心脏骤停和心脏性猝死.ppt

各种心脏原因急：1小时内死亡不可预料的自然的病理生理过程非人为或外伤因素心脏猝死是最常见、最凶险的死因FIGURE26–16.Influenceofresponsetimeonsurvivalfromout-of-hospitalcardiacarrest.A,Thetimefromonsetofcardiacarresttoinitialdefibrillationattemptisrelatedto1-monthsurvival,basedondatafromtheSwedishCardiacArrestRegistry.336Thecumulativesurvivalratewas5percent,andthesurvivalrateforvictimswhoseinitialrhythmwasventriculartachycardia(VT)orventricularfibrillation(VF)was9.5percent.Themedianresponsetimewasnearly13minutes.Thirty-daysurvivalrangedfromamaximumof48percentwithresponsesoflessthan2minutestolessthan5percentforresponsetimegreaterthan15minutes.B,Thepotentialforfasterresponsesystems,basedontheAmsterdamResuscitationStudy,isdemonstrated,comparingresponsetimesofpolicevehicleswiththoseofconventionalemergencymedicalsystems.Atthe50thpercentileofresponsetimes,policesvehiclesprovidedanearly5minuteimprovementinarrivaltime(approximately6minutes).337Preliminarydatasuggestthatimprovedresponsetimesofthistypetranslatetoimprovedsurvival.338W.B.SaundersCompanyitemsandderiveditemscopyright©2001byW.BSaundersCompany.40-45万(Circulation2001;104:2158-2163)5-15%能到医院,1-20%幸存50%出院前SCD发作先兆流行病学心脏猝死(SCD)的发病率RelativeRiskFactorsFIGURE26–4.Riskofsuddendeathbydecileofmultivariantrisk:26-yearfollow-up,theFraminghamStudy.ECG=electrocardiographic;I–V=intraventricular;LVH=leftventricularhypertrophy;non-specabn=nonspecificabnormality.(FromKannelWB,ShatzkinA:Suddendeath:Lessonsfromsubsetsinpopulationstudies.ReprintedbypermissionoftheAmericanCollegeofCardiology.JAmCollCardiol5[Suppl6]:141B,1985.)W.B.SaundersCompanyitemsandderiveditemscopyright©2001byW.BSaundersCompany.一、冠心病和非冠心病的冠状动脉结构异常㈠冠心病是SCD的最常见病因，西方国家80%SCD为冠心病20-25%冠心病中，SCD为首次临床表现SCD中75%有MI史1、左室射血分数（LVEF）＜0.3，最有力的预示SCD的独立因子。2、室早（PCVs）高危的（复杂形式）PCVs包括多形多源PCVs、二联律、短配时间期（RonT）、3个或3个以上成串PVCs。FIGURE26–6.Survivalduring3yearsoffollow-upafteracutemyocardialinfarctionasafunctionofleftventriculardysfunction(ejectionfraction,EF)andventriculararrhythmias(VPDs/hrasmeasuredbyHoltermonitoring).Thesurvivalcurveswerecalcu