The number of sudden cardiac death(SCD)has increased year by year,which has become one of the main causes of death in China.Timely cardiopulmonary resuscitation(CPR)and timely and accurate use of automatic external de...The number of sudden cardiac death(SCD)has increased year by year,which has become one of the main causes of death in China.Timely cardiopulmonary resuscitation(CPR)and timely and accurate use of automatic external defibrillator(AED)can greatly improve the survival rate of patients with sudden cardiac death.Because the large probability of sudden cardiac death occurs outside the hospital,it is very important for the general public to master first aid skills.This paper will mine all kinds of data from multi-dimensional and multi-angle,analyze the mastery of public first aid skills in China,and provide practical suggestions and ideas for popularizing first aid skills in the future.展开更多
Annual arrhythmic sudden cardiac death ranges from 0.6%to 4%in ischemic cardiomyopathy(ICM),1%to 2%in non-ischemic cardiomyopathy(NICM),and 1%in hypertrophic cardiomyopathy(HCM).Towards a more effective arrhythmic ris...Annual arrhythmic sudden cardiac death ranges from 0.6%to 4%in ischemic cardiomyopathy(ICM),1%to 2%in non-ischemic cardiomyopathy(NICM),and 1%in hypertrophic cardiomyopathy(HCM).Towards a more effective arrhythmic risk stratification(ARS)we hereby present a two-step ARS with the usage of seven non-invasive risk factors:Late potentials presence(≥2/3 positive criteria),premature ventricular contractions(≥30/h),non-sustained ventricular tachycardia(≥1episode/24 h),abnormal heart rate turbulence(onset≥0%and slope≤2.5 ms)and reduced deceleration capacity(≤4.5 ms),abnormal T wave alternans(≥65μV),decreased heart rate variability(SDNN<70ms),and prolonged QT_(c)interval(>440 ms in males and>450 ms in females)which reflect the arrhythmogenic mechanisms for the selection of the intermediate arrhythmic risk patients in the first step.In the second step,these intermediate-risk patients undergo a programmed ventricular stimulation(PVS)for the detection of inducible,truly high-risk ICM and NICM patients,who will benefit from an implantable cardioverter defibrillator.For HCM patients,we also suggest the incorporation of the PVS either for the low HCM Risk-score patients or for the patients with one traditional risk factor in order to improve the inadequate sensitivity of the former and the low specificity of the latter.展开更多
BACKGROUND: Survival from cardiac arrest is sensitive to the quality of delivered CPR. In 2010, updated international resuscitation guidelines emphasized deeper chest compressions and faster rates, yet it is unknown w...BACKGROUND: Survival from cardiac arrest is sensitive to the quality of delivered CPR. In 2010, updated international resuscitation guidelines emphasized deeper chest compressions and faster rates, yet it is unknown whether training laypersons using updated guidelines resulted in changed CPR performance. We hypothesized that laypersons taught CPR using the 2010 guidelines performed deeper and faster compressions than those taught using the 2005 materials.METHODS: This work represents a secondary analysis of a study conducted at eight hospitals where family members of hospitalized cardiac patients were trained in CPR. An initial cohort was trained using the 2005 guidelines, and a subsequent cohort was trained using the 2010 guideline materials. Post training, CPR skills were quantified using a recording manikin.RESULTS: Between May 2009 to August 2013, 338 subjects completed the assessment. Among the subjects, 176 received 2005 training and 162 underwent 2010 training. The mean compression rate in the 2005 cohort was 87(95%CI 83–90) per minute, and in the 2010 cohort was 86(95%CI 83–90) per minute(P=ns), while the mean compression depth was 34(95%CI 32–35) mm in the 2005 cohort and 46(95%CI 44–47) mm in the 2010 cohort(P<0.01).CONCLUSIONS: Training with the 2010 CPR guidelines resulted in a statistically significant increase in trainees' compression depth but there was no change in compression rate. Nevertheless, the majority of CPR performed by trainees in both cohorts was below the guideline recommendation, highlighting an important gap between training goals and trainee performance.展开更多
