心臟性猝死的預(yù)防

1、vt62%bradycardia17%tdp13%vf8%國外研究現(xiàn)狀國外研究現(xiàn)狀猝死的直接機(jī)制正 常 人 群 疾 病 人 群高危人群猝死猝死 一級預(yù)防一級預(yù)防 二級預(yù)防二級預(yù)防院外存活率院外存活率1-15%scdscdscdscdscdscdscdscdscdscd如何救治85%患者?一級預(yù)防一級預(yù)防二級預(yù)防二級預(yù)防except for bb)？icd的有用性與有限性icd?icd-icd+rfcarfca消除室性心律失常預(yù)防猝死0.5million 1.3 billionscd incidenceindia: 0.18% by estimating vs 0.1-0.2%/y in usa

2、 usascd的病因分類in chinain koreahow to 54萬萬prediction尋找尋找?prevention救治救治how to 54萬萬predictionpreventionscd的危險(xiǎn)因素危險(xiǎn)因素vt62%bradycardia17%tdp13%vf8%3020105210(%)發(fā)病率發(fā)病率 (%/年年)3002001000(x 1000)事件總數(shù)事件總數(shù) (#/年年)心臟猝死發(fā)病率及事件總數(shù)成人總發(fā)病率成人總發(fā)病率source: myerburg rj. circulation. 1992;85(suppl i):i-2 i-10.高危冠心病患者高危冠心病患者冠心病

3、的患者冠心病的患者ef 30%的心衰病人的心衰病人院外心臟驟停幸存者院外心臟驟停幸存者心梗后康復(fù)期伴心梗后康復(fù)期伴vt/vf冠心病幾種特殊疾病 30%只要只要 ef 30% 都要植入都要植入icd？3020105210(%)發(fā)病率發(fā)病率 (%/年年)3002001000(x 1000)事件總數(shù)事件總數(shù) (#/年年)成人總發(fā)病率成人總發(fā)病率source: myerburg rj. circulation. 1992;85(suppl i):i-2 i-10.高危冠心病患者高危冠心病患者冠心病的患者冠心病的患者ef 30%的心衰病人的心衰病人院外心臟驟停幸存者院外心臟驟停幸存者心梗后康復(fù)期伴心梗后

4、康復(fù)期伴vt/vf二級預(yù)防二級預(yù)防一一級級預(yù)預(yù)防防scd心臟疾病心臟疾病vaef基質(zhì)基質(zhì)結(jié)構(gòu)結(jié)構(gòu)自主自主神經(jīng)神經(jīng)電不電不穩(wěn)定穩(wěn)定基因基因異常異常scd risk predictionincidence of scd 5-10%10-15% 20%30%33% known disease; low power or non-specific markersfirstclinical eventacute mi,unstable aphemod-ynamicrisk markersarrhythmia risk markersat least 50% of all scds due to chd

5、occur as a first clinical event or among subgroups of patients thought to be at relatively low risk for scd.source: myerburg rj. jce. 2001;12:369-81.1 merit-hf study group. lancet. 1999;353:2001-2007. 12%12%24%24%64%64%心力衰竭其他猝死(n = 103)nyha iinyha ii26%26%15%15%59%59%心力衰竭其他猝死(n = 103)nyha iiinyha ii

6、i56%56%11%11%33%33%心力衰竭其他猝死(n = 27)nyha ivnyha iv心衰死亡類型死亡類型patients with mild to moderate heart failure are more likely to die suddenly.在輕度到中度心衰中最常見的死亡模式是scd 心臟性猝死預(yù)防心臟性猝死預(yù)防 trialsicd-預(yù)防預(yù)防 有效性有效性與心臟驟停有關(guān)的試驗(yàn)二級預(yù)防 心臟性猝死一級預(yù)防心臟性猝死一級預(yù)防與心梗后高?；颊哂嘘P(guān)的試驗(yàn)與心衰高?；颊哂嘘P(guān)的試驗(yàn)nmusttmusttnmadit-iimadit-iinmaditmadit心臟驟停心梗后暈厥

7、持續(xù)室速心衰3020105210(%)發(fā)病率發(fā)病率 (%/年年)3002001000(x 1000)事件總數(shù)事件總數(shù) (#/年年)成人總發(fā)病率成人總發(fā)病率source: myerburg rj. circulation. 1992;85(suppl i):i-2 i-10.高危冠心病患者高危冠心病患者冠心病的患者冠心病的患者ef 30%的心衰病人的心衰病人院外心臟驟停幸存者院外心臟驟停幸存者心梗后康復(fù)期伴心梗后康復(fù)期伴vt/vf二級預(yù)防二級預(yù)防一一級級預(yù)預(yù)防防abcdn67 units of aed has been installed in beijing capital internati

8、onal airportqualificationegislation some data showed -aed increase survival after scawhite rd. ann emer med. 96;28:480-485. cobb la. circ. 92;85:i98-102. smith sc. circ. 97;13:1321-1324. valenzuela td. n engl j med. 2000;343:1206-1209. 0%5%10%15%20%25%30%35%40%45%50%60% icd data in china (1/million)

9、icd- 適應(yīng)證(2008)1.1.因室速、室顫引起的心臟驟停，除外暫時(shí)性、可逆性原因因室速、室顫引起的心臟驟停，除外暫時(shí)性、可逆性原因(a)(a)2.2.自發(fā)性持續(xù)性室速自發(fā)性持續(xù)性室速 合并器質(zhì)性心臟病合并器質(zhì)性心臟病(b)(b)3.3.不明原因的暈厥不明原因的暈厥, , 合并電生理誘發(fā)出持續(xù)性合并電生理誘發(fā)出持續(xù)性vt, vt, 無論血流動無論血流動力學(xué)是否穩(wěn)定力學(xué)是否穩(wěn)定 (b)(b)4.4.冠心病冠心病, lvef35%, lvef35%，心梗后，心梗后4040天天, ,心功能心功能ii-iiiii-iii5.5.冠心病冠心病, lvef30%, lvef30%，心梗后，心梗后4040天天, ,心功能心功能i i6.6.擴(kuò)張性心肌病擴(kuò)張性心肌病, ,心功能心功能ii-iii, lvef35%ii-iii, lvef35%7.7.非持續(xù)性室速非持續(xù)性室速, , 有冠脈疾病有冠脈疾病, , 心梗病史、心梗病史、 lvef40%, lvef40%, 電生理電生理檢查誘發(fā)出持續(xù)性檢查誘發(fā)出持續(xù)性vt/vf (b)vt/vf (b)aad聯(lián)合治療聯(lián)合治療rfcaicd-onlyscd reimbursementpatients(%)medical insurance(%)government(%)chinahkcatheter ablation o