QRS波群时限及血浆BNP水平对慢性心衰致心源性猝死的预警价值

Feasibility of Preventing Sudden Cardiac Death Induced by Chronic Heart Failure with QRS Duration and Serum BNP Content

【目的】探讨ORS波群时限及血浆脑钠肽（BNP）水平预警慢性心衰致心源性猝死（SCD）的可行性。【方法】选择2011年1月至2013年1月期间本院收治的确诊为慢性心衰（CHF）患者210例作为研究对象，持续跟踪测定患者23个月的QRS波群时限和血浆BNP水平并记录终点事件。比较SCD患者与心源性非猝死、非心源性死亡、存活心衰患者和健康人群的QRS波群时限及血浆BNP水平差异，分析SCD发生率与QRS波群时限及血浆BNP的关系。【结果】198例CHF患者数据完整，按NYHA评定分级将观察组患者分为三组，QRS波群时限随心功受损加剧而逐级延迟，且差异有统计学意义（P〈0．05）；比较三组的血浆BNP水平，心衰NYHA评级上升则血浆BNP水平增高，组间比较差异有显著性统计学意义（均P〈0．01）。SCD组QRS波群时限高于其他四组，与心源性非猝死组、存活组和健康组差异有统计学意义（P〈0．05），与非心源性死亡组差异无统计学意义（P〉0．05）；SCD组BNP水平明显高于其他四组，且差异均有显著性统计学意义（P〈0．01）【结论】QRS波群时限和血浆BNP水平与CHF患者的SCD发生率密切相关，联合QRS波群时限和血浆BNP测定对社区CHF患者进行病情监测具有重要的临床意义。

[Objective] To investigate the feasibility of preventing sudden cardiac death induced by chronic heart failure with QRS duration and serum BNP content. [Methods] From 2011 January to 2013 January, 210 CHF patients treated in our hospital were selected. Their QRS duration and serum BNP content were determined for 23 months, and terminal events of patients were recorded. QRS duration and serum BNP content were compared between SCD victims and non-cardiac sudden death group, non-cardiac death group, and survivors. The relationship between the incidence of SCD and QRS duration and serum BNP content was then analyzed. [Results] Complete data was obtained from 198 patients. QRS duration of SCD victims was longer than that of the other four groups, and the difference between SCD victims and non-cardiac sudden death group, survivors and healthy controls had statistical significance（ P 〈0.05）. Furthermore, serum BNP content of SCD victims was significantly higher than in the other four groups（ P 〈0.01）. [Conclusion]QRS duration and serum BNP content are closely correlated with the SCD incidence of CHF patients, and detection of QRS duration and serum BNP content of CHF patients has important significance.