χ2=0.250, P=0.993). RBBB combined with left anterior branch block (LAFB) was the most common combined type of blocks both in adults and children group. ④The width of QRS in children with incomplete right bundle branch block (IRBBB) was (78.2±12.6) ms, which was lower than (98.9±9.3) ms in adults group, and the difference was statistically significant (t=-3.193, P=0.013). The QRS width of children with complete right bundle branch block (CRBBB) was (118.4±8.9) ms, which was significantly lower than (148.2±21.4) ms in adults group, and the difference was statistically significant (t=-3.214, P=0.012).

Conclusions

The distributions of RBBB in age, etiology, QRS width of electrocardiogram in children and adults are different. But there is no difference in the combination of other types of blocks betweeen children and adults with RBBB.

Key words: Bundle branch block, Electrocardiography, Child, Adult
表1 儿童组与成年人组右束支传导阻滞患者年龄分布情况
组别 例数 年龄(岁) 构成比[例数(%)]
儿童组 330 ? ?
? ? 0～1 36(10.9)
? ? >1～3 54(16.4)
? ? >3～7 132(40.0)
? ? >7～12 72(21.8)
? ? >12～18 36(10.9)
成年人组 500 ? ?
? ? >18～35 32(6.4)
? ? >35～50 70(14.0)
? ? >50～70 204(40.8)
? ? >70 194(38.8)
表2 儿童组与成年人组右束支传导阻滞患者病因分布情况
组别 例数 病因 构成比[例数(%)]
儿童组 330 ? ?
? ? 先天性心脏病术前 96(29.1)
? ? 先天性心脏病术后 186(56.4)
? ? 病毒性心肌炎 22(6.7)
? ? 心包积液 8(2.4)
? ? 无心脏病史 18(5.4)
成年人组 500 ? ?
? ? 慢性肺部疾病 134(26.8)
? ? 原发性高血压、冠心病 88(17.6)
? ? 先天性心脏病术前 36(7.2)
? ? 先天性心脏病术后 70(14.0)
? ? 不明确是否为心脏病变 172(34.4)
表3 儿童组与成年人组右束支传导阻滞合并其他阻滞类型分布情况[例数(%)]
组别 例数a RBBB＋LAFB RBBB＋Ⅲ度AVB RBBB＋Ⅰ度AVB RBBB＋LAFB＋Ⅰ度AVB
儿童组 54 42(77.8) 2(3.7) 4(7.4) 6(11.1)
成年人组 252 204(81.0) 20(7.9) 16(6.3) 12(4.8)
χ2值 0.250
P值 0.993
表4 2组右束支传导阻滞患者QRS波宽比较(ms，±s)
组别 例数 IRBBB CRBBB t值 P值
儿童组 330 78.2±12.6 118.4±8.9 －72.358 <0.001
成年人组 500 98.9±9.3 148.2±21.4 －59.266 <0.001
t值 ? －3.193 －3.214 ? ?
P值 ? 0.013 0.012 ? ?
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