住院患者心源性猝死发生的影响因素研究

Influencing factors for sudden cardiac death in inpatients

目的:探讨住院患者心源性猝死(SCD)发生的影响因素。方法:临床纳入因心脏病死亡的患者124例,根据是否为SCD分为SCD组(65例)与非SCD组(59例)。比较两组患者临床资料、实验室检测结果、死亡时生物节律以及心电图表现等。结果:死亡时生物节律方面,SCD组发生在6:01~12:00比例为41.54%,显著高于其它时段(P均<0.01);非SCD组各时段差异则无显著性(P>0.05)。与非SCD组比较,SCD组在6:01~12:00时段死亡的比例(23.73%比41.54%,P=0.007)明显升高,SCD组肌酸激酶[CK,(1140.66±176.63)IU/L比(1949.52±2141.22)IU/L]、肌酸激酶同工酶[CK-MB,(92.43±28.30)IU/L比(175.20±231.44)IU/L]、心肌肌钙蛋白I[cTnI,(30.09±34.27)mg/L比(44.34±10.60)mg/L]水平明显升高,左室射血分数[LVEF,(49.83±11.24)%比(37.53±23.11)%]明显降低(P均<0.01);在SCD组中,冠心病导致的SCD占86.15%(56/65),其中心肌梗死占66.15%(43/65)。结论:冠心病特别是心肌梗死是临床引发心源性猝死的重要因素。检测CK、CK-MB、cTnI及LVEF水平对防治心源性猝死有重要意义。

Objective： To explore influencing factors for sudden cardiac death （SCD） in inpatients. Methods： A total of 124 patients died of heart disease were enrolled. According to SCD or not, they were divided into SCD group （n = 65） and non-SCD group （n = 59）. Clinical data, laboratory examination results, biological rhythm and ECG manifestation at death were compared between two groups. Results： For biological rhythm at death, 41.54% death occurred during 6： 01-12.. 00 in SCD group, which was significantly higher than other time period （P〈0.01 all）; there was no significant difference in mortality among all time periods in non-SCD group （P〉 0.05）. Compared with non-SCD group, there were significant rise in death proportion in 6： 01-12：00 （23.73% vs. 41.54%, P= 0. 007）, in levels of creatine kinase FCK, （1140.66 ± 176.63） IU/L vs. （1949.52 ± 2141.22） IU/L], creatine kinase isoenzyme MB [CK-MB, （92.43 ± 28.30） IU/L vs. （175.20 ± 231.44） IU/L] and cardiac troponin I [cTnI, （30.09 ± 34. 27） mg/L vs. （44. 34 ± 10.60） mg/L], and significant reduction in left ventricular ejection fraction [LVEF, （49.83 ± 11.24）% vs. （37.53 ± 23.11） % ] in SCD group, P〈0.01 all; in SCD group, SCD caused by coronary heart disease occupied 86.15% （56/65）, and myocardial infarction occupied 66. 15% （43/65）. Conclusion.. Coronary heart disease, especially myocardial infarction, is an important factor leading to sudden cardiac death . Detection of CK, CK-MB, cTnI and LVEF levels have important sense for prevention and treatment of sudden cardiac death.