老年人心臟性猝死是指急性癥狀發作后1小時內發生的以意識突然喪失為特征的由心臟原因引起的自然死亡(wang)(wang)。1979年(nian)國(guo)際(ji)心臟(zang)病學(xue)(xue)會、美(mei)國(guo)心臟(zang)學(xue)(xue)會以及(ji)1970年(nian)世(shi)界衛生組(zu)織(zhi)定(ding)義的猝(cu)死為：急性癥(zheng)狀發生后即刻(ke)或者(zhe)情況24小時(shi)(shi)內發生的意外死亡(wang)(wang)。目前大多(duo)數學(xue)(xue)者(zhe)傾向(xiang)于將(jiang)猝(cu)死的時(shi)(shi)間限定(ding)在發病1小時(shi)(shi)內。其特點(dian)有三，①死亡(wang)(wang)急驟，②死亡(wang)(wang)出人意料，③自然死亡(wang)(wang)或非暴(bao)力死亡(wang)(wang)。
（1）冠心病
冠心(xin)(xin)病(急性(xing)(xing)缺血事件，慢性(xing)(xing)缺血性(xing)(xing)心(xin)(xin)臟(zang)(zang)病)是心(xin)(xin)臟(zang)(zang)性(xing)(xing)猝(cu)死(si)的(de)(de)(de)(de)(de)最常見(jian)的(de)(de)(de)(de)(de)原因。對心(xin)(xin)臟(zang)(zang)性(xing)(xing)猝(cu)死(si)的(de)(de)(de)(de)(de)尸檢發現，大約80%的(de)(de)(de)(de)(de)患(huan)者具(ju)有不同程度的(de)(de)(de)(de)(de)冠狀動脈(mo)病變，大約2/3以上的(de)(de)(de)(de)(de)患(huan)者為2支或(huo)3支以上的(de)(de)(de)(de)(de)病變。心(xin)(xin)肌梗死(si)后伴有左心(xin)(xin)功能下降(jiang)或(huo)嚴重(zhong)室性(xing)(xing)心(xin)(xin)律失常的(de)(de)(de)(de)(de)患(huan)者，心(xin)(xin)臟(zang)(zang)性(xing)(xing)猝(cu)死(si)的(de)(de)(de)(de)(de)發生率顯著增加。
（2）心肌病
擴(kuo)張(zhang)型心(xin)(xin)(xin)肌(ji)病(bing)(bing)的(de)(de)心(xin)(xin)(xin)臟(zang)性(xing)(xing)(xing)猝(cu)死(si)率(lv)為(wei)(wei)2%，在(zai)伴有(you)(you)室性(xing)(xing)(xing)心(xin)(xin)(xin)律失常(chang)時心(xin)(xin)(xin)臟(zang)性(xing)(xing)(xing)猝(cu)死(si)率(lv)可明顯增(zeng)加(jia)。而肥厚(hou)性(xing)(xing)(xing)心(xin)(xin)(xin)肌(ji)病(bing)(bing)患(huan)者(zhe)(zhe)(zhe)中(zhong)心(xin)(xin)(xin)臟(zang)性(xing)(xing)(xing)猝(cu)死(si)更常(chang)見。大(da)多數(shu)學者(zhe)(zhe)(zhe)報(bao)道(dao)，肥厚(hou)性(xing)(xing)(xing)心(xin)(xin)(xin)肌(ji)病(bing)(bing)的(de)(de)年(nian)(nian)病(bing)(bing)死(si)率(lv)為(wei)(wei)3%～4%，其中(zhong)大(da)多數(shu)為(wei)(wei)心(xin)(xin)(xin)臟(zang)性(xing)(xing)(xing)猝(cu)死(si)。在(zai)肥厚(hou)性(xing)(xing)(xing)心(xin)(xin)(xin)肌(ji)病(bing)(bing)患(huan)者(zhe)(zhe)(zhe)，下列情形(xing)為(wei)(wei)發(fa)生(sheng)心(xin)(xin)(xin)臟(zang)性(xing)(xing)(xing)猝(cu)死(si)的(de)(de)高(gao)危因(yin)素：①年(nian)(nian)齡較輕，在(zai)30歲以下。②曾有(you)(you)暈厥病(bing)(bing)史(shi)。③既往有(you)(you)心(xin)(xin)(xin)臟(zang)性(xing)(xing)(xing)猝(cu)死(si)的(de)(de)家族(zu)史(shi)。此外(wai)，各(ge)種原因(yin)產生(sheng)的(de)(de)心(xin)(xin)(xin)肌(ji)病(bing)(bing)和(he)致心(xin)(xin)(xin)律失常(chang)性(xing)(xing)(xing)心(xin)(xin)(xin)肌(ji)病(bing)(bing)也(ye)容易發(fa)生(sheng)心(xin)(xin)(xin)臟(zang)性(xing)(xing)(xing)猝(cu)死(si)。
（3）心臟瓣膜炎癥浸潤(run)
現已(yi)公認(ren)，二尖瓣(ban)脫垂(chui)綜(zong)合征可發生(sheng)(sheng)心臟(zang)(zang)性猝死，但發生(sheng)(sheng)率不高(gao)。據Jersaty報道(dao)，二尖瓣(ban)脫垂(chui)患(huan)者(zhe)伴有(you)下列情形(xing)者(zhe)易發生(sheng)(sheng)心臟(zang)(zang)性猝死：①40歲左(zuo)右的女性患(huan)者(zhe)。②有(you)暈(yun)厥病史。③心電圖上有(you)ST段改變(bian)或(huo)有(you)頻發室性期(qi)前收縮等室性心律失常。④有(you)&ldquo；喀(ka)啦&rdquo；音和收縮晚期(qi)或(huo)全收縮期(qi)雜音。
該圖片由注冊用戶"科技數碼行"提供，版權聲明反饋
（4）心律失常
一般不易(yi)發生心(xin)(xin)臟(zang)性(xing)(xing)猝(cu)死，但在老年患者(zhe)，常(chang)可并發嚴重(zhong)的冠狀(zhuang)動脈狹(xia)窄或(huo)高血壓致嚴重(zhong)左心(xin)(xin)室肥厚型心(xin)(xin)肌(ji)病的左心(xin)(xin)室流出道梗阻時，快速性(xing)(xing)室上性(xing)(xing)心(xin)(xin)律失常(chang)發作(zuo)時也易(yi)發生心(xin)(xin)臟(zang)性(xing)(xing)猝(cu)死。
多(duo)數學(xue)者(zhe)(zhe)認為(wei)，嚴(yan)重的(de)(de)(de)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常(chang)可(ke)發(fa)(fa)(fa)(fa)(fa)生(sheng)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)(cu)(cu)(cu)死(si)，尤其(qi)(qi)在(zai)(zai)(zai)(zai)患(huan)有(you)嚴(yan)重器質(zhi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)病(bing)的(de)(de)(de)老年(nian)患(huan)者(zhe)(zhe)。目前(qian)(qian)，室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)期前(qian)(qian)收(shou)(shou)縮(suo)(suo)在(zai)(zai)(zai)(zai)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)(cu)(cu)(cu)死(si)中的(de)(de)(de)意(yi)義(yi)尚存(cun)爭(zheng)議。有(you)些學(xue)者(zhe)(zhe)發(fa)(fa)(fa)(fa)(fa)現(xian)(xian)，室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)期前(qian)(qian)收(shou)(shou)縮(suo)(suo)并(bing)不能(neng)增加(jia)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)(cu)(cu)(cu)死(si)的(de)(de)(de)發(fa)(fa)(fa)(fa)(fa)生(sheng)率(lv)，尤其(qi)(qi)是(shi)無明顯(xian)器質(zhi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)病(bing)基礎的(de)(de)(de)單純性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)期前(qian)(qian)收(shou)(shou)縮(suo)(suo)。但也(ye)有(you)一(yi)(yi)些研究提示，室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)期前(qian)(qian)收(shou)(shou)縮(suo)(suo)本身即是(shi)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)(cu)(cu)(cu)死(si)的(de)(de)(de)危險因素，特別(bie)是(shi)嚴(yan)重的(de)(de)(de)冠狀動脈病(bing)變或(huo)(huo)(huo)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)肌梗(geng)死(si)后的(de)(de)(de)患(huan)者(zhe)(zhe)，頻發(fa)(fa)(fa)(fa)(fa)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)期前(qian)(qian)收(shou)(shou)縮(suo)(suo)對心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)(cu)(cu)(cu)死(si)的(de)(de)(de)發(fa)(fa)(fa)(fa)(fa)生(sheng)具有(you)一(yi)(yi)定的(de)(de)(de)意(yi)義(yi)，特別(bie)是(shi)合并(bing)有(you)左(zuo)(zuo)(zuo)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)肥厚、室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)內(nei)傳(chuan)導(dao)阻滯和ST-T改變者(zhe)(zhe)。而室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)動過速(su)(su)在(zai)(zai)(zai)(zai)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)(cu)(cu)(cu)死(si)中的(de)(de)(de)意(yi)義(yi)比室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)期前(qian)(qian)收(shou)(shou)縮(suo)(suo)為(wei)大(da)。在(zai)(zai)(zai)(zai)臨床中，我們常(chang)把(ba)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)速(su)(su)或(huo)(huo)(huo)成對、多(duo)源(yuan)及頻發(fa)(fa)(fa)(fa)(fa)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)期前(qian)(qian)收(shou)(shou)縮(suo)(suo)稱為(wei)復雜(za)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常(chang)。Morganroth根據復雜(za)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常(chang)引起心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)(cu)(cu)(cu)死(si)的(de)(de)(de)危險程度，將復雜(za)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常(chang)分為(wei)良(liang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)占(zhan)30%，其(qi)(qi)左(zuo)(zuo)(zuo)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)功(gong)(gong)(gong)能(neng)和血(xue)流(liu)動力(li)學(xue)均(jun)正(zheng)常(chang)，發(fa)(fa)(fa)(fa)(fa)生(sheng)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)(cu)(cu)(cu)死(si)的(de)(de)(de)危險性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)極小；潛(qian)在(zai)(zai)(zai)(zai)惡性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)占(zhan)65%，心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)結構輕度異常(chang)，有(you)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)功(gong)(gong)(gong)能(neng)不全和室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)異位(wei)激動，如室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)期前(qian)(qian)收(shou)(shou)縮(suo)(suo)和(或(huo)(huo)(huo))非持續(xu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)速(su)(su)，無血(xue)流(liu)動力(li)學(xue)障礙，但心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)(cu)(cu)(cu)死(si)的(de)(de)(de)危險性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)增加(jia)；惡性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常(chang)占(zhan)5%，幾乎都有(you)血(xue)流(liu)動力(li)學(xue)表(biao)現(xian)(xian)和體征(zheng)(zheng)(暈(yun)厥，心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)功(gong)(gong)(gong)能(neng)不全，心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)肌缺血(xue)或(huo)(huo)(huo)低血(xue)壓(ya))其(qi)(qi)發(fa)(fa)(fa)(fa)(fa)生(sheng)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)(cu)(cu)(cu)死(si)的(de)(de)(de)危險性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)最(zui)大(da)。