复杂性室性心律失常对老年充血性心力衰竭预后的影响

Prognostic influence of complexity ventricular arrhythmia on old-age patient of severe congestive heart failure

目的探讨复杂性室性心律失常对老年充血性心力衰竭(CHF)预后的影响。方法172例老年充血性心力衰竭(CHF)根据24hCCU或Holter检测结果,诊断为复杂性室性心律失常者(阳性组)58例,与无复杂性室性心律失常(阴性组114例)进行对比研究。终点:患者死亡或治愈出院日期,并以此计算死亡率及生存率。结果阳性组总体死亡率(51.72%)及猝死率(27.59%)明显高于阴性组(29.82%和7.89%)(P<0.01);阳性组86.4%的死亡者临终心电图表现为室速或室颤,而阴性组则以慢性心律失常或停搏为多(P<0.01);阳性多源性室早及R-ON-T室早猝死率明显高于对照组(16.63%和20.00%)(P<0.01及0.05)。结论老年重度CHF并复杂性室性心律失常时总死亡率、猝死率均明显增加,其中成对室早及非持续性心动过速的危险性最大。可能作为老年CHF患者总死亡率增加的独立预测指标。

Objective To study prognosis influence of complexity ventricular ar rhythmia on old-age patient of severe congestive heart failure (CHF). Methods T he 172 patients with severe CHF were selected sequentially and examined by CCU o r Holter of 24h,and divided into 2 groups the positive group (58 patients with the complexity ventricular arrhythmia, CVA),the negative group (114 patients, w ithout CVA). The total mortality and sudden death rate was counted. Results The total death rate (51.72%) and sudden death rate(27.59%) of positive group was o bvious higher than those of negative group (29.82% and 7.89%)(P<0.01);The elect rocardiogram before death showed that ventricular tachycardia and ventricular fi brillation mostly occurred in positive group, but the bradycardia arrhythmia or stop-cardia in negative group (P<0.01);Sudden death rate was higher in those of many source ventricular topic beat and the R-ON-T ventricular topic beat (16.63% and 20.00%) in positive group (P<0.01,0.05) than that in control group signific antly. Conclusion There is significant increase in that of total mortality and sudden death rate in old-age severe CHF with complexity ventricular arrhythmia, and the couple ventricular topic beat and non-sustained ventricular tachycardia( NSVT) is the most danger reason. Couple ventricular topic beat and NSVT can be u sed as predict indication of death possibility in old-age severe CHF.