Background:Little is known about the risk factors for sudden cardiac death (SCD) in the overall hospitalized cardiac department population.This study was conducted to investigate the risk factors and develop a predict...Background:Little is known about the risk factors for sudden cardiac death (SCD) in the overall hospitalized cardiac department population.This study was conducted to investigate the risk factors and develop a predictive model for SCD in a hospitalized cardiac department population.Methods:We conducted a retrospective study of patients admitted to the cardiac department of the First Affiliated Hospital of Xinjiang Medical University from June 2015 to February 2017.We collected the clinical data from medical records.Multiple stepwise logistic regression analysis was carried out to confirm the risk factors for SCD and develop a predictive risk model.The risk score was assessed by the area under receiver operating characteristic (AUROC) curve and the Hosmer-Lemeshow goodness-of-fit test.Results:A total of 262 patients with SCD and 4485 controls were enrolled in our study.Logistic regression modeling identified eight significant risk factors for in-hospital SCD:age,main admitting diagnosis,diabetes,corrected QT interval,QRS duration,ventricular premature beat burden,left ventricular ejection fraction,and estimated glomerular filtration rate.A predictive risk score including these variables showed an AUROC curve of 0.774 (95% confidence interval:0.744–0.805).The Hosmer-Lemeshow goodness-of-fit test showed the chi-square value was 2.527 (P= 0.640).The incidence of in-hospital SCD was 1.3%,4.1%,and 18.6% for scores of 0 to 2,3 to 5 and ≥6,respectively (P<0.001).Conclusions:Age,main admitting diagnosis,diabetes,QTc interval,QRS duration,ventricular premature beat burden,left ventricular ejection fraction,and estimated glomerular filtration rate are factors related to in-hospital SCD in a hospitalized cardiac department population.We developed a predictive risk score including these factors that could identify patients who are predisposed to in-hospital SCD.展开更多
目的探讨心源性脑卒中病情进展的危险因素。方法回顾性分析2008年8月1日~2014年12月31日在江苏省苏北人民医院诊治的急性缺血性脑卒中患者,根据中国缺血性脑卒中亚型分型筛选出心源性脑卒中患者71例,根据入院7d内病情是否加重分为进展...目的探讨心源性脑卒中病情进展的危险因素。方法回顾性分析2008年8月1日~2014年12月31日在江苏省苏北人民医院诊治的急性缺血性脑卒中患者,根据中国缺血性脑卒中亚型分型筛选出心源性脑卒中患者71例,根据入院7d内病情是否加重分为进展组14例和非进展组57例。2组入院时和30d后病情评估采用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分。采用单因素和logistic回归分析得出心源性脑卒中病情进展的危险因素,采用ROC曲线分析各因素预测的临界值。结果进展组NIHSS改善情况明显较非进展期差(P<0.01)。进展组年龄、右侧病灶和D-二聚体水平明显高于非进展组[(77.29±8.87)岁vs(71.44±9.51)岁,P=0.041;71.4%vs 33.3%,P=0.009;2.82mg/L vs 0.91mg/L,P=0.048],丙氨酸转氨酶水平明显低于非进展组[(13.79±4.44)U/L vs(21.98±17.34)U/L,P=0.002]。进一步行logistic回归分析显示,2组年龄、右侧病灶和D-二聚体比较,差异有统计学意义(P=0.030,P=0.007,P=0.025)。绘制ROC曲线下面积可见,年龄>70.75岁及D-二聚体>1.23mg/L患者易出现病情进展。结论年龄、右侧病灶和D-二聚体水平升高是心源性脑卒中病情进展的危险因素,可作为心源性脑卒中病情进展的预测因子。展开更多
文摘The number of sudden cardiac death(SCD)has increased year by year,which has become one of the main causes of death in China.Timely cardiopulmonary resuscitation(CPR)and timely and accurate use of automatic external defibrillator(AED)can greatly improve the survival rate of patients with sudden cardiac death.Because the large probability of sudden cardiac death occurs outside the hospital,it is very important for the general public to master first aid skills.This paper will mine all kinds of data from multi-dimensional and multi-angle,analyze the mastery of public first aid skills in China,and provide practical suggestions and ideas for popularizing first aid skills in the future.
文摘Annual arrhythmic sudden cardiac death ranges from 0.6%to 4%in ischemic cardiomyopathy(ICM),1%to 2%in non-ischemic cardiomyopathy(NICM),and 1%in hypertrophic cardiomyopathy(HCM).Towards a more effective arrhythmic risk stratification(ARS)we hereby present a two-step ARS with the usage of seven non-invasive risk factors:Late potentials presence(≥2/3 positive criteria),premature ventricular contractions(≥30/h),non-sustained ventricular tachycardia(≥1episode/24 h),abnormal heart rate turbulence(onset≥0%and slope≤2.5 ms)and reduced deceleration capacity(≤4.5 ms),abnormal T wave alternans(≥65μV),decreased heart rate variability(SDNN<70ms),and prolonged QT_(c)interval(>440 ms in males and>450 ms in females)which reflect the arrhythmogenic mechanisms for the selection of the intermediate arrhythmic risk patients in the first step.In the second step,these intermediate-risk patients undergo a programmed ventricular stimulation(PVS)for the detection of inducible,truly high-risk ICM and NICM patients,who will benefit from an implantable cardioverter defibrillator.For HCM patients,we also suggest the incorporation of the PVS either for the low HCM Risk-score patients or for the patients with one traditional risk factor in order to improve the inadequate sensitivity of the former and the low specificity of the latter.
