98心臟性猝死scd的一級(jí)和二級(jí)預(yù)防講稿(已修改)
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【正文】 心臟性猝死 (SCD)的一級(jí)和二級(jí)預(yù)防 XX省心血管病研究所 各種心臟原因 急： 1小時(shí)內(nèi)死亡 不可預(yù)料的 自然的病理生理過(guò)程 非人為或外傷因素 心臟性猝死（ SCD）定義： ? 心臟猝死是最常見(jiàn)、最兇險(xiǎn)的死因 FIGURE 26–16. Influence of response time on survival from outofhospital cardiac arrest. A, The time from onset of cardiac arrest to initial defibrillation attempt is related to 1month survival, based on data from the Swedish Cardiac Arrest The cumulative survival rate was 5 percent, and the survival rate for victims whose initial rhythm was ventricular tachycardia (VT) or ventricular fibrillation (VF) was percent. The median response time was nearly 13 minutes. Thirtyday survival ranged from a maximum of 48 percent with responses of less than 2 minutes to less than 5 percent for response time greater than 15 minutes. B, The potential for faster response systems, based on the Amsterdam Resuscitation Study, is demonstrated, paring response times of police vehicles with those of conventional emergency medical systems. At the 50th percentile of response times, polices vehicles provided a nearly 5 minute improvement in arrival time (approximately 6 minutes).337 Preliminary data suggest that improved response times of this type translate to improved . Saunders Company items and derived items copyright 169。 2023 by Saunders Company. ? 4045萬(wàn) (Circulation 2023。104:21582163) ? 515%能到醫(yī)院 , 120%幸存 ? 50%出院前 SCD發(fā)作 VT 62% Bradycardia 17% Torsades de Pointes 13% Primary VF 8% Adapted from Bay233。s de Luna A. Am Heart J 1989。117:151159. 美 國(guó) ? 79萬(wàn) /年 ? 院外 2%幸存 ? 15%一年內(nèi)復(fù)發(fā) 英 國(guó) 先 兆 新增或加重癥狀 胸痛 心慌 氣短 乏力 發(fā) 作 臨床狀態(tài)突然變化 心律失常 低血壓 胸痛 氣短 頭暈 心臟停跳 突然發(fā)作 心臟停跳 循環(huán)衰竭 意識(shí)喪失 生物學(xué)死亡 復(fù)蘇失敗 電機(jī)械分離 中樞神經(jīng) 功能不恢復(fù) 天 月 立刻 1小時(shí) 分 周 心臟猝死 (SCD)的發(fā)病率 ? 西歐： 300,000 / 年 ；平均生還率 23% ； ? 全球 ： 9,000,000 / 年；平均生還率小于 1％； ? 美國(guó)： 250,000350,000 / 年； ? 中國(guó)：心血管疾病致死 1,500,000 / 年； Relative Risk Factors FIGURE 26–4. Risk of sudden death by decile of multivariant risk: 26year followup, the Framingham Study. ECG = electrocardiographic。 I–V = intraventricular。 LVH = left ventricular hypertrophy。 nonspec abn = nonspecific abnormality. (From Kannel WB, Shatzkin A: Sudden death: Lessons from subsets in population studies. Reprinted by permission of the American College of Cardiology. J Am Coll Cardiol 5[Suppl 6]:141B, 1985.) . Saunders Company items and derived items copyright 169。 2023 by Saunders Company. 一、冠心病和非冠心病的冠狀動(dòng)脈結(jié)構(gòu)異常 ㈠冠心病是 SCD的最常見(jiàn)病因，西方國(guó)家 80% SCD為冠心病 2025%冠心病中， SCD為首次臨床表現(xiàn) SCD中 75%有 MI史 SCD的病因與有關(guān)因素 : 左室射血分?jǐn)?shù)（ LVEF）＜ ，最有力的 預(yù)示 SCD的獨(dú)立因子。 室早（ PCVs） 高危的（復(fù)雜形式） PCVs包括多形多源 PCVs、二聯(lián)律、短配時(shí)間期（ Ron T）、 3 個(gè)或 3個(gè)以上成串 PVCs。 FIGURE 26–6. Survival during 3 years of followup after acute myocardial infarction as a function of left ventricular dysfunction (ejection fraction, EF) and ventricular arrhythmias (VPDs/hr as measured by Holter monitoring). The survival curves were calculated as KaplanMeier estimates. With higher PVC frequencies and lower ejection fractions, the mortality rates increase. The number of patients in groups A, B, C, and D were 536, 136, 80, and 37, respectively. (From Bigger JT: Relation between left ventricular dysfunction and ventricular arrhythmias after myocardial infarction. Am J Cardiol 57:8B, 1986.) . Saunders Company items and derived items copyright 169。 2023 by Saunders Company. ㈡ 非冠心病的冠狀動(dòng)脈結(jié)構(gòu)異常 冠狀動(dòng)脈先天性異常 左冠狀動(dòng)脈異常起源于肺動(dòng)脈較常見(jiàn)， 兒童期 SCD發(fā)生率高，需手術(shù)糾治。成人仍 應(yīng)積極手術(shù)治療。 其他： 冠狀動(dòng)脈栓塞： 心內(nèi)膜炎、 MVR或 AVR后 血栓形成， 左房或左室附 壁血栓脫落 冠狀動(dòng)脈炎： 梅毒性主動(dòng)脈炎、粘膜皮膚 淋巴結(jié)綜合征等 冠狀動(dòng)脈機(jī)械性阻塞： 馬方氏綜合征、夾層 動(dòng)脈瘤等 冠脈痙攣或冠脈心肌橋 二、心肌肥厚 冠心病的左室肥厚 高血壓心臟病 繼發(fā)性瓣膜性心臟病的心肌肥厚 肥厚型心肌病 1）梗阻性 2）非梗阻性 原發(fā)或繼發(fā)性肺動(dòng)脈高壓 1）進(jìn)行性慢性右室超負(fù)荷 2）妊娠期肺動(dòng)脈高壓 三、心肌疾病與心力衰竭 慢性充血性心衰與各種心肌疾病關(guān)系密切 MERITHF試驗(yàn)猝死情況
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