Primary
VFTorsades 8%de Pointes
13%
VT 62%
Bradycardia 17%
英国
7-9万/年 院外2%幸存 15%一年内复发
Adapted from Bayés de Luna A. Am Hea心rt 脏性猝死SCD的一级和二级预防
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J 1989;117:151-159.
心脏性猝死SCD的一 级和二级预防讲稿
心脏性猝死（SCD）定义：
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
心脏性猝死SCD的一级和二级预防
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心脏猝死是最常见、最凶险的死因
心脏性猝死SCD的一级和二级预防
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FIGURE 26–16. Influence of response time on survival from out-of-hospital cardiac arrest. A, The time from onset of cardiac arrest to initial defibrillation attempt is related to 1-month survival, based on data from the Swedish Cardiac Arrest Registry.336 The cumulative survival rate was 5 percent, and the survival rate for victims whose initial rhythm was ventricular tachycardia (VT) or ventricular fibrillation (VF) was 9.5 percent. The median response time was nearly 13 minutes. Thirty-day survival ranged from a maximum of 48 percent with responses of less than 2 minutes to less than 5 percent for response time greater than 15 minutes. B, The potential for faster response systems, based on the Amsterdam Resuscitation Study, is demonstrated, comparing response times of police vehicles with those of conventional emergency medical systems. At the 50th percentile of response times, polices vehicles provided a nearly 5 minute improvement in arrival time (approximately 6 minutes).337 Preliminary data suggest that improved response times of this type translate to improved survival.338
hypertrophy; non-spec abn = nonspecific abnormality. (From Kannel WB, Shatzkin A: Sudden
death: Lessons from subsets in population studies. Reprinted by permission of the American
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心脏猝死(SCD)的发病率
西欧：300,000 / 年；平均生还率2-3% ； 全球：9,000,000 / 年；平均生还率小于1％； 美国：250,000-350,000 / 年； 中国：心血管疾病致死1,500,000 / 年；
心脏性猝死SCD的一级和二级预防
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Relative Risk Factors
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先兆
发作
心脏停跳 生物学死亡
新增或加重症状
胸痛 心慌 气短 乏力 天月
临床状态突然变化
心律失常 低血压 胸痛 气短 头晕
立刻 1小时
突然发作
心脏停跳 循环衰竭 意识丧失
复苏失败 电机械分离 中枢神经 功能不恢复
分周
ห้องสมุดไป่ตู้心脏性猝死SCD的一级和二级预防
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流行病学
心脏性猝死SCD的一级和二级预防
W.B. Saunders Company items and derived items copyright © 2001 by W.B Saunders Company.
心脏性猝死SCD的一级和二级预防
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美国
40-45万 (Circulation 2001;104:2158-2163) 5-15%能到医院, 1-20%幸存 50%出院前SCD发作
心脏性猝死SCD的一级和二级预防
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FIGURE 26–4. Risk of sudden death by decile of multivariant risk: 26-year follow-up, the
Framingham Study. ECG = electrocardiographic; I–V = intraventricular; LVH = left ventricular
College of Cardiology. J Am Coll Cardiol 5[Suppl 6]:141B, 1985.)
W.B. Saunders Company items and derived items copyright © 2001 by W.B
Saunders Company. 心脏性猝死SCD的一级和二级预防
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SCD的病因与有关因素:
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