心脏性猝死一级与二级预防植入型心律转复除颤器患者临床特征单中心分析

Clinical characteristics of patients undergoing cardioverter defibrillator implantation for primary and secondary prevention of sudden cardiac death

目的了解植入型心律转复除颤器（ICD）植入数量与心脏性猝死（SCD）一级与二级预防患者临床资料特征，为ICD患者筛选提供实践依据。方法连续入选2006年1月至2011年12月于我院行ICD或心脏再同步治疗除颤器（CRT—D）植入术的患者，收集患者术前资料与患者植入ICD类型，分析历年ICD植入数量与一级、二级预防患者资料的特征与差异。结果入选214例患者，一级预防108例，二级预防106例。ICD植入数量与一级预防患者比例逐年增加。与二级预防患者相比，一级预防患者术前心功能（NYHA分级）更差（P〈0．01），术前左心室射血分数更低[（0．34±0．01）对（0．50±0．16），P〈0．01]，QRS时限更长[（135．83±35．08）ms对（111．68±34．15）ms，P〈0．01]，10g（NT．proBNP）水平更高[（3．32±0．62）pg／ml对（2．83±0．83）pg／ml，P〈0．01]，肾小球滤过率更低[（75．15±24．23）ml／min对（90．25±70．30）ml／min，P：0．037]；一级预防患者冠状动脉疾病与扩张型心肌病占90％，与二级预防患者疾病组成差异有统计学意义（P〈0．01），两组内冠状动脉疾病比例均较低（13．1％与22．6％）；二级预防患者主要植入单腔ICD（84．0％），而一级预防患者植入CRT—D比例最高（74．1％），组间植入ICD类型差异有统计学意义（P〈0．01）。结论ICD植入数量与～级预防患者比例逐年增加，一级预防患者的识别与植入工作有待改进，特别是心肌梗死后左心室功能不良患者与未符合心脏再同步治疗适应证的慢性心功能不良患者的识别。

Objective To study the clinical characteristics of patients undergoing implanted cardio- verter defibrillator （ICD） implantation for primary prevention （PP） and secondary prevention （SP） of sudden cardiac death （SCD）. Methods Patients undergoing implantation of ICD or cardiac resynchronization therapy with defibrillator function （ CRT-D ） during 2006 to 2011 were consecutively recruited, of whom clinical data were collected. Change in the quantity of total implantations as well as proportion of PP implantations through years were calculated, and clinical characteristics of patients were compared between PP and SP groups. Results A total of 214 patients were enrolled,including 108 for PP and 106 for SP. Both the total number of implanta- tions and proportion of SP implantations increased over the years. Patients of PP suffer worse NYHA class （ P〈 0. 01 ） ,lower left ventricular ejection fraction[ （0. 34±0. 10） vs. （0. 50±0. 16） ,P〈0. 01 ） ,more widened QRS duration （ （ 135.83±35.08 ） ms vs. （ 111.68±34.15 ） ms ,P〈0.01 ,higher level of log （NT-proBNP） [ （3.32 ±0. 62） pg/ml vs. （2. 83±0. 83） pg/ml,P〈0.01 ] ,and lower glomerular filtration rate[ （75.15±24. 23） ml/min vs. （90. 25 ± 70. 30 ） ml/min, P = 0. 037 ]. Constitution of primary heart diseases was significantly different between PP as SP groups（P〈0. 01 ） ,with low proportion of coronary heart disease in both groups（ 13.1% and 22. 6% ）. Most patients of SP received single-chamber ICD（84. 0% ） ,while most PP patients received CRT-D （74. 1% ）, given significant difference between groups （P〈0. 01 ）. Conclusion With the increase in quantity of total implantations and proportion of PP implantations, PP patient screening deserves more attention, especially those of left ventricular dysfunction after myocardial infarction and without indication for cardiac resynchronization therapy.