臨床上常(chang)見5種類(lei)型：①心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)率(lv)&ge；230bpm的(de)(de)(de)持續(xu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)單形(xing)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)速(su)(su)。②心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)率(lv)逐漸加(jia)速(su)(su)的(de)(de)(de)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)速(su)(su)或(huo)(huo)(huo)可(ke)蛻變為(wei)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)撲和(或(huo)(huo)(huo))室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)顫(zhan)(zhan)趨勢(shi)者(zhe)(zhe)。③室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)速(su)(su)伴嚴(yan)重血(xue)流(liu)動力(li)學(xue)障礙如暈(yun)厥，左(zuo)(zuo)(zuo)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)功(gong)(gong)(gong)能(neng)不全和低血(xue)壓(ya)。④多(duo)形(xing)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(包括(kuo)長Q-T綜(zong)合征(zheng)(zheng)合并(bing)的(de)(de)(de)尖端扭轉型)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)速(su)(su)。⑤室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)撲和(或(huo)(huo)(huo))室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)顫(zhan)(zhan)起始心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常(chang)即為(wei)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)撲和(或(huo)(huo)(huo))室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)顫(zhan)(zhan)(如特發(fa)(fa)(fa)(fa)(fa)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)顫(zhan)(zhan)，Brugada綜(zong)合征(zheng)(zheng))。臨床表(biao)現(xian)(xian)為(wei)阿-斯綜(zong)合征(zheng)(zheng)發(fa)(fa)(fa)(fa)(fa)作。而由心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)電圖證實的(de)(de)(de)大(da)多(duo)數心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)(cu)(cu)(cu)死(si)發(fa)(fa)(fa)(fa)(fa)作(65%～85%)是(shi)由心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)顫(zhan)(zhan)動之類(lei)的(de)(de)(de)惡性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常(chang)所致。但緩(huan)慢性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常(chang)也(ye)可(ke)能(neng)是(shi)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)(cu)(cu)(cu)死(si)的(de)(de)(de)潛(qian)在(zai)(zai)(zai)(zai)原因，并(bing)可(ke)能(neng)在(zai)(zai)(zai)(zai)記錄到緩(huan)慢性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常(chang)之前(qian)(qian)就已(yi)轉變為(wei)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)室(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)(shi)顫(zhan)(zhan)動。
預激綜合征(zheng)患(huan)(huan)者(zhe)并發房室(shi)折(zhe)返(fan)性(xing)心(xin)(xin)動過速、心(xin)(xin)房顫動等快速性(xing)心(xin)(xin)律失常者(zhe)占(zhan)40%～80%。但發生心(xin)(xin)臟(zang)性(xing)猝(cu)死(si)(si)的危險性(xing)較低，有調查在4%以下，老年(nian)患(huan)(huan)者(zhe)也(ye)未(wei)見心(xin)(xin)臟(zang)性(xing)猝(cu)死(si)(si)增(zeng)加(jia)的報道。
（5）其他
糖尿病除了增加(jia)冠心病的發(fa)生率外，本身也可(ke)損傷心肌而增加(jia)心臟性猝死(si)的發(fa)生率。尤其(qi)女(nv)性患者的心臟性猝死(si)發(fa)生率增加(jia)更明顯，較同年齡組而無糖尿病的患者增加(jia)3倍。
目前(qian)已知，發生心(xin)(xin)臟性猝死的(de)(de)機制主要(yao)為(wei)嚴(yan)重的(de)(de)室(shi)性心(xin)(xin)律失常，包(bao)括室(shi)性心(xin)(xin)動(dong)過速，心(xin)(xin)室(shi)顫動(dong)等。也有一部分人為(wei)突然發生的(de)(de)嚴(yan)重血流動(dong)力學障礙，心(xin)(xin)臟破裂(lie)等。
一般(ban)認為，心室顫(zhan)動(dong)是多發的(de)(de)折返小波引起的(de)(de)持續性快而(er)不規則的(de)(de)心室激動(dong)。心室顫(zhan)動(dong)的(de)(de)發生必需包括以下幾個(ge)基本條件(jian)，即異步和分離的(de)(de)局部波前(qian)興奮，傳導延緩和心室不應期(qi)縮短。這(zhe)些變化(hua)，在缺(que)血的(de)(de)心肌中均可(ke)出現。
（1）缺(que)血性(xing)(xing)(xing)室(shi)(shi)性(xing)(xing)(xing)心(xin)(xin)律(lv)(lv)(lv)失(shi)(shi)常(chang)：包(bao)括急性(xing)(xing)(xing)心(xin)(xin)肌(ji)缺(que)血所致(zhi)的(de)(de)室(shi)(shi)性(xing)(xing)(xing)心(xin)(xin)律(lv)(lv)(lv)失(shi)(shi)常(chang)和心(xin)(xin)肌(ji)梗死后陳舊性(xing)(xing)(xing)病變并(bing)(bing)發(fa)的(de)(de)室(shi)(shi)性(xing)(xing)(xing)心(xin)(xin)律(lv)(lv)(lv)失(shi)(shi)常(chang)。如果急性(xing)(xing)(xing)心(xin)(xin)肌(ji)缺(que)血發(fa)生(sheng)在(zai)心(xin)(xin)肌(ji)梗死后瘢痕(hen)愈合的(de)(de)邊(bian)緣心(xin)(xin)肌(ji)，則(ze)室(shi)(shi)性(xing)(xing)(xing)心(xin)(xin)律(lv)(lv)(lv)失(shi)(shi)常(chang)的(de)(de)發(fa)生(sheng)率更高(gao)(gao)。在(zai)急性(xing)(xing)(xing)心(xin)(xin)肌(ji)缺(que)血時，局部(bu)心(xin)(xin)肌(ji)組(zu)織(zhi)灌注不足，導(dao)致(zhi)缺(que)血部(bu)位(wei)的(de)(de)心(xin)(xin)肌(ji)能量(liang)(liang)代謝較正(zheng)常(chang)心(xin)(xin)肌(ji)組(zu)織(zhi)明顯(xian)降(jiang)(jiang)低(di)(di)，大量(liang)(liang)游離脂肪酸(FFA)堆積(ji)，細胞(bao)內乳酸含量(liang)(liang)增(zeng)(zeng)加，細胞(bao)內鉀(jia)、鎂離子外流，則(ze)靜息電(dian)(dian)位(wei)的(de)(de)負值進一步增(zeng)(zeng)加，形成(cheng)舒張期電(dian)(dian)位(wei)。同(tong)時，動作電(dian)(dian)位(wei)的(de)(de)振幅下降(jiang)(jiang)，去極(ji)化的(de)(de)速(su)度減(jian)慢，興奮傳導(dao)速(su)度減(jian)慢，則(ze)心(xin)(xin)肌(ji)自律(lv)(lv)(lv)性(xing)(xing)(xing)增(zeng)(zeng)強，并(bing)(bing)易于(yu)形成(cheng)折(zhe)返(fan)的(de)(de)條件而(er)發(fa)生(sheng)室(shi)(shi)性(xing)(xing)(xing)折(zhe)返(fan)性(xing)(xing)(xing)心(xin)(xin)律(lv)(lv)(lv)失(shi)(shi)常(chang)及心(xin)(xin)室(shi)(shi)顫動。而(er)同(tong)時存(cun)在(zai)左心(xin)(xin)功能不全的(de)(de)患者，心(xin)(xin)臟性(xing)(xing)(xing)猝(cu)死的(de)(de)發(fa)生(sheng)率則(ze)更高(gao)(gao)，尤其左室(shi)(shi)射血分數低(di)(di)于(yu)30%是心(xin)(xin)臟性(xing)(xing)(xing)猝(cu)死的(de)(de)最強的(de)(de)預測因素。
現(xian)已知(zhi)再(zai)(zai)(zai)(zai)(zai)灌(guan)注(zhu)(zhu)(zhu)(zhu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失常(chang)(chang)(chang)(chang)(chang)是(shi)發(fa)(fa)(fa)生(sheng)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)死(si)的(de)(de)重要(yao)機(ji)制。再(zai)(zai)(zai)(zai)(zai)灌(guan)注(zhu)(zhu)(zhu)(zhu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)室(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失常(chang)(chang)(chang)(chang)(chang)可(ke)(ke)(ke)見于(yu)(yu)冠(guan)狀動(dong)(dong)(dong)脈(mo)痙攣緩解以后(hou)(hou)，也(ye)可(ke)(ke)(ke)見于(yu)(yu)急性(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)肌梗(geng)死(si)溶栓治療或機(ji)械性(xing)(xing)(xing)(xing)(xing)(xing)(xing)粉碎斑塊后(hou)(hou)使完全(quan)閉(bi)塞的(de)(de)血(xue)(xue)管再(zai)(zai)(zai)(zai)(zai)通(tong)(tong)(tong)等(deng)情況。常(chang)(chang)(chang)(chang)(chang)在(zai)(zai)冠(guan)狀動(dong)(dong)(dong)脈(mo)再(zai)(zai)(zai)(zai)(zai)通(tong)(tong)(tong)后(hou)(hou)幾(ji)秒鐘(zhong)而出現(xian)再(zai)(zai)(zai)(zai)(zai)灌(guan)注(zhu)(zhu)(zhu)(zhu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失常(chang)(chang)(chang)(chang)(chang)。