心力衰竭患者133例死亡原因及影响因素分析  

Causes of death analysis in 133 congestive heart failure patients

作　　者：许冬秀[1] 许晓伟[1] 纪翠玲[1] 宋颖[1] 宫丽婷[1] 曲秀芬[1] 黄永麟[1] 

机构地区：[1]哈尔滨医科大学附属第一医院心内科,150001

出　　处：《中华心血管病杂志》2009年第10期875-877,共3页Chinese Journal of Cardiology

基　　金：基金项目：黑龙江省教育厅海外学人科研资助项目（1055HZ013）

摘　　要：目的观察心力衰竭患者心原性猝死的发病情况及可能病因，为防治猝死探索对策。方法入选2005年1月至2008年12月住院的心力衰竭死亡患者133例，其中73例（54．9％）发生猝死（A组），55例（41．4％）死于泵衰竭（B组），其他原因死亡5例。回顾性分析A、B组死亡患者的临床资料，包括病史、临床表现、心功能分级、左室舒张末期内径、左室射血分数、药物治疗等。结果两组患者在病史、室性心律失常发生率方面差异无统计学意义。A组患者的纽约心脏病学会（NYHA）心功能分级多为Ⅱ、Ⅲ级，左室射血分数高于B组。A组心绞痛发生率高于B组（63．0％与21．8％，P〈0．05）。β受体阻滞剂和血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂在A组应用率高于B组，但其应用时间较B组短、剂量偏小。他汀类药物及抗血小板聚集药物的应用，A组少于B组。结论心原性猝死多发生在心功能Ⅱ、Ⅲ级的心力衰竭患者。猝死前多有心绞痛发作，可能是因为他汀类及抗血小板药物应用较少，β受体阻滞剂与血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂应用量小及疗程较短，未能在防治猝死及病情恶化中起到应有的作用。Objective To analyze the causes of death in patients with heart failure. Methods A total of 133 heart failure patients died during hospitalization in our hospital between January 2005 and December 2008 were enrolled in this study. Patients were divided to two groups ： sudden death （ group A, n = 73, 54.9% ）, chronic end-stage pump failure （group B, n = 55, 41.4% ）. The remaining 5 cases died of other causes were excluded from the final analysis. Clinical data （medical history,blood pressure, clinical manifestation,NYHA cardiac function class, left ventricular diameter of diastole, left ventricular ejection fraction,ventricular arrhythmias, drug therapy） of group A and B were analyzed. Results There were no significant differences in terms of medical history （ including hypertension and diabetes）, blood pressure, heart rate and the incidence of ventricular arrhythmia between the two groups. In group A, the NYHA functional class was mostly Ⅱ or Ⅲ grade, and LVEF value was significantly higher than that of group B. The incidence of angina pectoris was significantly higher in group A compared to group B. β-blocker and angiotensin-converting enzyme inhibitor or angiotensin Ⅱ receptor blocker use was also significantly higher in group A than in group B, however, the treatment dose was significantly lower and therapy duration was significantly shorter in group A than in group B. There were significantly less patients received statins and anti-platelet aggregation drugs in group A compred to group B. Conclusion In our patient cohort, sudden cardiac death often occurred in heart failure patients with NYHA cardiac function Ⅱ to Ⅲ grade, angina pectoris,probably due to the unstable coronary plaque and less statins and anti-platelet drug use in these patients.

关 键 词：心力衰竭 充血性 猝死 心脏 治疗结果 

分 类 号：R686[医药卫生—骨科学]