文档介绍：心脏性猝死(SCD)的一级和二级预防
广东省心血管病研究所
吴书林
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)定义:
心脏猝死是最常见、最凶险的死因
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 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 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
. pany items and derived items copyright © 2001 by pany.
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
VT
62%
Bradycardia
17%
Torsades
de Pointes
13%
Primary
VF
8%
Adapted from Bayés de Luna A. Am Heart J 1989;117:151-159.
美 国
7-9万/年
院外2%幸存
15%一年内复发
英 国
先 兆
新增或加重症状
胸痛
心慌
气短
乏力
发 作
临床状态突然变化
心律失常
低血压
胸痛
气短
头晕
心脏停跳
突然发作
心脏停跳
循环衰竭
意识丧失
生物学死亡
复苏失败
电机械分离
中枢神经
功能不恢复
天
月
立刻
1小时
分
周
流行病学
Relative Risk Factors
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 hypertrophy; non-spec abn = nonspecific abnormality. (From Kannel WB, Shatzkin A: Sudden death: Lessons from subsets in population studies.