許多研(yan)究(jiu)表明，冠(guan)狀動(dong)(dong)(dong)脈(mo)再(zai)(zai)(zai)(zai)(zai)通(tong)(tong)(tong)時，再(zai)(zai)(zai)(zai)(zai)灌(guan)注(zhu)(zhu)(zhu)(zhu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失常(chang)(chang)(chang)(chang)(chang)的(de)(de)發(fa)(fa)(fa)生(sheng)率高達82%。在(zai)(zai)再(zai)(zai)(zai)(zai)(zai)灌(guan)注(zhu)(zhu)(zhu)(zhu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失常(chang)(chang)(chang)(chang)(chang)的(de)(de)不同類型中60%～80%為加速(su)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)室(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)自(zi)主心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)和室(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)期前收縮(suo)，可(ke)(ke)(ke)引(yin)起(qi)(qi)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)死(si)的(de)(de)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失常(chang)(chang)(chang)(chang)(chang)為室(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)動(dong)(dong)(dong)過速(su)和心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)室(shi)(shi)顫動(dong)(dong)(dong)，嚴重的(de)(de)緩慢性(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失常(chang)(chang)(chang)(chang)(chang)也(ye)可(ke)(ke)(ke)引(yin)起(qi)(qi)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)死(si)。而再(zai)(zai)(zai)(zai)(zai)灌(guan)注(zhu)(zhu)(zhu)(zhu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失常(chang)(chang)(chang)(chang)(chang)的(de)(de)類型和冠(guan)狀動(dong)(dong)(dong)脈(mo)的(de)(de)再(zai)(zai)(zai)(zai)(zai)通(tong)(tong)(tong)部位(wei)有一定的(de)(de)關系。左前降(jiang)支(zhi)和左旋(xuan)支(zhi)再(zai)(zai)(zai)(zai)(zai)灌(guan)注(zhu)(zhu)(zhu)(zhu)時易(yi)發(fa)(fa)(fa)生(sheng)加速(su)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)室(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)自(zi)主心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)，室(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)動(dong)(dong)(dong)過速(su)和心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)室(shi)(shi)顫動(dong)(dong)(dong)。右冠(guan)狀動(dong)(dong)(dong)脈(mo)阻塞再(zai)(zai)(zai)(zai)(zai)灌(guan)注(zhu)(zhu)(zhu)(zhu)時易(yi)發(fa)(fa)(fa)生(sheng)竇性(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)動(dong)(dong)(dong)過緩，房室(shi)(shi)傳導(dao)阻滯(zhi)。實(shi)驗研(yan)究(jiu)提示，再(zai)(zai)(zai)(zai)(zai)灌(guan)注(zhu)(zhu)(zhu)(zhu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失常(chang)(chang)(chang)(chang)(chang)的(de)(de)發(fa)(fa)(fa)生(sheng)機(ji)制包括觸(chu)(chu)發(fa)(fa)(fa)激(ji)動(dong)(dong)(dong)、折返(fan)(fan)(fan)激(ji)動(dong)(dong)(dong)和異位(wei)自(zi)律(lv)(lv)(lv)(lv)(lv)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)增(zeng)高。目前多數學者認為，觸(chu)(chu)發(fa)(fa)(fa)激(ji)動(dong)(dong)(dong)在(zai)(zai)再(zai)(zai)(zai)(zai)(zai)灌(guan)注(zhu)(zhu)(zhu)(zhu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失常(chang)(chang)(chang)(chang)(chang)的(de)(de)發(fa)(fa)(fa)生(sheng)中占據重要(yao)位(wei)置。而折返(fan)(fan)(fan)機(ji)制的(de)(de)產(chan)生(sheng)可(ke)(ke)(ke)能與再(zai)(zai)(zai)(zai)(zai)灌(guan)注(zhu)(zhu)(zhu)(zhu)后(hou)(hou)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)肌細(xi)(xi)胞電(dian)生(sheng)理恢復不均(jun)勻有關。心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)肌缺血(xue)(xue)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)損傷使心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)肌細(xi)(xi)胞的(de)(de)電(dian)生(sheng)理改變不均(jun)勻，血(xue)(xue)管再(zai)(zai)(zai)(zai)(zai)通(tong)(tong)(tong)后(hou)(hou)的(de)(de)再(zai)(zai)(zai)(zai)(zai)灌(guan)注(zhu)(zhu)(zhu)(zhu)使血(xue)(xue)流(liu)(liu)恢復，但恢復血(xue)(xue)流(liu)(liu)后(hou)(hou)的(de)(de)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)肌細(xi)(xi)胞血(xue)(xue)液供應(ying)和代謝恢復也(ye)不均(jun)勻，結(jie)果導(dao)致(zhi)缺血(xue)(xue)區內心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)肌應(ying)激(ji)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)的(de)(de)恢復程(cheng)度(du)不一致(zhi)，則易(yi)于(yu)(yu)形成折返(fan)(fan)(fan)而引(yin)起(qi)(qi)室(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)動(dong)(dong)(dong)過速(su)和(或)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)室(shi)(shi)顫動(dong)(dong)(dong)。此(ci)外(wai)，心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)肌缺血(xue)(xue)-再(zai)(zai)(zai)(zai)(zai)灌(guan)注(zhu)(zhu)(zhu)(zhu)損傷也(ye)可(ke)(ke)(ke)引(yin)起(qi)(qi)異位(wei)興(xing)奮灶的(de)(de)自(zi)律(lv)(lv)(lv)(lv)(lv)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)增(zeng)加，引(yin)起(qi)(qi)室(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失常(chang)(chang)(chang)(chang)(chang)。Pogwizd等(deng)用心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)三維標測技術研(yan)究(jiu)表明，75%的(de)(de)再(zai)(zai)(zai)(zai)(zai)灌(guan)注(zhu)(zhu)(zhu)(zhu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失常(chang)(chang)(chang)(chang)(chang)是(shi)由觸(chu)(chu)發(fa)(fa)(fa)激(ji)動(dong)(dong)(dong)引(yin)起(qi)(qi)的(de)(de)，25%的(de)(de)再(zai)(zai)(zai)(zai)(zai)灌(guan)注(zhu)(zhu)(zhu)(zhu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失常(chang)(chang)(chang)(chang)(chang)是(shi)由折返(fan)(fan)(fan)機(ji)制引(yin)起(qi)(qi)。
病(bing)因不明(ming)，無明(ming)顯(xian)冠狀動脈或(huo)心(xin)肌本(ben)身的病(bing)變，常常突然或(huo)在某(mou)些誘(you)因的作用下發(fa)(fa)(fa)生嚴重的室性(xing)心(xin)律(lv)(lv)失常和(或(huo))心(xin)室顫動，而發(fa)(fa)(fa)生心(xin)臟性(xing)猝(cu)死。研究(jiu)表明(ming)，原發(fa)(fa)(fa)性(xing)室性(xing)心(xin)律(lv)(lv)失常的發(fa)(fa)(fa)生機制多為觸發(fa)(fa)(fa)激動，也有的為折返機制。
Raizes等研究表明，非心(xin)(xin)(xin)(xin)(xin)律(lv)失(shi)常(chang)(chang)引(yin)起的(de)心(xin)(xin)(xin)(xin)(xin)臟(zang)性(xing)猝死(si)只(zhi)占0.56%，包括心(xin)(xin)(xin)(xin)(xin)臟(zang)或主動(dong)脈破裂，心(xin)(xin)(xin)(xin)(xin)肌(ji)(ji)梗死(si)擴(kuo)展，交感神經(jing)反射性(xing)抑制(zhi)，以及各種原因引(yin)起的(de)心(xin)(xin)(xin)(xin)(xin)臟(zang)嚴重的(de)機械性(xing)梗阻(zu)等。尤其伴(ban)(ban)有(you)左心(xin)(xin)(xin)(xin)(xin)功(gong)(gong)(gong)能(neng)(neng)不(bu)(bu)(bu)全(quan)(quan)的(de)患(huan)者心(xin)(xin)(xin)(xin)(xin)臟(zang)性(xing)猝死(si)的(de)發生率最高。左心(xin)(xin)(xin)(xin)(xin)功(gong)(gong)(gong)能(neng)(neng)不(bu)(bu)(bu)全(quan)(quan)又常(chang)(chang)有(you)冠(guan)(guan)狀(zhuang)動(dong)脈病(bing)(bing)變(bian)和彌漫的(de)心(xin)(xin)(xin)(xin)(xin)肌(ji)(ji)病(bing)(bing)變(bian)，因而可伴(ban)(ban)有(you)急性(xing)心(xin)(xin)(xin)(xin)(xin)肌(ji)(ji)缺(que)血(xue)或心(xin)(xin)(xin)(xin)(xin)肌(ji)(ji)瘢痕組織所(suo)(suo)(suo)誘發的(de)惡性(xing)心(xin)(xin)(xin)(xin)(xin)律(lv)失(shi)常(chang)(chang)，從而導致(zhi)心(xin)(xin)(xin)(xin)(xin)臟(zang)性(xing)猝死(si)。在(zai)冠(guan)(guan)心(xin)(xin)(xin)(xin)(xin)病(bing)(bing)合并(bing)左心(xin)(xin)(xin)(xin)(xin)室功(gong)(gong)(gong)能(neng)(neng)不(bu)(bu)(bu)全(quan)(quan)致(zhi)心(xin)(xin)(xin)(xin)(xin)臟(zang)性(xing)猝死(si)事件(jian)(jian)中(zhong)，36%表現為(wei)嚴重心(xin)(xin)(xin)(xin)(xin)動(dong)過緩或電-機械分離。心(xin)(xin)(xin)(xin)(xin)臟(zang)驟停前(qian)并(bing)未伴(ban)(ban)心(xin)(xin)(xin)(xin)(xin)力衰竭癥狀(zhuang)的(de)惡化。緩慢性(xing)心(xin)(xin)(xin)(xin)(xin)律(lv)失(shi)常(chang)(chang)或電-機械分離可能(neng)(neng)因左室收縮(suo)(suo)功(gong)(gong)(gong)能(neng)(neng)衰竭終末期心(xin)(xin)(xin)(xin)(xin)室壁應激時使心(xin)(xin)(xin)(xin)(xin)室內壓力和容量突然(ran)增(zeng)加(jia)，而周(zhou)圍血(xue)管收縮(suo)(suo)同時出現障(zhang)礙，不(bu)(bu)(bu)能(neng)(neng)維持體循環(huan)血(xue)壓，以至虛脫和暈厥。猝死(si)則為(wei)血(xue)流(liu)動(dong)力學障(zhang)礙所(suo)(suo)(suo)致(zhi)，并(bing)非心(xin)(xin)(xin)(xin)(xin)電不(bu)(bu)(bu)穩(wen)定事件(jian)(jian)。另一部分左心(xin)(xin)(xin)(xin)(xin)功(gong)(gong)(gong)能(neng)(neng)不(bu)(bu)(bu)全(quan)(quan)的(de)患(huan)者伴(ban)(ban)有(you)室性(xing)心(xin)(xin)(xin)(xin)(xin)動(dong)過速，則可能(neng)(neng)為(wei)心(xin)(xin)(xin)(xin)(xin)律(lv)失(shi)常(chang)(chang)所(suo)(suo)(suo)致(zhi)。
