植入型心律转复除颤器对于射血分数减低性心力衰竭患者心源性猝死的预防作用研究  

Prevention of sudden cardiac death in patients with ejection fraction reduced heart failure receiving ICD implantation

作　　者：王震 程中伟[1] 邓华 程康安 陈太波 高鹏[1] 杨德彦[1] 范静波 张宇成[1] 方全[1] WANG Zhen;CHENG Zhong-wei;DENG Hua;CHENG Kang-an;CHEN Tai-bo;GAO Peng;YANG De-yan;FAN Jing-bo;ZHANG Yu-cheng;FANG Quan(Department of Cardiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]北京协和医学院中国医学科学院北京协和医院心内科

出　　处：《中国实用内科杂志》2019年第9期800-804,共5页Chinese Journal of Practical Internal Medicine

基　　金：国家科技支撑计划课题(2011BAI11B11)

摘　　要：目的通过记录射血分数降低性心力衰竭(heart failure with reduced ejection fraction,HFrEF)患者植入型心律转复除颤器(implantable cardioverter defibrillator,ICD)治疗事件,研究并分析其在一、二级预防患者中的差异。方法单中心回顾性队列研究,纳入2006-01-2017-12于北京协和医院住院行ICD或心脏再同步化并心律转复除颤器(cardiac resynchronization therapy with cardioverter defibrillator,CRT-D)植入的HFrEF患者,随访患者ICD治疗事件,根据腔内心电图鉴定是否为恰当治疗,并分析治疗事件在一、二级预防患者中的差异。结果 (1)共纳入145例患者,一级预防患者103例,二级预防患者42例。其中一级预防患者较二级预防患者左室收缩末期内径值更高,左室射血分数更低。(2)多因素竞争风险回归分析结果显示心源性猝死二级预防患者、男性患者恰当治疗及恰当放电治疗风险更高。(3)K-M曲线及Log-Rank检验提示一、二级预防患者不恰当治疗风险无显著差异,不恰当治疗事件原因大部分为心房扑动或心房颤动。结论 (1)一级预防患者接受恰当治疗、恰当放电治疗的风险较二级预防患者更低;(2)一级预防患者不恰当治疗风险与二级预防患者相比无显著差异,不恰当治疗事件主要原因是心房扑动或心房颤动。Objective By recording the treatment events of implantable cardioverter defibrillator(ICD) in patients with ejection fraction reduced heart failure(HFrEF), to analyze the difference in primary and secondary prevention patients. Methods A single center retrospective study was conducted. HFrEF patients with ICD or cardiac resynchronization therapy with cardioverter defibrillator(CRT-D) implanted in Peking Union Medical College Hospital from January 2006 to December 2017 were enrolled in our study. Basic clinical data was collected and ICD treatment events were recorded during follow-up. The appropriate treatment events were identified according to electrocardiogram recorded by ICD. The ICD treatment events of primary and secondary prevention patients were analyzed. Results 1) A total of 145 patients with HFrEF implanted with ICD or CRT-D were enrolled, 103 primary prevention patients and 42 secondary prevention patients. Primary prevention patients had longer left ventricular end-systolic diameter(LVESD) and lower left ventricular ejection fraction(LVEF) than secondary prevention patients. 2) Multivariate competitive risk regression analysis showed that secondary prevention patients and male patients had higher risk of receiving appropriate treatment and appropriate shock therapy. 3) K-M curve and Log-Rank test showed that there was no significant difference in the risk of inappropriate treatment between primary and secondary prevention patients. The main cause of inappropriate treatment was atrial flutter or atrial fibrillation. Conclusion 1) Primary prevention patients have lower risk of receiving appropriate treatment and appropriate shock therapy than secondary prevention patients;2) There is no significant difference between primary and secondary prevention patients in the risk of inappropriate treatment. The main cause of inappropriate treatment events is atrial flutter or atrial fibrillation.

关 键 词：HFrEF ICD 一级预防 恰当放电治疗 

分 类 号：R541.6[医药卫生—心血管疾病]