CAJ | 학술논문

目的观察心力衰竭患者心原性猝死的发病情况及可能病因,为防治猝死探索对策.方法入选2005年1月至2008年12月住院的心力衰竭死亡患者133例,其中73例(54.9%)发生猝死(A组),55例(41.4%)死于泵衰竭(B组),其他原因死亡5例.回顾性分析A、B组死亡患者的临床资料,包括病史、临床表现、心功能分级、左室舒张末期内径、左室射血分数、药物治疗等.结果两组患者在病史、室性心律失常发生率方面差异无统计学意义.A组患者的纽约心脏病学会(NVHA)心功能分级多为Ⅱ、Ⅲ级,左窜射血分数高于B组.A组心绞痛发生率高于B组(63.0%与21.8%,P<0.05).β受体阻滞剂和血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂在A组应用率高于B组,但其应用时间较B组短、剂量偏小.他汀类药物及抗血小板聚集药物的应用,A组少于B组.结论心原性猝死多发生在心功能Ⅱ、Ⅲ级的心力衰竭患者.猝死前多有心绞痛发作,可能是因为他汀类及抗血小板药物应用较少,β受体阻滞剂与血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂应用量小及疗程较短,未能在防治猝死及病情恶化中起到应有的作用.
목적 관찰심력쇠갈환자심원성졸사적발병정황급가능병인,위방치졸사탐색대책.방법 입선2005년1월지2008년12월주원적심력쇠갈사망환자133례,기중73례(54.9%)발생졸사(A조),55례(41.4%)사우빙쇠갈(B조),기타원인사망5례.회고성분석A、B조사망환자적림상자료,포괄병사、림상표현、심공능분급、좌실서장말기내경、좌실사혈분수、약물치료등.결과 량조환자재병사、실성심률실상발생솔방면차이무통계학의의.A조환자적뉴약심장병학회(NVHA)심공능분급다위Ⅱ、Ⅲ급,좌찬사혈분수고우B조.A조심교통발생솔고우B조(63.0%여21.8%,P<0.05).β수체조체제화혈관긴장소전환매억제제혹혈관긴장소Ⅱ수체길항제재A조응용솔고우B조,단기응용시간교B조단、제량편소.타정류약물급항혈소판취집약물적응용,A조소우B조.결론 심원성졸사다발생재심공능Ⅱ、Ⅲ급적심력쇠갈환자.졸사전다유심교통발작,가능시인위타정류급항혈소판약물응용교소,β수체조체제여혈관긴장소전환매억제제혹혈관긴장소Ⅱ수체길항제응용량소급료정교단,미능재방치졸사급병정악화중기도응유적작용.
Objective To analyze the causes of death in patients with heart failure. Methods A total of 133 heart failure patients died during hospitalization in our hospital between January 2005 and December 2008 were enrolled in this study. Patients were divided to two groups : sudden death (group A, n=73, 54.9% ), chronic end-stage pump failure (group B, n=55, 41.4%). The remaining 5 cases died of other causes were excluded from the final analysis. Clinical data (medical history, blood pressure, clinical manifestation, NYHA cardiac function class, left ventricular diameter of diastole, left ventricular ejection fraction, ventricular arrhythmias, drug therapy) of group A and B were analyzed. Results There were no significant differences in terms of medical history ( including hypertension and diabetes), blood pressure, heart rate and the incidence of ventricular arrhythmia between the two groups. In group A, the NYHA functional class was mostly Ⅱ or Ⅲ grade, and LVEF value was significantly higher than that of group B. The incidence of angina pectoris was significantly higher in group A compared to group B. β-blocker and angiotensin-converting enzyme inhibitor or angiotensin Ⅱ receptor blocker use was also significantly higher in group A than in group B, however, the treatment dose was significantly lower and therapy duration was significantly shorter in group A than in group B. There were significantly less patients received statins and anti-platelet aggregation drugs in group A compred to group B. Conclusion In our patient cohort, sudden cardiac death often occurred in heart failure patients with NYHA cardiac function Ⅱ to Ⅲ grade, angina pectoris, probably due to the unstable coronary plaque and less statins and anti-platelet drug use in these patients.