（2）心臟(zang)性猝死后的病生理變化
原發(fa)(fa)(fa)性(xing)(xing)(xing)改變：心(xin)(xin)(xin)(xin)臟(zang)性(xing)(xing)(xing)猝死(si)的(de)(de)(de)心(xin)(xin)(xin)(xin)臟(zang)病(bing)理(li)改變資料主(zhu)要(yao)來自尸(shi)體解剖。但不(bu)同學者(zhe)所(suo)報道(dao)的(de)(de)(de)尸(shi)體解剖病(bing)理(li)結果(guo)有(you)(you)很大的(de)(de)(de)不(bu)一致，且多數(shu)學者(zhe)研究為(wei)冠(guan)(guan)(guan)心(xin)(xin)(xin)(xin)病(bing)猝死(si)。從冠(guan)(guan)(guan)心(xin)(xin)(xin)(xin)病(bing)猝死(si)的(de)(de)(de)病(bing)理(li)資料來看(kan)，主(zhu)要(yao)病(bing)理(li)結果(guo)為(wei)冠(guan)(guan)(guan)狀(zhuang)動(dong)(dong)脈(mo)狹窄(zhai)程(cheng)度重(zhong)，冠(guan)(guan)(guan)狀(zhuang)動(dong)(dong)脈(mo)內并(bing)發(fa)(fa)(fa)血(xue)栓(shuan)(shuan)形成，心(xin)(xin)(xin)(xin)肌出現嚴重(zhong)的(de)(de)(de)缺(que)血(xue)或梗(geng)死(si)。Schwartz等發(fa)(fa)(fa)現，1/3以上的(de)(de)(de)冠(guan)(guan)(guan)心(xin)(xin)(xin)(xin)病(bing)猝死(si)患者(zhe)的(de)(de)(de)冠(guan)(guan)(guan)狀(zhuang)動(dong)(dong)脈(mo)內有(you)(you)血(xue)栓(shuan)(shuan)形成。國內外的(de)(de)(de)一些資料提(ti)示：冠(guan)(guan)(guan)心(xin)(xin)(xin)(xin)病(bing)猝死(si)患者(zhe)中急性(xing)(xing)(xing)心(xin)(xin)(xin)(xin)肌梗(geng)死(si)的(de)(de)(de)發(fa)(fa)(fa)生(sheng)率約為(wei)40%，并(bing)且冠(guan)(guan)(guan)心(xin)(xin)(xin)(xin)病(bing)猝死(si)患者(zhe)的(de)(de)(de)竇(dou)房結和(he)傳導系統并(bing)無明(ming)顯(xian)(xian)的(de)(de)(de)急性(xing)(xing)(xing)病(bing)變，亦證實(shi)了冠(guan)(guan)(guan)心(xin)(xin)(xin)(xin)病(bing)猝死(si)的(de)(de)(de)發(fa)(fa)(fa)生(sheng)機(ji)制為(wei)心(xin)(xin)(xin)(xin)電不(bu)穩定所(suo)致。心(xin)(xin)(xin)(xin)臟(zang)性(xing)(xing)(xing)猝死(si)很少(shao)發(fa)(fa)(fa)生(sheng)在(zai)沒(mei)有(you)(you)器質(zhi)(zhi)性(xing)(xing)(xing)心(xin)(xin)(xin)(xin)臟(zang)病(bing)的(de)(de)(de)患者(zhe)。有(you)(you)些患者(zhe)發(fa)(fa)(fa)生(sheng)心(xin)(xin)(xin)(xin)臟(zang)性(xing)(xing)(xing)猝死(si)后(hou)，即(ji)使(shi)心(xin)(xin)(xin)(xin)臟(zang)的(de)(de)(de)大體檢查(cha)無明(ming)顯(xian)(xian)肉(rou)眼病(bing)變，但可能其心(xin)(xin)(xin)(xin)臟(zang)的(de)(de)(de)分(fen)子(zi)(zi)結構(gou)和(he)功能也存在(zai)著明(ming)顯(xian)(xian)的(de)(de)(de)異常(chang)。如離子(zi)(zi)通道(dao)、蛋白質(zhi)(zhi)結構(gou)異常(chang)等。
繼發性改變：正常(chang)心(xin)(xin)臟做功所需能量(liang)首(shou)先來自脂肪(fang)，約占心(xin)(xin)肌(ji)(ji)總(zong)耗氧(yang)量(liang)的(de)67%，其次來自葡萄糖和(he)乳酸，分別占17.9%和(he)16.46%，極(ji)少(shao)數來自醋酸、氨基(ji)酸、丙酮酸等。同時心(xin)(xin)臟必(bi)須(xu)依賴ATP來維持(chi)其心(xin)(xin)室壁(bi)的(de)張(zhang)力和(he)收(shou)(shou)縮狀態。研(yan)究(jiu)表(biao)明，心(xin)(xin)肌(ji)(ji)缺血(xue)缺氧(yang)10s即(ji)可代(dai)謝底物耗竭，心(xin)(xin)臟即(ji)完全失(shi)去收(shou)(shou)縮功能。在常(chang)溫下，如(ru)果心(xin)(xin)肌(ji)(ji)缺血(xue)3～4min，心(xin)(xin)肌(ji)(ji)內(nei)(nei)磷酸肌(ji)(ji)酸含(han)量(liang)減(jian)少(shao)70%～75%，ATP減(jian)少(shao)15%。如(ru)在此期內(nei)(nei)進(jin)行有(you)效的(de)心(xin)(xin)肺(fei)復(fu)蘇，心(xin)(xin)肌(ji)(ji)供血(xue)改善，則心(xin)(xin)肌(ji)(ji)張(zhang)力可完全恢復(fu)；缺血(xue)8～10min，心(xin)(xin)肌(ji)(ji)內(nei)(nei)磷酸肌(ji)(ji)酸和(he)ATP將全部(bu)耗盡，如(ru)在此期內(nei)(nei)進(jin)行有(you)效的(de)心(xin)(xin)肺(fei)復(fu)蘇，心(xin)(xin)臟的(de)收(shou)(shou)縮和(he)舒(shu)張(zhang)功能仍(reng)可恢復(fu)，10min后(hou)才進(jin)行有(you)效的(de)心(xin)(xin)肺(fei)復(fu)蘇者，復(fu)蘇的(de)成功機會顯著減(jian)少(shao)。
腦(nao)(nao)：腦(nao)(nao)的能(neng)(neng)(neng)量代(dai)(dai)謝(xie)(xie)主要來(lai)自葡萄糖，但腦(nao)(nao)組(zu)織本身對葡萄糖的儲備很少(shao)，必須依賴于循(xun)環血(xue)(xue)液(ye)來(lai)供應(ying)(ying)。并且腦(nao)(nao)組(zu)織的代(dai)(dai)謝(xie)(xie)85%～90%為有氧(yang)代(dai)(dai)謝(xie)(xie)，而無氧(yang)酵解(jie)只占腦(nao)(nao)組(zu)織代(dai)(dai)謝(xie)(xie)的5%～15%，所以，腦(nao)(nao)組(zu)織的代(dai)(dai)謝(xie)(xie)和(he)生(sheng)理(li)功能(neng)(neng)(neng)的維(wei)持則完(wan)全(quan)(quan)(quan)依賴于有效(xiao)的血(xue)(xue)液(ye)供應(ying)(ying)。血(xue)(xue)液(ye)供應(ying)(ying)障(zhang)礙(ai)引起(qi)(qi)腦(nao)(nao)細(xi)胞(bao)功能(neng)(neng)(neng)的改(gai)(gai)變的基礎是缺血(xue)(xue)缺氧(yang)引起(qi)(qi)腦(nao)(nao)組(zu)織的原(yuan)發(fa)(fa)和(he)繼發(fa)(fa)損(sun)害。原(yuan)發(fa)(fa)損(sun)害為腦(nao)(nao)組(zu)織缺血(xue)(xue)缺氧(yang)時，ATP不(bu)(bu)能(neng)(neng)(neng)合成，細(xi)胞(bao)鈉泵(beng)功能(neng)(neng)(neng)喪失(shi)(shi)，細(xi)胞(bao)內(nei)鈉離子(zi)不(bu)(bu)能(neng)(neng)(neng)轉運(yun)到細(xi)胞(bao)外(wai)，鉀離子(zi)不(bu)(bu)能(neng)(neng)(neng)從細(xi)胞(bao)內(nei)逸出，細(xi)胞(bao)膜電(dian)(dian)位發(fa)(fa)生(sheng)改(gai)(gai)變，因(yin)此不(bu)(bu)能(neng)(neng)(neng)產生(sheng)電(dian)(dian)活動(dong)，細(xi)胞(bao)也失(shi)(shi)去了(le)產生(sheng)和(he)傳(chuan)導沖動(dong)的功能(neng)(neng)(neng)。研究表(biao)明，在(zai)完(wan)全(quan)(quan)(quan)缺氧(yang)情況下，20s后大腦(nao)(nao)皮質的生(sheng)物電(dian)(dian)活動(dong)完(wan)全(quan)(quan)(quan)消失(shi)(shi)，30～90s后小(xiao)腦(nao)(nao)和(he)延髓的生(sheng)物電(dian)(dian)活動(dong)完(wan)全(quan)(quan)(quan)消失(shi)(shi)。而缺血(xue)(xue)缺氧(yang)所致的繼發(fa)(fa)損(sun)害包(bao)括兩個方面：
A.細(xi)胞內電解質紊亂和(he)各種代謝產(chan)物的堆積而使腦組織腫(zhong)脹(zhang)和(he)腦水腫(zhong)。
B.腦(nao)(nao)(nao)組(zu)織(zhi)(zhi)(zhi)的(de)局部(bu)循環(huan)功(gong)能(neng)(neng)障礙進一步加重。已(yi)有研究(jiu)提示，心(xin)臟驟停(ting)引起的(de)腦(nao)(nao)(nao)組(zu)織(zhi)(zhi)(zhi)缺(que)血(xue)缺(que)氧(yang)時(shi)，病變(bian)主要在大腦(nao)(nao)(nao)海馬回先出現，如(ru)(ru)缺(que)血(xue)進一步加重，則迅(xun)速波及全腦(nao)(nao)(nao)，包括腦(nao)(nao)(nao)干和延髓。而患者發生(sheng)心(xin)臟性猝死(si)后，如(ru)(ru)果(guo)能(neng)(neng)及時(shi)、有效地進行心(xin)肺復蘇，則腦(nao)(nao)(nao)組(zu)織(zhi)(zhi)(zhi)的(de)血(xue)流有可能(neng)(neng)恢復，但腦(nao)(nao)(nao)組(zu)織(zhi)(zhi)(zhi)由于受到(dao)完全缺(que)血(xue)缺(que)氧(yang)的(de)影響(xiang)，腦(nao)(nao)(nao)水腫和微循環(huan)障礙將繼續發展。腦(nao)(nao)(nao)組(zu)織(zhi)(zhi)(zhi)的(de)缺(que)血(xue)缺(que)氧(yang)時(shi)間(jian)長短(duan)直(zhi)接影響(xiang)大腦(nao)(nao)(nao)功(gong)能(neng)(neng)的(de)恢復及患者的(de)臨床預后。
腎：
心臟驟停時，腎(shen)臟的(de)(de)血流供應和濾過功能完全停止。首先受累的(de)(de)是腎(shen)小(xiao)管(guan)，引起腎(shen)小(xiao)管(guan)細胞壞死，并(bing)逐步累及(ji)基(ji)底膜及(ji)整個腎(shen)單位。如果(guo)發(fa)生(sheng)時間(jian)短，基(ji)底膜可保(bao)持相對完整，腎(shen)臟功能可恢(hui)復，但缺血缺氧的(de)(de)時間(jian)過長，腎(shen)小(xiao)管(guan)及(ji)腎(shen)小(xiao)球產(chan)生(sheng)廣泛(fan)的(de)(de)嚴重破壞，則易發(fa)生(sheng)急性(xing)腎(shen)功能衰竭。
肺(fei)(fei)(fei)(fei)：發生(sheng)(sheng)心臟性猝死后，肺(fei)(fei)(fei)(fei)可(ke)發生(sheng)(sheng)淤(yu)血(xue)(xue)、水腫。顯微鏡下其主要特(te)征是肺(fei)(fei)(fei)(fei)間質(zhi)水腫，并可(ke)見微血(xue)(xue)栓形成。長時間的肺(fei)(fei)(fei)(fei)缺(que)血(xue)(xue)缺(que)氧容易發生(sheng)(sheng)彌漫性血(xue)(xue)管內凝(ning)血(xue)(xue)，不僅可(ke)通(tong)過機械堵塞使(shi)肺(fei)(fei)(fei)(fei)部缺(que)血(xue)(xue)缺(que)氧進一步加重，而且(qie)還可(ke)引起血(xue)(xue)小板聚集(ji)，釋放5-HT等物質(zhi)產生(sheng)(sheng)終(zhong)末氣(qi)道痙攣，結果血(xue)(xue)液-氣(qi)體(ti)交換障礙進一步惡化。
（3）與心臟性猝死(si)發生(sheng)的相關因(yin)素