基金supported by a grant from the National Institutes of Health(R18HL107217)
文摘BACKGROUND: Survival from cardiac arrest is sensitive to the quality of delivered CPR. In 2010, updated international resuscitation guidelines emphasized deeper chest compressions and faster rates, yet it is unknown whether training laypersons using updated guidelines resulted in changed CPR performance. We hypothesized that laypersons taught CPR using the 2010 guidelines performed deeper and faster compressions than those taught using the 2005 materials.METHODS: This work represents a secondary analysis of a study conducted at eight hospitals where family members of hospitalized cardiac patients were trained in CPR. An initial cohort was trained using the 2005 guidelines, and a subsequent cohort was trained using the 2010 guideline materials. Post training, CPR skills were quantified using a recording manikin.RESULTS: Between May 2009 to August 2013, 338 subjects completed the assessment. Among the subjects, 176 received 2005 training and 162 underwent 2010 training. The mean compression rate in the 2005 cohort was 87(95%CI 83–90) per minute, and in the 2010 cohort was 86(95%CI 83–90) per minute(P=ns), while the mean compression depth was 34(95%CI 32–35) mm in the 2005 cohort and 46(95%CI 44–47) mm in the 2010 cohort(P<0.01).CONCLUSIONS: Training with the 2010 CPR guidelines resulted in a statistically significant increase in trainees' compression depth but there was no change in compression rate. Nevertheless, the majority of CPR performed by trainees in both cohorts was below the guideline recommendation, highlighting an important gap between training goals and trainee performance.
文摘Background:Little is known about the risk factors for sudden cardiac death (SCD) in the overall hospitalized cardiac department population.This study was conducted to investigate the risk factors and develop a predictive model for SCD in a hospitalized cardiac department population.Methods:We conducted a retrospective study of patients admitted to the cardiac department of the First Affiliated Hospital of Xinjiang Medical University from June 2015 to February 2017.We collected the clinical data from medical records.Multiple stepwise logistic regression analysis was carried out to confirm the risk factors for SCD and develop a predictive risk model.The risk score was assessed by the area under receiver operating characteristic (AUROC) curve and the Hosmer-Lemeshow goodness-of-fit test.Results:A total of 262 patients with SCD and 4485 controls were enrolled in our study.Logistic regression modeling identified eight significant risk factors for in-hospital SCD:age,main admitting diagnosis,diabetes,corrected QT interval,QRS duration,ventricular premature beat burden,left ventricular ejection fraction,and estimated glomerular filtration rate.A predictive risk score including these variables showed an AUROC curve of 0.774 (95% confidence interval:0.744–0.805).The Hosmer-Lemeshow goodness-of-fit test showed the chi-square value was 2.527 (P= 0.640).The incidence of in-hospital SCD was 1.3%,4.1%,and 18.6% for scores of 0 to 2,3 to 5 and ≥6,respectively (P<0.001).Conclusions:Age,main admitting diagnosis,diabetes,QTc interval,QRS duration,ventricular premature beat burden,left ventricular ejection fraction,and estimated glomerular filtration rate are factors related to in-hospital SCD in a hospitalized cardiac department population.We developed a predictive risk score including these factors that could identify patients who are predisposed to in-hospital SCD.
文摘目的探讨心源性脑卒中病情进展的危险因素。方法回顾性分析2008年8月1日~2014年12月31日在江苏省苏北人民医院诊治的急性缺血性脑卒中患者,根据中国缺血性脑卒中亚型分型筛选出心源性脑卒中患者71例,根据入院7d内病情是否加重分为进展组14例和非进展组57例。2组入院时和30d后病情评估采用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分。采用单因素和logistic回归分析得出心源性脑卒中病情进展的危险因素,采用ROC曲线分析各因素预测的临界值。结果进展组NIHSS改善情况明显较非进展期差(P<0.01)。进展组年龄、右侧病灶和D-二聚体水平明显高于非进展组[(77.29±8.87)岁vs(71.44±9.51)岁,P=0.041;71.4%vs 33.3%,P=0.009;2.82mg/L vs 0.91mg/L,P=0.048],丙氨酸转氨酶水平明显低于非进展组[(13.79±4.44)U/L vs(21.98±17.34)U/L,P=0.002]。进一步行logistic回归分析显示,2组年龄、右侧病灶和D-二聚体比较,差异有统计学意义(P=0.030,P=0.007,P=0.025)。绘制ROC曲线下面积可见,年龄>70.75岁及D-二聚体>1.23mg/L患者易出现病情进展。结论年龄、右侧病灶和D-二聚体水平升高是心源性脑卒中病情进展的危险因素,可作为心源性脑卒中病情进展的预测因子。
