摘要
目的分析影响植入心律转复除颤器(implantable cardioverter defibrillator,ICD)患者预后的临床因素。方法回顾性分析2014年12月至2018年12月于山西省心血管病医院行ICD及心脏再同步化起搏-除颤器(cardiac resynchronization pacemaker defibrillator,CRTD)植入术的患者的临床资料,术后发生室性心律失常的患者设为A组,未发生的患者设为B组。分析影响术后室性心律失常和临床事件(死亡或再住院)发生的因素,并作生存分析及COX多因素分析。结果共纳入87例患者,中位随访28.4个月,A组44例(50.5%),其中23例(26.4%)进行了恰当电击,B组43例中有8例(9.2%)进行了误电击。生存分析显示,相比于术前QT间期离散度(QT interval dispersion,QTd)<80 ms患者,QTd≥80 ms患者术后室性心律失常发生率(P<0.001)及临床事件发生率(P=0.001)较高,差异有统计学意义。对术后室性心律失常和临床事件作多因素分析发现,术前QTd≥80 ms是术后发生室性心律失常(HR=8.493,95%CI:3.348~21.544,P<0.001)和死亡或再住院(HR=3.788,95%CI:1.756~8.172,P=0.001)的危险因素,胺碘酮(HR=0.375,95%CI:0.153~0.921,P=0.032)可降低术后室性心律失常的发生。结论术前QTd≥80 ms是ICD或CRTD植入患者术后发生室性心律失常和死亡或再住院的危险因素,而胺碘酮可有效降低室性心律失常发生率。
Objectives To analyze the clinical factors influencing the prognosis of patients with implantable cardioverter defibrillator(ICD).Methods Clinical data of ICD and cardiac resynchronization pacemaker-defibrillator(CRTD)implantation patients from December 2014 to December 2018 in Shanxi Cardiovasular Hospital was retrospectively analyzed.The patients occurred postoperative ventricular arrhythmia were assigned to A group,otherwise to B group.Risk factors of postoperative ventricular arrhythmia(ventricular tachycardia or ventricular fibrillation)events and clinical events(death or rehospitalization)were analyzed.Survival analysis and COX regression analysis of multiple factors were done.Results A total number of 87 patients were enrolled.The median follow-up was 28.4 months.There were 44 patients(50.5%)in A group after surgery,23(26.4%)received appropriate electric shocks.In B group,8 of the 43 patients(9.2%)received false electric shocks.Survival analysis showed that patients with preoperative QT interval dis⁃persion(QTd)≥80 ms had higher rate of postoperative ventricular arrhythmia(P<0.001)and higher rate of clinical events(P=0.001)compared with patients who had preoperative QT interval dispersion(QTd)<80 ms.Multiariable analysis showed that the preoperative QTd≥80 ms was a risk factor for postoperative ventricular arrhythmia(HR=8.493,95%CI:3.348-21.544,P<0.001)and death or rehospitalization(HR=3.788,95%CI:1.756-8.172,P=0.001),amiodarone(HR=0.375,95%CI:0.153-0.921,P=0.032)can reduce the occurrence of postoperative ventricular arrhythmia.Conclusions Preoperative QTd≥80 ms is a risk factor for postoperative ventricular arrhythmia and death or rehospitalization in patients who had implanted ICD or CRTD,while the use of amiodarone can effectively re⁃duce the incidence of ventricular arrhythmia.
作者
韩志成
李小明
HAN Zhi-cheng;LI Xiao-ming(The Second Clinical College of Shanxi Medical University,Taiyuan 030001,China;Department of Cardiol-ogy,Shanxi Cardiovascular Hospital,Shanxi Cardiovascular Hospital Affiliated,Shanxi Medical University,Tai-yuan 030001,China)
出处
《岭南心血管病杂志》
2020年第5期560-564,共5页
South China Journal of Cardiovascular Diseases
关键词
心律失常
心脏性猝死
植入型心律转复除颤器
预后
危险因素
arrhythmia
sudden cardiac death
implantable cardioverter defibrillator
prognosis
risk factors
