心脏性猝死预防课件.pptx

1、2VT62%Bradycardia17%TdP13%VF8%3国外研究现状国外研究现状4猝死的直接机制5正 常 人 群 疾 病 人 群高危人群猝死猝死 一级预防一级预防 二级预防二级预防6院外存活率院外存活率1-15%SCDSCDSCDSCDSCDSCDSCDSCDSCDSCD如何救治85%患者?一级预防一级预防二级预防二级预防7except for BB)？8ICD的有用性与有限性9ICD?ICD-ICD+RFCA10RFCA消除室性心律失常预防猝死110.5million 1.3 billion12SCD IncidenceIndia:0.18%by estimating vs 0.1-0

2、.2%/Y in USA USA13SCD的病因分类in Chinain Korea14How to 54万万Prediction寻找寻找?Prevention救治救治15How to 54万万PredictionPrevention16SCD的危险因素17危险因素VT62%Bradycardia17%TdP13%VF8%183020105210(%)发病率发病率(%/年年)3002001000(x 1000)事件总数事件总数(#/年年)心脏猝死发病率及事件总数成人总发病率成人总发病率Source:Myerburg RJ.Circulation.1992;85(suppl I):I-2 I-1

3、0.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脏骤停幸存者院外心脏骤停幸存者心梗后康复期伴心梗后康复期伴VT/VF19冠心病20几种特殊疾病21 30%只要只要 EF 30%都要植入都要植入ICD？22233020105210(%)发病率发病率(%/年年)3002001000(x 1000)事件总数事件总数(#/年年)成人总发病率成人总发病率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脏骤

4、停幸存者院外心脏骤停幸存者心梗后康复期伴心梗后康复期伴VT/VF二级预防二级预防一一级级预预防防24SCD心脏疾病心脏疾病VAEF25基质基质结构结构自主自主神经神经电不电不稳定稳定基因基因异常异常26SCD 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 5

5、0%of all SCDs due to CHD 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;12:369-81.271 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=10

6、3)NYHA IIINYHA III56%56%11%11%33%33%心力衰竭其他猝死(N=27)NYHA IVNYHA IV心衰死亡类型死亡类型Patients with mild to moderate heart failure are more likely to die suddenly.在轻度到中度心衰中最常见的死亡模式是SCD28 心脏性猝死预防心脏性猝死预防 TrialsICD-预防预防 有效性有效性与心脏骤停有关的试验二级预防29 心脏性猝死一级预防心脏性猝死一级预防与心梗后高危患者有关的试验与心衰高危患者有关的试验nMUSTTMUSTTnMADIT-IIMADIT-IIn

7、MADITMADIT30心脏骤停心梗后晕厥持续室速心衰313020105210(%)发病率发病率(%/年年)3002001000(x 1000)事件总数事件总数(#/年年)成人总发病率成人总发病率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脏骤停幸存者院外心脏骤停幸存者心梗后康复期伴心梗后康复期伴VT/VF二级预防二级预防一一级级预预防防3233abcd34n67 units of AED has been installed in B

8、eijing Capital International Airportqualificationegislation35 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%363738 ICD data

9、in China(1/million)39ICD-适应证(2008)1.1.因室速、室颤引起的心脏骤停，除外暂时性、可逆性原因因室速、室颤引起的心脏骤停，除外暂时性、可逆性原因(A)(A)2.2.自发性持续性室速自发性持续性室速 合并器质性心脏病合并器质性心脏病(B)(B)3.3.不明原因的晕厥不明原因的晕厥,合并电生理诱发出持续性合并电生理诱发出持续性VT,VT,无论血流动无论血流动力学是否稳定力学是否稳定 (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

10、梗后，心梗后4040天天,心功能心功能I I6.6.扩张性心肌病扩张性心肌病,心功能心功能II-III,LVEF35%II-III,LVEF35%7.7.非持续性室速非持续性室速,有冠脉疾病有冠脉疾病,心梗病史、心梗病史、LVEF40%,LVEF40%,电生理电生理检查诱发出持续性检查诱发出持续性VT/VF(B)VT/VF(B)40AAD联合治疗联合治疗RFCAICD-onlySCD41 4243ReimbursementPatients(%)Medical insurance(%)Government(%)CHINAHK4445Catheter Ablation of VT in Fuwai Hospital,Beijing China(1995-2009)19951998200120042007YearTotal VT:1180 cases200927846建立建立以降低死亡率为目的以降低死亡率为目的治疗模式治疗模式建议及呼吁47建议及呼吁每位医师明确认识：SCD风险48总 结4950