自主(zhu)神(shen)經(jing)(jing)系統在(zai)心(xin)(xin)(xin)(xin)臟(zang)(zang)性(xing)(xing)(xing)(xing)猝(cu)死的(de)(de)(de)(de)發(fa)生(sheng)中具有重要作用(yong)。臨床觀察發(fa)現(xian)，冠心(xin)(xin)(xin)(xin)病患者的(de)(de)(de)(de)心(xin)(xin)(xin)(xin)臟(zang)(zang)性(xing)(xing)(xing)(xing)猝(cu)死常發(fa)生(sheng)在(zai)凌晨至午間這段(duan)(duan)時間，與(yu)(yu)自主(zhu)神(shen)經(jing)(jing)活動(dong)(dong)的(de)(de)(de)(de)晝夜節律性(xing)(xing)(xing)(xing)變化相一致。此時間段(duan)(duan)，交(jiao)感神(shen)經(jing)(jing)活動(dong)(dong)較高(gao)，血(xue)壓(ya)與(yu)(yu)心(xin)(xin)(xin)(xin)率(lv)增加(jia)，血(xue)小板聚集性(xing)(xing)(xing)(xing)也增加(jia)。實驗(yan)研究(jiu)表(biao)明，刺激心(xin)(xin)(xin)(xin)臟(zang)(zang)的(de)(de)(de)(de)交(jiao)感神(shen)經(jing)(jing)可降低室(shi)(shi)(shi)顫(zhan)閾值，增加(jia)室(shi)(shi)(shi)顫(zhan)發(fa)生(sheng)的(de)(de)(de)(de)危(wei)險(xian)(xian)性(xing)(xing)(xing)(xing)；刺激迷(mi)走神(shen)經(jing)(jing)，可降低室(shi)(shi)(shi)顫(zhan)發(fa)生(sheng)的(de)(de)(de)(de)危(wei)險(xian)(xian)性(xing)(xing)(xing)(xing)。所(suo)以交(jiao)感神(shen)經(jing)(jing)的(de)(de)(de)(de)過度(du)興(xing)(xing)奮(fen)可促(cu)進(jin)惡(e)性(xing)(xing)(xing)(xing)室(shi)(shi)(shi)性(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)律失常的(de)(de)(de)(de)發(fa)生(sheng)，而興(xing)(xing)奮(fen)迷(mi)走神(shen)經(jing)(jing)則具有保護(hu)心(xin)(xin)(xin)(xin)臟(zang)(zang)及(ji)抗室(shi)(shi)(shi)顫(zhan)的(de)(de)(de)(de)作用(yong)。但是，對(dui)下后(hou)壁(bi)急(ji)性(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)肌(ji)缺血(xue)或缺血(xue)性(xing)(xing)(xing)(xing)再(zai)灌(guan)注的(de)(de)(de)(de)患者，因迷(mi)走神(shen)經(jing)(jing)的(de)(de)(de)(de)傳入受體多數分(fen)布在(zai)心(xin)(xin)(xin)(xin)室(shi)(shi)(shi)的(de)(de)(de)(de)下后(hou)壁(bi)，該部(bu)位發(fa)生(sheng)心(xin)(xin)(xin)(xin)肌(ji)缺血(xue)或缺血(xue)后(hou)再(zai)灌(guan)注，可觸發(fa)Bezold-Jarish反射，導(dao)致或加(jia)重緩(huan)慢(man)性(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)律失常，如嚴(yan)重竇性(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)動(dong)(dong)過緩(huan)，高(gao)度(du)房室(shi)(shi)(shi)傳導(dao)阻滯(zhi)，周圍血(xue)管擴張和低血(xue)壓(ya)，嚴(yan)重者可發(fa)生(sheng)心(xin)(xin)(xin)(xin)臟(zang)(zang)驟停。
許多心(xin)臟(zang)性(xing)猝死的(de)患者發(fa)生(sheng)(sheng)在睡(shui)眠(mian)中。其(qi)機制主要為(wei)睡(shui)眠(mian)時迷走神(shen)經興奮，冠狀動脈痙攣(luan)，心(xin)臟(zang)傳導系統發(fa)生(sheng)(sheng)缺氧(yang)，心(xin)電不穩定，發(fa)生(sheng)(sheng)室顫而引起心(xin)臟(zang)性(xing)猝死。但目前尚未能提供冠狀動脈痙攣(luan)的(de)形態(tai)學依據(ju)。
（1）心臟病發作前(qian)，身體上例如頸、后(hou)背(bei)、頭皮、手心或者(zhe)腳(jiao)掌都會大(da)量(liang)出汗，此時應提高警惕，當心猝死發生，最(zui)好停止活動(dong)休息，及時服用藥物，必要時應立即撥打120。
（2）在無激烈運動(dong)、缺少睡眠或者生病等誘因(yin)的情況下，連(lian)續(xu)幾(ji)天、幾(ji)周(zhou)甚至幾(ji)月出現(xian)極度疲(pi)勞感，伴有焦(jiao)慮、失眠、無癥狀(zhuang)驚醒等癥狀(zhuang)，此(ci)時(shi)應考慮心臟出現(xian)問題。
（3）心臟病患者經常感到肩膀、頸部(bu)、下巴、手臂疼痛，這是心肌缺血的信(xin)號，因為心肌缺血疼痛在傳(chuan)遞至大腦中樞神經時，會同時反映(ying)在水平(ping)相同的脊髓段區域。
（4）心臟病發作前(qian)的典型癥狀是(shi)突然、或者無緣由(you)的心跳(tiao)加劇(ju)，一旦發生心室性心搏(bo)過速，則極(ji)有(you)可能在(zai)短(duan)時間(jian)內(nei)突然死亡。
（5）很多心(xin)源性猝死患者在(zai)死亡前(qian)都反復出現(xian)胃腸道癥狀，不少人生前(qian)并沒有(you)胃病病史，這(zhe)是心(xin)臟病發作的信號之一(yi)，腸胃不適是因(yin)為心(xin)血管出現(xian)異(yi)常(chang)。動脈(mo)由于(yu)脂肪沉積物(wu)堵塞將會減少甚至阻斷血液(ye)傳(chuan)輸給心(xin)臟，而這(zhe)會引起心(xin)絞(jiao)痛。
心(xin)(xin)臟(zang)性猝死的(de)(de)(de)(de)經過大體(ti)上(shang)可(ke)分為(wei)4 個時期。即前驅期，終末事件開始，心(xin)(xin)臟(zang)驟(zou)停和生(sheng)物(wu)學死亡。不同的(de)(de)(de)(de)患(huan)者各期表現(xian)(xian)也有(you)(you)明(ming)顯差異(yi)。在發生(sheng)心(xin)(xin)臟(zang)性猝死的(de)(de)(de)(de)前數天到數月，有(you)(you)些患(huan)者可(ke)出現(xian)(xian)心(xin)(xin)前區不適、心(xin)(xin)悸(ji)、氣(qi)短(duan)、乏力等(deng)非特(te)異(yi)性表現(xian)(xian)。但(dan)亦可(ke)無前驅表現(xian)(xian)，直接發生(sheng)心(xin)(xin)臟(zang)驟(zou)停。而有(you)(you)些報道佩帶(dai)動(dong)(dong)(dong)(dong)態心(xin)(xin)電(dian)圖的(de)(de)(de)(de)猝死患(huan)者，當時心(xin)(xin)電(dian)記錄多為(wei)心(xin)(xin)室顫動(dong)(dong)(dong)(dong)，說明(ming)心(xin)(xin)臟(zang)驟(zou)停時多為(wei)心(xin)(xin)室顫動(dong)(dong)(dong)(dong)。部分患(huan)者先有(you)(you)心(xin)(xin)臟(zang)缺血或(huo)左室功能不全癥狀(zhuang)(zhuang)，迅即發生(sheng)心(xin)(xin)臟(zang)驟(zou)停。心(xin)(xin)臟(zang)驟(zou)停前未(wei)訴(su)有(you)(you)不適感覺者，是否(fou)有(you)(you)無癥狀(zhuang)(zhuang)心(xin)(xin)肌缺血則不能確定(ding)。心(xin)(xin)臟(zang)驟(zou)停后腦(nao)血流(liu)銳減，可(ke)導致意(yi)識突然(ran)喪失。下列體(ti)征有(you)(you)助于判(pan)斷(duan)是否(fou)發生(sheng)心(xin)(xin)臟(zang)驟(zou)停：意(yi)識喪失，頸、股動(dong)(dong)(dong)(dong)脈搏動(dong)(dong)(dong)(dong)消失，呼吸斷(duan)續或(huo)停止，皮膚蒼白或(huo)明(ming)顯發紺。如聽診心(xin)(xin)音消失更可(ke)確立(li)(li)診斷(duan)。經檢(jian)查確立(li)(li)診斷(duan)后，應立(li)(li)即進行(xing)有(you)(you)效的(de)(de)(de)(de)心(xin)(xin)肺復蘇(su)。
（1）心電圖
目前已知，心(xin)(xin)肌(ji)肥厚是心(xin)(xin)臟性猝死(si)的(de)(de)標志性心(xin)(xin)電(dian)圖。QRS波群高(gao)電(dian)壓和側壁導聯明顯(xian)的(de)(de)間隔部Q波的(de)(de)出(chu)現(xian)可能是猝死(si)的(de)(de)危(wei)險因素。大面積(ji)前壁心(xin)(xin)肌(ji)梗死(si)的(de)(de)患者，心(xin)(xin)電(dian)圖出(chu)現(xian)右束(shu)支阻(zu)滯，6個月的(de)(de)猝死(si)風險約30%。
（2）動態心電圖(tu)(Holter)
動態(tai)心(xin)電圖可使(shi)39%～82%的室(shi)性(xing)心(xin)律(lv)(lv)失常(chang)患(huan)者得到診斷(duan)，并能(neng)了解室(shi)性(xing)心(xin)律(lv)(lv)失常(chang)的頻度(du)、復雜程度(du)、晝夜節律(lv)(lv)等變化，尤其是心(xin)肌梗(geng)死和嚴(yan)重的冠心(xin)病(bing)患(huan)者。動態(tai)心(xin)電圖發(fa)現的室(shi)性(xing)心(xin)律(lv)(lv)失常(chang)對心(xin)臟性(xing)猝(cu)死的發(fa)生(sheng)有(you)明確(que)的預(yu)測價(jia)值(zhi)。心(xin)臟性(xing)猝(cu)死的危險(xian)性(xing)隨著室(shi)性(xing)心(xin)律(lv)(lv)失常(chang)的復雜性(xing)和頻發(fa)性(xing)而增加(jia)。
（3）運動試驗
有研究表明，運動試驗對心(xin)肌(ji)梗死(si)后的患(huan)者發生心(xin)臟(zang)性(xing)猝死(si)有一(yi)定的預(yu)測價值。
（4）心室晚電位
(ventricular late potential，VLP) 心(xin)(xin)(xin)室(shi)晚(wan)(wan)電位是體表記錄到(dao)的局(ju)部心(xin)(xin)(xin)室(shi)延(yan)遲(chi)碎(sui)裂(lie)(lie)電活動，一(yi)般(ban)出現在QRS終末部并可(ke)延(yan)伸到(dao)ST內，呈高(gao)頻(20～80Hz)、低幅(25V=碎(sui)裂(lie)(lie)波)，持(chi)續10s以上。從目前已有(you)的資(zi)料(liao)來看，心(xin)(xin)(xin)室(shi)晚(wan)(wan)電位在預測患(huan)者發(fa)生致命性(xing)(xing)(xing)快速性(xing)(xing)(xing)心(xin)(xin)(xin)律失常方面(mian)具(ju)有(you)一(yi)定的價值。Brethard等報道，冠心(xin)(xin)(xin)病患(huan)者伴有(you)心(xin)(xin)(xin)室(shi)晚(wan)(wan)電位陽性(xing)(xing)(xing)者，發(fa)生心(xin)(xin)(xin)臟(zang)性(xing)(xing)(xing)猝死的危險性(xing)(xing)(xing)比心(xin)(xin)(xin)室(shi)晚(wan)(wan)電位陰性(xing)(xing)(xing)者高(gao)3.3倍。
臨床(chuang)上須與(yu)暈厥、癔癥(zheng)或癲(dian)癇相鑒別。
（1）心(xin)(xin)(xin)臟(zang)(zang)性(xing)(xing)猝(cu)死的(de)緊急治療(liao)：①心(xin)(xin)(xin)肺(fei)復蘇(CPR)。早(zao)期、有(you)效(xiao)的(de)措施至(zhi)關重要(具體(ti)措施請參(can)閱心(xin)(xin)(xin)肺(fei)復蘇)。②進一(yi)步的(de)心(xin)(xin)(xin)臟(zang)(zang)生命(ming)支持(ACLS)。早(zao)期除(chu)顫對改(gai)善存活至(zhi)關重要。大約40%心(xin)(xin)(xin)臟(zang)(zang)性(xing)(xing)猝(cu)死患者(zhe)在醫務人員到達時發現有(you)心(xin)(xin)(xin)室顫動(dong)(dong)。目前至(zhi)少有(you)兩(liang)個(ge)正在進行的(de)前瞻性(xing)(xing)隨機臨床實驗，研(yan)究胺碘(dian)酮在院外心(xin)(xin)(xin)臟(zang)(zang)性(xing)(xing)猝(cu)死患者(zhe)對電擊難治性(xing)(xing)心(xin)(xin)(xin)室顫動(dong)(dong)中的(de)作用(yong)。有(you)一(yi)個(ge)實驗的(de)初步結果提示胺碘(dian)酮是這類患者(zhe)急診治療(liao)的(de)有(you)效(xiao)藥物。
（2）心臟性猝(cu)死的(de)預防性治療(liao)
一級預防治療：
可聯合(he)使(shi)用心臟(zang)性猝死的(de)多種預測因(yin)素。
