307例有症状心动过缓急诊科诊治分析  

Emergency treatment of 307 cases of patients with symptomatic bradycardia

作　　者：赵志刚[1] 刘小敏[1] 刘德红[1] 魏刚[1] 周炯峰[1] 

机构地区：[1]深圳市第二人民医院急诊科,广东518029

出　　处：《中国急救医学》2011年第10期887-891,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨有症状心动过缓病因、发病率及急诊科的诊治和预后。方法回顾性查阅我院近五年有症状心动过缓患者急诊科抢救病历收集的相关资料进行统计分析。307例患者被纳入研究。患者男女比例为206／101，年龄（66±28）岁，心室率（40±12）次／min；发病率为每年0．005％。结果根据统计资料，最常见的病因为急性心肌梗死（AMI）43％（132／307）；最常见的伴随症是：胸痛／胸闷138（45％）、晕厥／眩晕123（40％）；最常见的心律失常为高度房室传导阻滞138（45％）；患者需静脉给药或联合紧急起搏治疗295例（96％）；继发性心动过缓药物治疗效果明显优于原发性（56％和17％，P〈0．01）；有紧急起搏治疗指征166例（54％），而其中仅25例（8％）接受急诊科紧急起搏治疗；急诊科死亡率为5．2％（16／307），有紧急起搏器指征患者急诊科死亡率比无紧急起搏者明显高（7．8％和2．1％，P〈0．05）。结论有症状心动过缓患者良好的预后依赖于准确的病因诊断和治疗，紧急起搏治疗是急诊科医师处理有症状心动过缓患者必备的重要抢救技术之一。Objective To investigate etiology, incidence, and outcomes of symptomatic bradycardia （SB） in emergency department（ED） settings. Methods This is a 5 - years retrospective cohort study. Medical records of patients with SB managed in ED were reviewed. Results 307 patients [206 men and 101 women, age （66 ±28） years, ventricular rate （40 ± 12） beats/rain） who met the inclusion criteria were enrolled. The incidence was 0. 005%/year. Acute myocardial infarction was identified as the most common cause for SB in 132 patients. The leading clinical symptom in patients was chest pain/constriction [ 138 （ 45% ） ], followed by dizziness/syncope [ 123 （ 40% ） 1- Analysis of ECG - recordings showed high grade atrioventricular block in 138 patients as the most presenting rhythm. Intravenous drug treatment in combination with urgent pacing if in need to increase ventricular rate was started in 295 （96%）. Patients with secondary SB were more likely to respond drug treatment than patients with primary SB （ 56% vs 17% , P 〈 0. 01 ）. 54% of 307 patients were candidates for urgent pacing, but Only 8% of candidates were paced in emergency department. 5.2% of 307 patients died in ED. Difference between the mortality of patients with and without indications for urgent pacing was significant（7.8% vs 2.1% P 〈 0.05 ）. Conclusion A good prognosis of SB is based on etiological diagnosis and treatment; urgent pacing is a must for physicians to manage SB in ED settings.

关 键 词：心动过缓 急诊处理 房室传导阻滞 起搏 

分 类 号：R197.32[医药卫生—卫生事业管理]