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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吴书林各种心脏原因急：1小时内死亡不可预料的自然的病理生理过程非人为或外伤因素心脏性猝死（SCD）定义：心脏猝死是最常见、最凶险的死因FIGURE26–16.Influenceofresponsetimeonsurvivalfromout-of-hospitalcardiacarrest.A,Thetimefromonsetofcardiacarresttoinitialdefibrillationattemptisrelatedto1-monthsurvival,basedondatafr
2、omtheSwedishCardiacArrestRegistry.336Thecumulativesurvivalratewas5percent,andthesurvivalrateforvictimswhoseinitialrhythmwasventriculartachycardia(VT)orventricularfibrillation(VF)was9.5percent.Themedianresponsetimewasnearly13minutes.Thirty-daysurvivalrangedfromamaximumof48perc
3、entwithresponsesoflessthan2minutestolessthan5percentforresponsetimegreaterthan15minutes.B,Thepotentialforfasterresponsesystems,basedontheAmsterdamResuscitationStudy,isdemonstrated,comparingresponsetimesofpolicevehicleswiththoseofconventionalemergencymedicalsystems.Atthe50thpe
4、rcentileofresponsetimes,policesvehiclesprovidedanearly5minuteimprovementinarrivaltime(approximately6minutes).337Preliminarydatasuggestthatimprovedresponsetimesofthistypetranslatetoimprovedsurvival.338W.B.SaundersCompanyitemsandderiveditemscopyright©2001byW.BSaundersCompany.40
5、-45万(Circulation2001;104:2158-2163)5-15%能到医院,1-20%幸存50%出院前SCD发作VT62%Bradycardia17%TorsadesdePointes13%PrimaryVF8%AdaptedfromBayésdeLunaA.AmHeartJ1989;117:151-159.美国7-9万/年院外2%幸存15%一年内复发英国先兆新增或加重症状胸痛心慌气短乏力发作临床状态突然变化心律失常低血压胸痛气短头晕心脏停跳突然发作心脏停跳循环衰竭意识丧失生物学死亡复苏失败电机械分离中枢神经功能不恢复天月立刻1小时
6、分周流行病学心脏猝死(SCD)的发病率西欧：300,000/年；平均生还率2-3%；全球：9,000,000/年；平均生还率小于1％；美国：250,000-350,000/年；中国：心血管疾病致死1,500,000/年；RelativeRiskFactorsFIGURE26–4.Riskofsuddendeathbydecileofmultivariantrisk:26-yearfollow-up,theFraminghamStudy.ECG=electrocardiographic;I–V=intraventricular;LVH=leftve
7、ntricularhypertrophy;non-specabn=nonspecificabnormality.(FromKannelWB,ShatzkinA:Suddendeath:Lessonsfromsubsetsinpopulationstudies.ReprintedbypermissionoftheAmericanCollegeofCardiology.JAmCollCardiol5[Suppl6]:141B,1985.)W.B.SaundersCompanyitemsandderiveditemscopyright©2001byW.
8、BSaundersCompany.一、冠心病和非冠心病的冠状动脉结构异常㈠冠心病是SCD的最常见病因，西方国家80%SCD为冠心病20-
