住院患者心源性猝死发生的影响因素研究

摘要

目的:探讨住院患者心源性猝死(SCD)发生的影响因素.方法:临床纳入因心脏病死亡的患者124例,根据是否为SCD分为SCD组(65例)与非SCD组(59例).比较两组患者临床资料、实验室检测结果、死亡时生物节律以及心电图表现等.结果:死亡时生物节律方面,SCD组发生在6:01~12:00比例为41.54%,显著高于其它时段(P均<0.01);非SCD组各时段差异则无显著性(P>0.05).与非SCD组比较,SCD组在6:01~12:00时段死亡的比例(23.73%比41.54%,P=0.007)明显升高,SCD组肌酸激酶[CK, (1140.66±176.63) IU/L比(1949.52±2141.22) IU/L]、肌酸激酶同工酶[CK-MB, (92.43±28.30) IU/L比(175.20±231.44) IU/L]、心肌肌钙蛋白I [cTnI, (30.09±34.27) mg/L比(44.34±10.60) mg/L]水平明显升高,左室射血分数[LVEF, (49.83±11.24)%比(37.53±23.11)%]明显降低(P均<0.01);在SCD组中,冠心病导致的SCD占86.15%(56/65),其中心肌梗死占66.15%(43/65).结论:冠心病特别是心肌梗死是临床引发心源性猝死的重要因素.检测CK、CK-MB、cTnI及LVEF水平对防治心源性猝死有重要意义.%Objective: To explore influencing factors for sudden cardiac death (SCD) in inpatients.Methods: A total of 124 patients died of heart disease were enrolled.According to SCD or not, they were divided into SCD group (n=65) and non-SCD group (n=59).Clinical data, laboratory examination results, biological rhythm and ECG manifestation at death were compared between two groups.Results: For biological rhythm at death, 41.54% death occurred during 6:01~12:00 in SCD group, which was significantly higher than other time period (P<0.01 all);there was no significant difference in mortality among all time periods in non-SCD group (P>0.05).Compared with non-SCD group, there were significant rise in death proportion in 6:01~12:00 (23.73% vs.41.54%,P=0.007), in levels of creatine kinase [CK, (1140.66±176.63) IU/L vs.(1949.52±2141.22) IU/L], creatine kinase isoenzyme MB [CK-MB, (92.43±28.30) IU/L vs.(175.20±231.44) IU/L] and cardiac troponin I [cTnI, (30.09±34.27) mg/L vs.(44.34±10.60) mg/L], and significant reduction in left ventricular ejection fraction [LVEF, (49.83±11.24)% vs.(37.53±23.11)%] in SCD group, P<0.01 all;in SCD group, SCD caused by coronary heart disease occupied 86.15% (56/65), and myocardial infarction occupied 66.15%(43/65).Conclusion: Coronary heart disease, especially myocardial infarction, is an important factor leading to sudden cardiac death.Detection of CK, CK-MB, cTnI and LVEF levels have important sense for prevention and treatment of sudden cardiac death.