植入型心律转复除颤器在心脏性猝死一级和二级预防中的应用  

Comparison study of defibrillator therapy for primary and secondary prevention of sudden cardiac death

作　　者：李晓宏[1] 徐伟[1] 吉文庆[1] 余洪松[1] 狄文成[1] 裴立刚[1] 兰荣芳[1] 施广飞[1] 徐标[1] 

机构地区：[1]南京医科大学鼓楼临床医院,210008

出　　处：《中华心律失常学杂志》2010年第1期15-18,共4页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的比较植入型心律转复除颤器（ICD）在心脏性猝死一级及二级预防中的治疗作用。方法对2005年1月至2009年6月符合ICD一级预防及二级预防标准并在我院植入ICD的患者进行随访。ICD的诊断设置室性心动过速（VT）、快速室性心动过速（FVT）及心室颤动（VF）3个工作区，治疗设置抗心动过速起搏（ATP）、低能量同步转复（CV）和高能量除颤（DF）。术后每3—6个月随访1次，利用程控仪获取ICD储存资料，了解患者心律失常发作情况以及ICD的诊断和治疗情况。结果共随访了40例患者，一级预防及二级预防各20例，平均随访时间一级预防组（12．2±7．6）个月，二级预防组（14．6±9．6）个月。随访过程中共13例患者发生了VF事件，其中一级预防组4例，二级预防组9例，21例患者发生了VT事件，其中一级预防组9例，二级预防组12例，统计学分析显示两组患者间VF及VT事件发生率差异无统计学意义。VT发生频率（VTfrenquency）在一级预防组为4．465次／月，二级预防组为26．16次／月（P〈0．001）。VT发作时间（VTduration）在一级预防组为（25．6±15．6）s，二级预防组为（78．1±58．7）s（P〈0．001）。一级预防组中9例患者ICD记录有持久性VT事件，其中由ATP终止6例，CV终止3例。4例患者有VF事件，均DF成功，二级预防组中12例患者ICD记录有持久性VT事件，其中由ATP终止7例，CV终止5例。9例患者有VF事件，均DF成功。结论二级预防的患者室性心律失常发作频率及发作时间均明显高于一级预防的患者，但因样本量较小，两组患者间因VT或VF接受ICD治疗的比例差异无统计学意义。Objective To compare the defibrillator therapy between primary and secondary prevention of sudden cardiac death. Methods Patients scheduled for defibrillator implantation were enrolled from January 2005 until June 2009. Patients were divided into Group A （ primary prevention） and Group B （ secondary prevention ） according to the indication of implantation. All ICD interventions were registered and classified as ventricular tachyeardia （VT） ,fast VT （FVT） and ventricular fibrillation （VF）. Anti-tachyeardia parameters were standardized, ATP and shock therapy were provided in VT and VF zone. Follow-up was performed every 3 - 6 months after implantation and stored arrhythmic episodes and anti-taehycardia therapies documentation was used to clarify the character of treated tachyeardia. Results A total of 40 patients were enrolled, 20 in each group. Patients were followed up for （12. 2 ± 7. 6） months in group A and （14. 6 ± 9. 6） months in group B. There are similar incidences of VT （9 patients from group A vs. 12 patients from group B,P =0. 38） and VF （4 patients from group A vs. 9 patients from group B,P =0. 17） for both groups. VT frenqueney was 4. 47 per months in group A and 26. 16 per months in group B（P 〈0. 001 ）. The VT duration were significantly shorter in group A than that of group B[ （25.6± 15.6） ms vs （78. 1 ±58.7） ms,P 〈0. 0011. The therapy for VT/VF episode occurred in 10 patients in group A and 12 patients in group B. Conclusion Patients in the secondary prevention group had significantly more events than those in the primary prevention group. But the ICD interven- tions events show no difference between two groups.

关 键 词：植入型心律转复除颤器 一级预防 二级预防 心脏性猝死 

分 类 号：R541.7[医药卫生—心血管疾病]