摘要
目的：扩张型心肌病（ DCM）患者病死率高，预后差，植入型心律转复除颤器（ ICD）预防心脏性猝死虽有效，但价格昂贵，广泛应用受到限制。分析DCM室性心律失常引起心脏性猝死（ SCD）患者的临床特征，有助于更好地预防SCD事件。方法从2008年4月至2013年10月入住中国医学科学院阜外医院的符合诊断标准的DCM患者中选取曾因室性心律失常出现心脏骤停（心室颤动、持续性室性心动过速）引起意识丧失并进行电转复和／或心肺复苏的患者共100例作为SCD组，对照组为同期入住我院的未出现过心脏骤停事件的DCM患者104例。采集两组患者基线资料及检查信息，并进行对比。结果两组患者左心房内径（LAD）、左心室舒张末期内径（LVEDD）、左心室射血分数（LVEF）、心功能分级、按心率校正的QRS波起点至T波终点的时间（ QTc）水平及心房颤动及室内阻滞发生率、室性早搏（室早）数量、成对室早、非持续性室性心动过速（ NSVT）的阵次、NSVT持续的最大心搏数、NSVT最大频率、心率变异性（ HRV）等差异均无统计学意义（ P＞0．05）；SCD组房室阻滞发生率（25％对11．5％）明显高于对照组（P＜0．05），β受体阻滞剂的使用（56％对74％）则显著低于对照组（P＜0．05）。结论在本研究人群中LAD、LVEDD、LVEF、室早的数量、成对室早、NSVT的阵次、HRV、QTc水平等未证实与室性心律失常引起猝死有关，而房室阻滞、未使用β受体阻滞剂可能与猝死风险增加有关。
Objective The patients with dilated cardiomyopathy （DCM）have high mortality and poor prognosis.Therefore,it is crucial to analyze the clinical features of sudden cardiac death （ SCD） patients with DCM to find which patients prone to sudden death .Methods Patients with DCM hospitalized in Fuwai hospi-tal from April 2008 to October 2013 were screened ,and those who had experienced cardiac arrest events （ ven-tricular fibrillation,persistent tachycardia）and received cardiopulmonary resuscitation were recruited （n=100）. Patients with DCM hospitalized in same period in our hospital were enrolled as controls if they did not experi -ence cardiac arrest events.Their baseline data and blood tests,electrocardiogram,echocardiography and holter information were collected .Results No significant differences were found in left atrial diameter ,left ventricular end-diastolic diameter ,left ventricular ejection fraction （ LVEF） ,the proportion of patients with cardiac function classification,According to heart rate correction QRS complex starting point to the time at the end of T wave （ QTc） level between DCM patients with and without SCD .The limb lead low voltage ,abnormal Q wave ,the num-ber of atrial fibrillation and bundle brunch block ,ventricular premature beat ,nonsustained ventricular tachycar-dia and heart rate variability did not differ betwen two groups .However ,more patients with poor R wave progres-sion,atrioventricular block,fewer people using beta blockers were observed in SCD group than the control group（P 〈0.05）.Conclusion Our study provide no evidence for the role of the left atrial diameter ,left ventricular end-diastolic diameter,LVEF,the number of ventricular premature beat,and non sustained ventricular tachycardia,pairs of premature ventricular beat,heart rate variability and QTc in the warning of sudden death.Atrio-ventricular block and fewer people using beta blockers may be associated with an increased risk for sudden death .
出处
《中华心律失常学杂志》
2016年第3期207-211,共5页
Chinese Journal of Cardiac Arrhythmias
基金
国家自然科学基金（81270243）
关键词
扩张型心肌病
心脏性猝死
心脏骤停
Dilated cardiomyopathy
Sudden cardiac death
Cardiac arrest
