精神疾病患者猝死前心电图分析

Analysis of electrocardiography before sudden death in patients with mental disorders

目的:探讨精神疾病患者猝死前心电图特征及其相关影响因素。方法:将临床诊断为心脏性猝死的49例患者作为猝死组;随机抽出同期住院的60例患者作为对照组。比较两组患者心电图特征,人口学资料以及临床特征。结果:猝死组心电图异常发生率显著高于对照组(P<0.05),主要表现为窦性心动过速、室性期前收缩、QT间期延长、T波改变、ST段低平、U波或TU融合波、左束支传导阻滞(LBBB)。猝死组氯氮平使用率显著高于对照组(P<0.05)。两组使用氯氮平者心电图异常率明显高于未使用氯氮平者(P<0.05或P<0.01)。猝死组高龄,兴奋状态,低血钾,肌酸激酶升高,心脑血管疾病的发生率均显著高于对照组(P均<0.05)。结论:精神疾病患者猝死前大多心电图异常,多呈非特异性改变。高龄、使用氯氮平以及某些临床征象可能成为患者猝死的危险因素。

Objective：To investigate the electrocardiography （ECG） characters and its related influence factors in patients with mental disorder before sudden death. Method：49 patients with clinic diagnosis of cardiac sudden death were collected as sudden death group and 60 inpatients at corresponding time were randomly sampled as control group. The ECG characters, demographic data and clinic features were compared between the two groups. Results： Compared to control group, patients in sudden death group had significantly higher abnormal incidence rate in ECG, including sinus tachycardia, premature ventrictdar systole, prolonged QTc interval, change of T wave, lower ST, appearance of U wave or syncretic wave of TU and conductive block of left bundle branch （ P 〈 0.05）. The number of patients in sudden death group taking clozapine was significantly more than that in control group （P 〈 0.05）. Patients taking clozapine had markedly abnormal ECG compared to those taking other drugs in both groups （ P 〈 0.05 or P 〈 0.01 ）. Compared to control group, patients in sudden death group had higher incidence rate in senihty, excitement status, hypokalium, higher creatine kinase and cardiovascular and cerebrovascular disease （ all P 〈 0. 05）. Conclusion： Most patients with mental disorders before sudden death has abnormal ECG which is of nonspecific. Senility, clozapine taking and some chnic signs may be risk factors for sudden death.