心脏性猝死的预防及我国埋藏式心律转复除颤器应用状况

The prevention of sudden cardiac death and clinical application of implantable cardioverter-defibrillator in Mainland of China

目的 通过对全国部分医院的回顾性调查研究 ,了解我国埋藏式心律转复除颤器 (ICD)使用状况。方法 回顾性分析了 1996年 1月 18日到 2 0 0 3年 1月 31日 ,来自 82家医院的 173例ICD患者的临床情况 ,了解其基础病因、心律失常类型、ICD对心律失常的治疗情况以及ICD的并发症。结果 173例植入ICD患者 ,其中 115例 (6 6 5 % )有各种器质性心脏病 ,以冠心病为最常见。植入患者中室性心动过速 (VT) 10 6例 (6 1 3% ) ,心室颤动 (VF) 34例 (19 6 % ) ,VT合并VF 33例 (19 1% )。在平均随访 2 7 8个月 (1～ 86个月 )中 ,82例 (47 4 % )发生VT和 或VF ,并接受ICD成功治疗 ;73 0 4 %的VT通过抗心动过速起搏 (ATP)终止 ;VF除颤成功率为 10 0 % ;误放电率为 2 0 %。术后并发症发生率为 2 3% ,随访期间共有 11例患者死亡 ,占 6 4 %。结论 本研究的有限数据表明ICD治疗对我国患者带来的好处 ,但其应用尚处于起步阶段。

Objective To investigate the current application of implantable cardioverter-defibrillator (ICD) in Mainland of China.Methods A retrospective analysis was performed in patients with implanted ICD from 1996 to 2003 in 82 hospitals. All patients were followed up by out-patient clinic in order to ensure safety and optimal device performance. Results During the period of 1996-2003,there were 173 patients who accepted ICD implantation according to data from these hospitals. The proportion with underlying diseases was 66.5%, and coronary artery disease was the most common cause. The causes for ICD implantation were ventricular tachycardia (VT) in 106 cases (61.3%), ventricular fibrillation (VF) in 34 cases (19.6%),and VT/VF in 33 cases (19.1%). VTs/VFs occurred in 82 cases (47.4%) and were treated by ICD. VT was terminated by antitachycardia pacing in 204 episodes (73.04%). All VFs (142 episodes) were successfully converted by ICD shock. Inappropriate shock occurred in 4 cases (2.0%). Complications were seen in 6 cases (2.3%). The mortality rate was 6.4% by a follow-up for the mean time of 27.8 months. Conclusion The limited data from 82 hospitals have shown that the ICD therapy is of benefit to patients with sustained VT or VF and effective against sudden cardiac death in susceptive patients.