鑒(jian)于大(da)多數心(xin)臟性(xing)猝(cu)(cu)死(si)(si)發(fa)生(sheng)在冠心(xin)病的(de)患(huan)者(zhe)，減(jian)輕心(xin)肌缺血，預防心(xin)肌梗死(si)(si)或縮(suo)小(xiao)梗死(si)(si)范圍，改(gai)變(bian)心(xin)肌梗死(si)(si)后心(xin)室(shi)(shi)重構的(de)藥(yao)物應能減(jian)少心(xin)臟性(xing)猝(cu)(cu)死(si)(si)的(de)發(fa)生(sheng)率。早期研究顯(xian)示(shi)與藥(yao)物治(zhi)(zhi)療相(xiang)比(bi)，外科血管重建，使3支血管病變(bian)及(ji)左心(xin)室(shi)(shi)功能不(bu)全的(de)冠心(xin)病患(huan)者(zhe)的(de)心(xin)臟性(xing)猝(cu)(cu)死(si)(si)下降。最近的(de)研究顯(xian)示(shi)，應用溶栓藥(yao)和(或)經皮介入(ru)治(zhi)(zhi)療可獲得心(xin)肌再灌注(zhu)和血管重建。已有(you)研究證(zheng)實β-阻滯劑(ji)在預防心(xin)肌梗死(si)(si)存活者(zhe)心(xin)臟性(xing)猝(cu)(cu)死(si)(si)及(ji)降低其總死(si)(si)亡率方(fang)面是(shi)有(you)效的(de)。血管緊張素(su)轉(zhuan)換(huan)酶抑制(zhi)劑(ji)(ACEI)在這方(fang)面的(de)證(zheng)據(ju)要少一(yi)些(xie)，但(dan)有(you)少數研究提示(shi)，血管緊張素(su)轉(zhuan)換(huan)酶抑制(zhi)劑(ji)(ACEI)使左心(xin)室(shi)(shi)功能不(bu)全的(de)患(huan)者(zhe)的(de)心(xin)臟性(xing)猝(cu)(cu)死(si)(si)減(jian)少。
已有幾(ji)個隨(sui)機試驗(yan)(yan)開(kai)始實施(shi)，以(yi)(yi)比較ICD和藥(yao)物對(dui)心臟性(xing)(xing)猝死一級預(yu)防的(de)效果(guo)。在多中(zhong)心自(zi)動心臟復律除顫器植入試驗(yan)(yan)(MADIT)中(zhong)，對(dui)非持(chi)續性(xing)(xing)室(shi)性(xing)(xing)心動過(guo)速、心肌梗死后左室(shi)功能差以(yi)(yi)及(ji)電生理檢查(cha)時可(ke)誘發出用普魯卡(ka)因胺(an)不能抑制(zhi)的(de)室(shi)性(xing)(xing)心動過(guo)速患者(zhe)(zhe)，ICD比常(chang)規抗心律失常(chang)藥(yao)物更有效。但最近報(bao)道(dao)的(de)冠狀動脈旁路(lu)移植(CABG)補片(pian)試驗(yan)(yan)(patch trail)證明給伴左室(shi)功能不全和信號平(ping)均心電圖(tu)異常(chang)的(de)患者(zhe)(zhe)做CABG時，預(yu)防性(xing)(xing)植入ICD，并不能改善存活。
二級預防治療：
①抗心律失常藥：
心(xin)(xin)(xin)臟性猝(cu)死(si)的(de)發生機制主要是心(xin)(xin)(xin)室(shi)顫動，從理(li)論上講，使用抗(kang)(kang)心(xin)(xin)(xin)律(lv)(lv)失(shi)常藥物控(kong)制或消除(chu)各種室(shi)性心(xin)(xin)(xin)律(lv)(lv)失(shi)常具有防治心(xin)(xin)(xin)臟性猝(cu)死(si)的(de)作用，但是，不(bu)同(tong)抗(kang)(kang)心(xin)(xin)(xin)律(lv)(lv)失(shi)常藥物的(de)臨床使用結果卻不(bu)盡相同(tong)。
Ⅰ類抗心律(lv)失常藥物(wu)一度使(shi)用十分廣(guang)泛，但到目前為止(zhi)，一些(xie)大規(gui)模隨機臨床試(shi)驗的(de)結果表明，許多Ⅰ類抗心律(lv)失常藥物(wu)的(de)使(shi)用并不能降低心臟(zang)性猝(cu)死(si)的(de)發(fa)(fa)生率，相反卻使(shi)心臟(zang)性猝(cu)死(si)的(de)發(fa)(fa)生率升高，其中，比(bi)較典型的(de)是CAST。
CAST即(ji)心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)抑(yi)(yi)制(zhi)實驗(Cardiac arrhythmic suppression trial，CAST)，是(shi)一項由美國國立心(xin)(xin)(xin)(xin)肺(fei)血(xue)(xue)液研究組(zu)織(zhi)的(de)(de)(de)隨機、雙盲對(dui)照的(de)(de)(de)多中心(xin)(xin)(xin)(xin)臨床試驗。旨在確定抗(kang)(kang)心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)藥物抑(yi)(yi)制(zhi)心(xin)(xin)(xin)(xin)肌(ji)梗死(si)后(hou)無癥(zheng)狀或(huo)伴有(you)輕(qing)度癥(zheng)狀的(de)(de)(de)室性心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)，并了(le)解(jie)能(neng)(neng)否(fou)(fou)降(jiang)(jiang)低(di)心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)所致的(de)(de)(de)病(bing)死(si)率(lv)。1989年報道的(de)(de)(de)CASTⅠ結果(guo)發表在《新英格蘭(lan)醫院學雜志》第321卷上。這些(xie)研究結果(guo)表明(ming)，Ⅰc類(lei)抗(kang)(kang)心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)藥物不(bu)僅不(bu)能(neng)(neng)降(jiang)(jiang)低(di)心(xin)(xin)(xin)(xin)肌(ji)梗死(si)后(hou)心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)的(de)(de)(de)發生(sheng)率(lv)，相反卻可使患者(zhe)(zhe)的(de)(de)(de)心(xin)(xin)(xin)(xin)臟猝死(si)率(lv)增(zeng)加。其原因可能(neng)(neng)與下列2個因素有(you)關，一是(shi)Ⅰ類(lei)抗(kang)(kang)心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)藥物本身(shen)具有(you)促心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)作用(yong);二是(shi)Ⅰc類(lei)抗(kang)(kang)心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)藥物具有(you)不(bu)同(tong)程(cheng)度的(de)(de)(de)心(xin)(xin)(xin)(xin)肌(ji)抑(yi)(yi)制(zhi)作用(yong)，可使患者(zhe)(zhe)的(de)(de)(de)心(xin)(xin)(xin)(xin)功能(neng)(neng)進一步減退，射血(xue)(xue)分(fen)數進一步降(jiang)(jiang)低(di)。但是(shi)，CAST僅僅是(shi)在心(xin)(xin)(xin)(xin)肌(ji)梗死(si)后(hou)的(de)(de)(de)室性心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)患者(zhe)(zhe)中進行的(de)(de)(de)，在非心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)的(de)(de)(de)患者(zhe)(zhe)發生(sheng)的(de)(de)(de)室性心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)中，Ⅰc類(lei)抗(kang)(kang)心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)藥物能(neng)(neng)否(fou)(fou)降(jiang)(jiang)低(di)心(xin)(xin)(xin)(xin)臟性猝死(si)的(de)(de)(de)發生(sheng)率(lv)，目前尚(shang)不(bu)清(qing)楚。
在抗(kang)(kang)(kang)心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)(shi)常(chang)(chang)藥物(wu)中，目前Ⅲ類(lei)抗(kang)(kang)(kang)心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)(shi)常(chang)(chang)藥物(wu)是最受(shou)推崇的(de)(de)，其(qi)原因是這(zhe)些(xie)(xie)藥物(wu)不(bu)僅能有(you)(you)(you)(you)效控(kong)制(zhi)各種(zhong)室(shi)(shi)性(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)(shi)常(chang)(chang)，而且一(yi)些(xie)(xie)多(duo)中心(xin)(xin)(xin)(xin)隨(sui)(sui)機(ji)(ji)臨(lin)(lin)床試(shi)驗結(jie)果表明(ming)胺(an)(an)(an)(an)(an)碘(dian)(dian)酮(tong)，長期(qi)口(kou)服時能增(zeng)加各種(zhong)心(xin)(xin)(xin)(xin)肌(ji)組(zu)(zu)(zu)(zu)織(zhi)的(de)(de)動(dong)(dong)作(zuo)電(dian)位時程和(he)(he)(he)有(you)(you)(you)(you)效不(bu)應期(qi)，對各種(zhong)室(shi)(shi)上性(xing)(xing)(xing)(xing)和(he)(he)(he)室(shi)(shi)性(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)(shi)常(chang)(chang)，包括(kuo)心(xin)(xin)(xin)(xin)房顫動(dong)(dong)、心(xin)(xin)(xin)(xin)房撲動(dong)(dong)和(he)(he)(he)室(shi)(shi)上性(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)動(dong)(dong)過速等都有(you)(you)(you)(you)較(jiao)好的(de)(de)效果。口(kou)服劑量為200～800mg/d，，胺(an)(an)(an)(an)(an)碘(dian)(dian)酮(tong)除(chu)了Ⅲ類(lei)抗(kang)(kang)(kang)心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)(shi)常(chang)(chang)藥物(wu)的(de)(de)特性(xing)(xing)(xing)(xing)外(wai)，還有(you)(you)(you)(you)Ⅰ類(lei)抗(kang)(kang)(kang)心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)(shi)常(chang)(chang)藥物(wu)作(zuo)用(yong)(yong)(yong)，表現(xian)(xian)為使用(yong)(yong)(yong)依賴性(xing)(xing)(xing)(xing)動(dong)(dong)力學(xue)特征，并(bing)具有(you)(you)(you)(you)一(yi)定的(de)(de)阻(zu)滯(zhi)作(zuo)用(yong)(yong)(yong)和(he)(he)(he)鈣通道阻(zu)滯(zhi)作(zuo)用(yong)(yong)(yong)，其(qi)主要代謝(xie)產物(wu)脫乙(yi)基胺(an)(an)(an)(an)(an)腆(tian)(tian)酮(tong)仍具有(you)(you)(you)(you)抗(kang)(kang)(kang)心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)(shi)常(chang)(chang)作(zuo)用(yong)(yong)(yong)。胺(an)(an)(an)(an)(an)腆(tian)(tian)酮(tong)和(he)(he)(he)Ⅰc類(lei)抗(kang)(kang)(kang)心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)(shi)常(chang)(chang)藥物(wu)不(bu)同，除(chu)了發揮抗(kang)(kang)(kang)心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)(shi)常(chang)(chang)作(zuo)用(yong)(yong)(yong)之外(wai)，還有(you)(you)(you)(you)冠狀(zhuang)動(dong)(dong)脈擴張作(zuo)用(yong)(yong)(yong)、抗(kang)(kang)(kang)交感(gan)神經的(de)(de)激活作(zuo)用(yong)(yong)(yong)和(he)(he)(he)抗(kang)(kang)(kang)甲狀(zhuang)腺作(zuo)用(yong)(yong)(yong)。近年來，一(yi)些(xie)(xie)研究(jiu)發現(xian)(xian)胺(an)(an)(an)(an)(an)碘(dian)(dian)酮(tong)還有(you)(you)(you)(you)抗(kang)(kang)(kang)氧化(hua)作(zuo)用(yong)(yong)(yong)和(he)(he)(he)拮抗(kang)(kang)(kang)鈣調節蛋(dan)白的(de)(de)作(zuo)用(yong)(yong)(yong)。在心(xin)(xin)(xin)(xin)肌(ji)缺血時，胺(an)(an)(an)(an)(an)腆(tian)(tian)酮(tong)能保護線粒體的(de)(de)完整性(xing)(xing)(xing)(xing)和(he)(he)(he)高能磷酸鹽(yan)的(de)(de)功(gong)能。