1、心脏性猝死 (SCD)的一级和二级预防广东省心血管病研究所广东省心血管病研究所吴吴 书书 林林各种心脏原因各种心脏原因急：急： 1小时内死亡小时内死亡不可预料的不可预料的自然的病理生理过程自然的病理生理过程非人为或外伤因素非人为或外伤因素心脏性猝死（ SCD） 定义：l 心脏猝死是最常见、最凶险的死因FIGURE 2616. Influence of response time on survival from out-of-hospital cardiac arrest. A, The time from onset of cardiac arrest to initial defibril
2、lation attempt is related to 1-month survival, based on data from the Swedish Cardiac Arrest Registry.336 The cumulative survival rate was 5 percent, and the survival rate for victims whose initial rhythm was ventricular tachycardia (VT) or ventricular fibrillation (VF) was 9.5 percent. The median r
3、esponse time was nearly 13 minutes. Thirty-day survival ranged from a maximum of 48 percent with responses of less than 2 minutes to less than 5 percent for response time greater than 15 minutes. B, The potential for faster response systems, based on the Amsterdam Resuscitation Study, is demonstrate
4、d, comparing response times of police vehicles with those of conventional emergency medical systems. At the 50th percentile of response times, polices vehicles provided a nearly 5 minute improvement in arrival time (approximately 6 minutes).337 Preliminary data suggest that improved response times o
5、f this type translate to improved survival.338W.B. Saunders Company items and derived items copyright 2001 by W.B Saunders Company.l 40-45万 (Circulation 2001;104:2158-2163)l 5-15% 能到医院 , 1-20% 幸存l 50% 出院前 SCD发作VT62% Bradycardia17%Torsadesde Pointes13%PrimaryVF8%Adapted from Bays de Luna A. Am Heart
6、J 1989;117:151-159.美 国l 7-9万 /年l 院外 2% 幸存l 15% 一年内复发英 国先先 兆兆新增或加重症状新增或加重症状胸痛胸痛心慌心慌气短气短乏力乏力发发 作作临床状态突然变化临床状态突然变化心律失常心律失常低血压低血压胸痛胸痛气短气短头晕头晕心脏停跳心脏停跳突然发作突然发作心脏停跳心脏停跳循环衰竭循环衰竭意识丧失意识丧失生物学死亡生物学死亡复苏失败复苏失败电机械分离电机械分离中枢神经中枢神经功能不恢复功能不恢复天天 月月 立刻立刻 1小时小时 分分 周周心脏猝死 (SCD)的发病率l 西欧： 300,000 / 年 ；平均生还率 2-3% ；l 全球 ： 9,0
7、00,000 / 年；平均生还率小于 1；l 美国： 250,000-350,000 / 年；l 中国：心血管疾病致死 1,500,000 / 年；Relative Risk FactorsFIGURE 264. Risk of sudden death by decile of multivariant risk: 26-year follow-up, the Framingham Study. ECG = electrocardiographic; IV = intraventricular; LVH = left ventricular hypertrophy; non-spec abn
8、 = nonspecific abnormality. (From Kannel WB, Shatzkin A: Sudden death: Lessons from subsets in population studies. Reprinted by permission of the American College of Cardiology. J Am Coll Cardiol 5Suppl 6:141B, 1985.) W.B. Saunders Company items and derived items copyright 2001 by W.B Saunders Company.
