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目的分析本中心埋藏式心脏转复除颤器(ICD)防治心脏性猝死(SCD)的疗效及其影响因素。方法回顾性分析2010至2015年,于本中心行ICD及心脏再同步化起搏-除颤器(CRT-D)植入术患者的全部临床资料,并分为一级及二级预防。评价ICD对于SCD一级与二级预防患者的整体效用及差异的原因,并根据年龄、肾功能等对一级预防进行亚组分析。结果共110例最终纳入研究,一级与二级预防分别为57例和53例。二级预防术后ICD恰当治疗比例高于一级预防(94.8%vs 86.6%,P<0.05)。共有20例死亡(18.2%),一级与二级预防间术后生存率无显著差异(17.5%vs 18.9%,P=0.817)。术前脑尿钠肽(BNP)和肾小球滤过率(eGFR){(HR=13.95,95%CI=2.05~94.84,P=0.007)/(HR=0.92,95%CI=0.87~0.98,P=0.006)}是术后生存情况的独立预测因素。一级预防亚组分析显示年龄≥65岁和eGFR≤45ml/min患者术后生存率较低。结论 SCD二级预防组ICD恰当治疗比例高,但两组术后累积生存率无显著性差异。术前BNP和eGFR是术后生存状况的预测因素;高龄及低eGFR降低ICD一级预防SCD的临床效用。
Objective To analyze the curative effect and its influential factors of ICD in preventing and treating sudden cardiac death (SCD) in our center. Methods The clinical data of patients undergoing ICD and cardiac resynchronization pacing-defibrillator (CRT-D) implantation at our center from 2010 to 2015 were retrospectively analyzed and divided into primary and secondary prevention. Assess the overall utility and differences of ICD for primary and secondary prevention of SCD and analyze subgroups of primary prevention based on age and renal function. Results A total of 110 cases were finally included in the study. The primary and secondary prevention were 57 and 53 respectively. The appropriate proportion of ICD for secondary prevention was higher than that of primary prevention (94.8% vs 86.6%, P <0.05). There were 20 deaths (18.2%), and there was no significant difference in postoperative survival between primary and secondary prevention (17.5% vs 18.9%, P = 0.817). Preoperative brain natriuretic peptide (BNP) and glomerular filtration rate (eGFR) {HR = 13.95,95% CI = 2.05-94.84, P = 0.007) / (HR = 0.92, 95% CI = 0.87-0.98 , P = 0.006)} was an independent predictor of postoperative survival. A primary prevention subgroup analysis showed a lower postoperative survival rate for patients aged 65 years and eGFR ≤ 45 ml / min. Conclusion The appropriate proportion of ICD in SCD secondary prevention group is high, but there is no significant difference between the two groups in the cumulative survival rate. Preoperative BNP and eGFR were predictors of postoperative survival; advanced and low eGFR decreased the primary efficacy of ICD in the prevention of SCD.