因此(ci)，從理論上講，胺(an)(an)(an)(an)(an)碘(dian)(dian)酮(tong)在室(shi)(shi)性(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)(shi)常(chang)(chang)的(de)(de)防治(zhi)中具有(you)(you)(you)(you)自己獨特的(de)(de)治(zhi)療(liao)(liao)(liao)價值(zhi)。“巴塞爾心(xin)(xin)(xin)(xin)肌(ji)梗(geng)幸存(cun)者(zhe)(zhe)的(de)(de)抗(kang)(kang)(kang)心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)(shi)常(chang)(chang)研究(jiu)(Basel antiarrhythmic study of infarction survival，BASIS)”在臨(lin)(lin)床實(shi)踐中提示胺(an)(an)(an)(an)(an)碘(dian)(dian)酮(tong)在心(xin)(xin)(xin)(xin)臟(zang)性(xing)(xing)(xing)(xing)猝死(si)(si)(si)(si)防治(zhi)中的(de)(de)價值(zhi)。BASIS由瑞士學(xue)者(zhe)(zhe)完成，入選病(bing)例為心(xin)(xin)(xin)(xin)肌(ji)梗(geng)死(si)(si)(si)(si)后(hou)(hou)8～24天并(bing)伴有(you)(you)(you)(you)室(shi)(shi)性(xing)(xing)(xing)(xing)期(qi)前收縮在Lown氏分(fen)(fen)級4～6級的(de)(de)患(huan)者(zhe)(zhe)。321例患(huan)者(zhe)(zhe)被隨(sui)(sui)機(ji)(ji)分(fen)(fen)為2組(zu)(zu)(zu)(zu)，分(fen)(fen)別用(yong)(yong)(yong)安(an)(an)慰(wei)(wei)劑、胺(an)(an)(an)(an)(an)碘(dian)(dian)酮(tong)和(he)(he)(he)其(qi)他抗(kang)(kang)(kang)心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)(shi)常(chang)(chang)藥物(wu)治(zhi)療(liao)(liao)(liao)，結(jie)果胺(an)(an)(an)(an)(an)腆(tian)(tian)酮(tong)治(zhi)療(liao)(liao)(liao)組(zu)(zu)(zu)(zu)的(de)(de)心(xin)(xin)(xin)(xin)臟(zang)性(xing)(xing)(xing)(xing)猝死(si)(si)(si)(si)率為5%，顯(xian)著(zhu)低于安(an)(an)慰(wei)(wei)劑治(zhi)療(liao)(liao)(liao)組(zu)(zu)(zu)(zu)的(de)(de)11.4%t和(he)(he)(he)其(qi)他抗(kang)(kang)(kang)心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)(shi)常(chang)(chang)藥物(wu)治(zhi)療(liao)(liao)(liao)組(zu)(zu)(zu)(zu)的(de)(de)9%。此(ci)外(wai)，另外(wai)兩項大規模隨(sui)(sui)機(ji)(ji)臨(lin)(lin)床試(shi)驗“加拿大胺(an)(an)(an)(an)(an)碘(dian)(dian)酮(tong)心(xin)(xin)(xin)(xin)肌(ji)梗(geng)死(si)(si)(si)(si)心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)(shi)常(chang)(chang)試(shi)驗(Canadian amiodarone myocardial infarction arrhythmia trial，CAMIAT)”和(he)(he)(he)歐洲心(xin)(xin)(xin)(xin)肌(ji)梗(geng)死(si)(si)(si)(si)胺(an)(an)(an)(an)(an)碘(dian)(dian)酮(tong)試(shi)驗“European myocardial infarction amiodarone trial，EMIAT)”正在進行，最后(hou)(hou)結(jie)果尚未揭曉(xiao)。CAMLAT有(you)(you)(you)(you)21個(ge)醫學(xue)中心(xin)(xin)(xin)(xin)參加，計劃入選心(xin)(xin)(xin)(xin)肌(ji)梗(geng)死(si)(si)(si)(si)后(hou)(hou)6～45天伴室(shi)(shi)性(xing)(xing)(xing)(xing)期(qi)前收縮10次/h以(yi)上或室(shi)(shi)性(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)動(dong)(dong)過速1次以(yi)上的(de)(de)患(huan)者(zhe)(zhe)，隨(sui)(sui)機(ji)(ji)分(fen)(fen)為胺(an)(an)(an)(an)(an)碘(dian)(dian)酮(tong)治(zhi)療(liao)(liao)(liao)組(zu)(zu)(zu)(zu)和(he)(he)(he)安(an)(an)慰(wei)(wei)劑治(zhi)療(liao)(liao)(liao)組(zu)(zu)(zu)(zu)，預(yu)試(shi)完成77例，20個(ge)月的(de)(de)觀(guan)察表明(ming)，胺(an)(an)(an)(an)(an)碘(dian)(dian)酮(tong)治(zhi)療(liao)(liao)(liao)組(zu)(zu)(zu)(zu)的(de)(de)病(bing)死(si)(si)(si)(si)率4%而安(an)(an)慰(wei)(wei)劑治(zhi)療(liao)(liao)(liao)組(zu)(zu)(zu)(zu)的(de)(de)病(bing)死(si)(si)(si)(si)率14%。EMIAT由61個(ge)醫學(xue)中心(xin)(xin)(xin)(xin)參加，計劃入選心(xin)(xin)(xin)(xin)肌(ji)梗(geng)死(si)(si)(si)(si)后(hou)(hou)5～21天、左(zuo)心(xin)(xin)(xin)(xin)室(shi)(shi)射血分(fen)(fen)數在40%以(yi)下的(de)(de)室(shi)(shi)性(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)(shi)常(chang)(chang)患(huan)者(zhe)(zhe)，隨(sui)(sui)機(ji)(ji)分(fen)(fen)為安(an)(an)慰(wei)(wei)劑治(zhi)療(liao)(liao)(liao)組(zu)(zu)(zu)(zu)和(he)(he)(he)胺(an)(an)(an)(an)(an)碘(dian)(dian)酮(tong)治(zhi)療(liao)(liao)(liao)組(zu)(zu)(zu)(zu)。中期(qi)結(jie)果表明(ming)，胺(an)(an)(an)(an)(an)腆(tian)(tian)酮(tong)可顯(xian)著(zhu)降低心(xin)(xin)(xin)(xin)肌(ji)梗(geng)死(si)(si)(si)(si)后(hou)(hou)室(shi)(shi)性(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)律(lv)(lv)(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)(shi)常(chang)(chang)患(huan)者(zhe)(zhe)的(de)(de)心(xin)(xin)(xin)(xin)臟(zang)性(xing)(xing)(xing)(xing)猝死(si)(si)(si)(si)率。
索(suo)(suo)他洛爾(er)(sotalol)與(yu)胺碘酮相似，也具(ju)有(you)(you)混(hun)合性(xing)抗心(xin)律失(shi)常(chang)作用。許(xu)多(duo)學者的臨床觀(guan)察表明，索(suo)(suo)他洛爾(er)對(dui)心(xin)律失(shi)常(chang)患者的生存有(you)(you)益，但(dan)還缺乏(fa)長期多(duo)中心(xin)臨床試驗的結果(guo)。
②β-腎上(shang)(shang)腺素(su)受體阻滯藥(yao)：β-腎上(shang)(shang)腺能(neng)受體阻滯藥(yao)的(de)作用在于競爭心臟(zang)，血管和支(zhi)氣(qi)管等組織器官β腎上(shang)(shang)的(de)腺素(su)能(neng)受體，使受體不能(neng)恢復到高(gao)親和力狀態而(er)(er)(er)與激(ji)動劑結(jie)合，從而(er)(er)(er)抑制β腎上(shang)(shang)腺素(su)能(neng)受體的(de)活性(xing)而(er)(er)(er)發揮一系列(lie)的(de)藥(yao)理(li)作用。
β受體阻滯藥在心(xin)臟(zang)性猝(cu)死中的(de)(de)應用價(jia)值仍(reng)有爭議，但多數學者認為在一些心(xin)臟(zang)的(de)(de)某一亞組可使心(xin)臟(zang)性猝(cu)死的(de)(de)發生(sheng)率(lv)降(jiang)低。
到目前為止，已有(you)大(da)量的(de)研究提示，心(xin)(xin)(xin)肌(ji)梗死(si)(si)后(hou)(hou)的(de)患(huan)者接(jie)受(shou)β受(shou)體阻滯劑治療非常有(you)益，特別是(shi)在降低(di)心(xin)(xin)(xin)臟(zang)性猝死(si)(si)方(fang)面有(you)較顯著的(de)意義，并且還有(you)人發(fa)現，在一定范圍內心(xin)(xin)(xin)率降得越(yue)慢效果越(yue)明顯。已有(you)2項多(duo)中心(xin)(xin)(xin)隨機臨床試驗-(MIAMI)和(he)(ISIS-I)觀察了β受(shou)體阻滯劑在胸痛發(fa)作12～24h內早期干(gan)預的(de)作用(yong)。MIAMI入(ru)選(xuan)胸痛發(fa)作24h以內的(de)心(xin)(xin)(xin)肌(ji)梗死(si)(si)患(huan)者5778例，首先使(shi)用(yong)美托洛爾15mg靜脈(mo)注射(she)，然(ran)后(hou)(hou)200mg/d口服(fu)，1周病(bing)死(si)(si)率下降13%。ISIS-I入(ru)選(xuan)胸痛發(fa)作12h內的(de)心(xin)(xin)(xin)肌(ji)梗死(si)(si)患(huan)者16000例，首先靜脈(mo)注射(she)阿替洛爾5～10mg，然(ran)后(hou)(hou)每周口服(fu)100mg，1周內心(xin)(xin)(xin)血管(guan)病(bing)死(si)(si)率下降15%。β-受(shou)體阻滯藥的(de)作用(yong)主(zhu)要是(shi)降低(di)了心(xin)(xin)(xin)室(shi)顫動或心(xin)(xin)(xin)臟(zang)破裂的(de)發(fa)生(sheng)率。在心(xin)(xin)(xin)肌(ji)梗死(si)(si)的(de)后(hou)(hou)期，使(shi)用(yong)β-受(shou)體阻滯藥可使(shi)心(xin)(xin)(xin)血管(guan)總病(bing)死(si)(si)率降低(di)20%～25%，但對心(xin)(xin)(xin)臟(zang)性猝死(si)(si)發(fa)生(sheng)率的(de)影響尚不清(qing)楚。
在高(gao)血(xue)壓(ya)患者中，β-受體(ti)阻滯藥(yao)治療(liao)也(ye)對心(xin)臟性(xing)(xing)(xing)猝(cu)死具有防治作用。但更多的(de)(de)學(xue)者認為，只有脂(zhi)(zhi)溶性(xing)(xing)(xing)的(de)(de)β-受體(ti)阻滯藥(yao)如美(mei)托洛爾才能(neng)有效地降低心(xin)臟性(xing)(xing)(xing)猝(cu)死的(de)(de)發生(sheng)率。脂(zhi)(zhi)溶性(xing)(xing)(xing)β-受體(ti)阻滯藥(yao)在消化道易于(yu)吸收，易于(yu)通過(guo)血(xue)腦屏(ping)障，在中樞神(shen)經系(xi)統(tong)可以達到(dao)較高(gao)的(de)(de)血(xue)藥(yao)濃度。一些小樣本研究提示，選擇性(xing)(xing)(xing)β-受體(ti)阻滯藥(yao)美(mei)托洛爾和阿替(ti)爾對心(xin)臟性(xing)(xing)(xing)猝(cu)死的(de)(de)防治有效。
③正性肌(ji)力藥物：
在充血性(xing)心(xin)(xin)(xin)力(li)衰(shuai)竭(jie)患(huan)者中，心(xin)(xin)(xin)臟(zang)(zang)性(xing)猝死(si)的(de)發生(sheng)很(hen)高。1993年，Goldman等報道，冠(guan)心(xin)(xin)(xin)病引起(qi)(qi)的(de)充血性(xing)心(xin)(xin)(xin)力(li)衰(shuai)竭(jie)患(huan)者中44%死(si)于心(xin)(xin)(xin)臟(zang)(zang)性(xing)猝死(si);非(fei)冠(guan)心(xin)(xin)(xin)病引起(qi)(qi)的(de)充血性(xing)心(xin)(xin)(xin)力(li)衰(shuai)竭(jie)患(huan)者中，心(xin)(xin)(xin)臟(zang)(zang)性(xing)猝死(si)的(de)發生(sheng)率為48%。因(yin)此(ci)，正性(xing)肌力(li)藥物(wu)在心(xin)(xin)(xin)臟(zang)(zang)性(xing)猝死(si)防治中的(de)價值受到(dao)人們的(de)關注(zhu)。
正(zheng)性(xing)肌力藥物(wu)主要包括(kuo)兩類，即洋地(di)黃類藥物(wu)和(he)cAMP依賴(lai)性(xing)強(qiang)心(xin)劑。
洋(yang)地黃(huang)類藥物仍是(shi)目(mu)前治(zhi)療心(xin)力衰(shuai)(shuai)竭(jie)的(de)(de)(de)基本藥物。近年來的(de)(de)(de)研究表明，洋(yang)地黃(huang)類藥物不僅(jin)能(neng)增強心(xin)肌收縮力、減慢心(xin)率(lv)和(he)傳導，而且具有神(shen)(shen)經內分泌調節作(zuo)用，可(ke)改善(shan)心(xin)力衰(shuai)(shuai)竭(jie)患(huan)者的(de)(de)(de)壓(ya)力感受器功(gong)能(neng)低(di)下和(he)交感神(shen)(shen)經系(xi)統、腎素-血管(guan)緊(jin)張素-醛固酮系(xi)統的(de)(de)(de)功(gong)能(neng)亢進，并可(ke)提(ti)高(gao)心(xin)鈉素的(de)(de)(de)分泌，降低(di)心(xin)臟前負荷。盡管(guan)洋(yang)地黃(huang)的(de)(de)(de)應用已(yi)有200多年的(de)(de)(de)歷史，但(dan)他(ta)在充(chong)血性(xing)心(xin)力衰(shuai)(shuai)竭(jie)治(zhi)療中是(shi)否(fou)能(neng)降低(di)心(xin)臟性(xing)猝死的(de)(de)(de)發生率(lv)仍不十分清(qing)楚。1998年以來，已(yi)有幾項大規模隨機臨床試驗結(jie)果(guo)可(ke)直接或間接反映地高(gao)辛(xin)治(zhi)療心(xin)力衰(shuai)(shuai)竭(jie)是(shi)有效的(de)(de)(de)，不僅(jin)能(neng)改善(shan)充(chong)血性(xing)心(xin)力衰(shuai)(shuai)竭(jie)的(de)(de)(de)癥狀(zhuang)，而且可(ke)以提(ti)高(gao)患(huan)者的(de)(de)(de)運(yun)動量(liang)和(he)心(xin)功(gong)能(neng)，但(dan)均未(wei)闡明地高(gao)辛(xin)對心(xin)臟性(xing)猝死的(de)(de)(de)防治(zhi)作(zuo)用。
CAMP依(yi)賴性(xing)強心(xin)(xin)劑(ji)包(bao)(bao)括：受體激動(dong)劑(ji)和磷酸二酯酶(mei)Ⅲ抑制劑(ji)。前者主要多(duo)(duo)巴酚丁胺、沙丁胺醇等；后(hou)者包(bao)(bao)括氨(an)力(li)農。米力(li)農。臨(lin)床實踐的結果表明，cAMP依(yi)賴性(xing)強心(xin)(xin)劑(ji)在增(zeng)強心(xin)(xin)肌(ji)收縮(suo)力(li)和改善患(huan)者的癥狀方面具有一度的療效，但口(kou)(kou)服(fu)給藥的不良反應較多(duo)(duo)，而且可(ke)增(zeng)加心(xin)(xin)臟(zang)性(xing)猝死的發生率。因此，氨(an)力(li)農和米力(li)農等藥物的口(kou)(kou)服(fu)給藥已(yi)經禁止(zhi)采用。
④抗血小板藥：
A.臨(lin)床常用(yong)的抗血小板藥物及(ji)其作用(yong)原理(li)：
抗(kang)血(xue)(xue)小(xiao)板(ban)藥物(wu)是指(zhi)能阻礙血(xue)(xue)小(xiao)板(ban)黏附、聚集和(he)釋放(fang)反應，以防止血(xue)(xue)栓形成的(de)藥物(wu)。根據作用(yong)的(de)環節(jie)，常用(yong)的(de)抗(kang)血(xue)(xue)小(xiao)板(ban)藥物(wu)包括以下(xia)幾類(lei)：
a.環氧化酶抑(yi)制(zhi)藥(yao)：
包括阿司匹(pi)林(lin)(aspirin)、磺(huang)吡(bi)酮(tong)(苯磺(huang)唑酮(tong))等。阿司匹(pi)林(lin)是一(yi)種(zhong)非甾體(ti)抗炎(yan)藥，1971年發現它有抑制環氧化酶(mei)的作用，目前已(yi)成為(wei)最(zui)常(chang)用的抗血小板藥物。
花生(sheng)四烯(xi)酸在環氧(yang)化(hua)酶(即前列腺(xian)(xian)素合成酶)的(de)作(zuo)(zuo)用(yong)(yong)下(xia)形成不穩定(ding)(ding)的(de)環內過氧(yang)化(hua)物(wu)，即前列腺(xian)(xian)素C2(PGG2)和前列腺(xian)(xian)素H2(PGH2)。環內過氧(yang)化(hua)物(wu)在血(xue)(xue)(xue)(xue)小板微粒(li)體中(zhong)血(xue)(xue)(xue)(xue)栓(shuan)烷合酶的(de)作(zuo)(zuo)用(yong)(yong)下(xia)生(sheng)成血(xue)(xue)(xue)(xue)栓(shuan)素A2(TXA2)，但TXA2不穩定(ding)(ding)，半衰期為30s，迅速轉變為穩定(ding)(ding)的(de)TXB2。在血(xue)(xue)(xue)(xue)管(guan)(guan)壁微粒(li)體中(zhong)，環內過氧(yang)化(hua)物(wu)在6(9)-環氧(yang)化(hua)酶作(zuo)(zuo)用(yong)(yong)下(xia)合成前列腺(xian)(xian)素I2(PGl2)，然(ran)后代謝(xie)為6-酮-PGFla。TAX2使血(xue)(xue)(xue)(xue)管(guan)(guan)收(shou)縮(suo)，降低血(xue)(xue)(xue)(xue)小板cAMP，促進(jin)血(xue)(xue)(xue)(xue)小板聚集和血(xue)(xue)(xue)(xue)栓(shuan)形成。
阿司(si)匹林(lin)(lin)(lin)主(zhu)要(yao)抑(yi)制(zhi)環氧化酶，使(shi)其活性基團乙酰(xian)化，從而(er)阻止TXA2和PGI2的生成。由于阿司(si)匹林(lin)(lin)(lin)在(zai)抑(yi)制(zhi)TXB2的同(tong)時，也對PGI2造成了抑(yi)制(zhi)，則阿司(si)匹林(lin)(lin)(lin)使(shi)用(yong)的有(you)(you)益作用(yong)被削弱或抵消。大量(liang)研(yan)究表明，75～325mg/d的阿司(si)匹林(lin)(lin)(lin)給藥對PGI2的影(ying)(ying)響較弱或幾乎沒有(you)(you)影(ying)(ying)響，而(er)對TXB2的仍有(you)(you)明顯(xian)的抑(yi)制(zhi)作用(yong)。
磺(huang)吡酮(苯磺(huang)唑酮)是保太松類藥物(wu)的(de)衍生物(wu)，1950年被(bei)用于治療痛風，1965年發(fa)現它對血小板(ban)功能(neng)具有明顯影響。現已知道，主(zhu)要抑制血小板(ban)的(de)環氧化酶而抑制TXA2的(de)合成(cheng)，并可抑制血小板(ban)的(de)聚集和釋放反應。對血管(guan)內皮細胞(bao)合成(cheng)的(de)PGI2影響極小。
b.磷酸(suan)二酯(zhi)酶抑制藥：
包括(kuo)雙(shuang)嘧(mi)(mi)(mi)達(da)莫(persantine)等。雙(shuang)嘧(mi)(mi)(mi)達(da)莫又叫潘(pan)生(sheng)丁，是一種廣泛應(ying)用于臨床的(de)(de)(de)(de)抗血(xue)(xue)小(xiao)板藥物，其機制(zhi)(zhi)(zhi)是抑制(zhi)(zhi)(zhi)血(xue)(xue)小(xiao)板的(de)(de)(de)(de)磷酸二酯酶(mei)，使(shi)血(xue)(xue)小(xiao)板的(de)(de)(de)(de)cAMP含(han)量升高。同時，雙(shuang)嘧(mi)(mi)(mi)達(da)莫(潘(pan)生(sheng)丁)還(huan)可通(tong)過(guo)增加血(xue)(xue)液(ye)的(de)(de)(de)(de)腺(xian)苷濃度而(er)抑制(zhi)(zhi)(zhi)血(xue)(xue)小(xiao)板的(de)(de)(de)(de)聚集和(he)釋放反應(ying)。潘(pan)生(sheng)丁可抑制(zhi)(zhi)(zhi)紅細(xi)胞(bao)(bao)和(he)心、肺等組織細(xi)胞(bao)(bao)對血(xue)(xue)中(zhong)腺(xian)苷的(de)(de)(de)(de)攝取(qu)。則腺(xian)苷不(bu)能被腺(xian)苷脫胺酶(mei)所破壞，血(xue)(xue)液(ye)中(zhong)腺(xian)苷水平(ping)增加，一般口(kou)服(fu)給藥，每次400mg，1～2次/d。主要不(bu)良反應(ying)為(wei)胃腸道(dao)癥狀。
c.血栓合成酶(mei)抑(yi)制藥：
包括水楊酸咪唑(咪唑)、達唑氧(yang)苯(dazoxiben)、對乙酰氨基酚(APA)等(deng)。
d.腺苷酸(suan)環(huan)化酶激活劑：
依前(qian)列(lie)醇(前(qian)列(lie)腺(xian)素I2)和前(qian)列(lie)地爾(前(qian)列(lie)腺(xian)素E1) 等。
e.其他：
噻氯匹定(ding)(噻氯吡啶)、舒洛地爾(suloctidil)等。
B.抗血小板藥物防治心臟性猝死的(de)價值：
在(zai)抗(kang)血小(xiao)板(ban)藥物(wu)的(de)(de)(de)研(yan)究(jiu)中，較多(duo)的(de)(de)(de)資料為(wei)(wei)阿(a)(a)司(si)匹(pi)(pi)(pi)(pi)林(lin)。許多(duo)研(yan)究(jiu)表明，阿(a)(a)司(si)匹(pi)(pi)(pi)(pi)林(lin)在(zai)穩(wen)定性(xing)和不(bu)穩(wen)定性(xing)心(xin)(xin)(xin)絞痛(tong)患者中的(de)(de)(de)應用(yong)(yong)后(hou)(hou)，可(ke)顯著(zhu)降(jiang)(jiang)低致死(si)(si)性(xing)和非致死(si)(si)性(xing)心(xin)(xin)(xin)肌(ji)梗死(si)(si)的(de)(de)(de)發生(sheng)(sheng)率;在(zai)心(xin)(xin)(xin)肌(ji)梗死(si)(si)患者應用(yong)(yong)后(hou)(hou)，可(ke)顯著(zhu)降(jiang)(jiang)低再(zai)梗死(si)(si)的(de)(de)(de)發生(sheng)(sheng)率。但(dan)是，有關(guan)阿(a)(a)司(si)匹(pi)(pi)(pi)(pi)林(lin)防(fang)治(zhi)心(xin)(xin)(xin)臟(zang)(zang)病(bing)猝(cu)(cu)死(si)(si)的(de)(de)(de)價值，不(bu)同學者的(de)(de)(de)報(bao)道不(bu)盡一(yi)致。德國-奧地利多(duo)中心(xin)(xin)(xin)研(yan)究(jiu)結(jie)果(guo)提示，阿(a)(a)司(si)匹(pi)(pi)(pi)(pi)林(lin)對心(xin)(xin)(xin)臟(zang)(zang)性(xing)猝(cu)(cu)死(si)(si)的(de)(de)(de)防(fang)治(zhi)有一(yi)定作(zuo)用(yong)(yong)。Elwood等報(bao)道用(yong)(yong)阿(a)(a)司(si)匹(pi)(pi)(pi)(pi)林(lin)治(zhi)療心(xin)(xin)(xin)肌(ji)梗死(si)(si)進(jin)行隨機、雙盲大宗病(bing)例研(yan)究(jiu)的(de)(de)(de)結(jie)果(guo)，發現(xian)在(zai)心(xin)(xin)(xin)肌(ji)梗死(si)(si)后(hou)(hou)6周以內使用(yong)(yong)阿(a)(a)司(si)匹(pi)(pi)(pi)(pi)林(lin)者，33個(ge)月隨訪期間的(de)(de)(de)心(xin)(xin)(xin)臟(zang)(zang)性(xing)猝(cu)(cu)死(si)(si)率在(zai)阿(a)(a)司(si)匹(pi)(pi)(pi)(pi)林(lin)組為(wei)(wei)7.8%、安慰劑組為(wei)(wei)13.5%，阿(a)(a)司(si)匹(pi)(pi)(pi)(pi)林(lin)組心(xin)(xin)(xin)臟(zang)(zang)性(xing)猝(cu)(cu)死(si)(si)的(de)(de)(de)發生(sheng)(sheng)率降(jiang)(jiang)低了42%。如果(guo)阿(a)(a)司(si)匹(pi)(pi)(pi)(pi)林(lin)的(de)(de)(de)使用(yong)(yong)時間較晚則對心(xin)(xin)(xin)臟(zang)(zang)性(xing)猝(cu)(cu)死(si)(si)的(de)(de)(de)發生(sheng)(sheng)率無明顯作(zuo)用(yong)(yong)。
雙(shuang)嘧達(da)莫(mo)(潘生(sheng)丁)在心(xin)臟(zang)性猝(cu)死(si)防治中的評價研究多為與阿司(si)匹林聯(lian)合應用。雙(shuang)嘧達(da)莫(mo)(潘生(sheng)丁)和阿司(si)匹林的再(zai)梗死(si)研究(PARIS)的結果提示(shi)，雙(shuang)嘧達(da)莫(mo)(潘生(sheng)丁)和阿司(si)匹林合用可降低(di)心(xin)肌梗死(si)后(hou)的總(zong)病死(si)率和心(xin)臟(zang)性猝(cu)死(si)發(fa)生(sheng)率。
磺(huang)(huang)(huang)吡酮(tong)(tong)(tong)(苯(ben)磺(huang)(huang)(huang)唑(zuo)酮(tong)(tong)(tong))在心(xin)臟(zang)性(xing)猝(cu)死防治中的(de)(de)價(jia)值(zhi)研究不多。美國磺(huang)(huang)(huang)吡酮(tong)(tong)(tong)(苯(ben)磺(huang)(huang)(huang)唑(zuo)酮(tong)(tong)(tong))研究組(zu)報道(dao)，在6個(ge)月(yue)內，磺(huang)(huang)(huang)吡酮(tong)(tong)(tong)(苯(ben)磺(huang)(huang)(huang)唑(zuo)酮(tong)(tong)(tong))可顯著(zhu)降低心(xin)臟(zang)性(xing)猝(cu)死的(de)(de)發生率;而在6個(ge)月(yue)后對心(xin)臟(zang)性(xing)猝(cu)死的(de)(de)發生率無明顯影(ying)響。
⑤血管緊張素(su)轉換酶抑制藥：
血管緊(jin)張素(su)轉換酶(mei)抑(yi)制藥(angiotensin converting enzyme inhibitor，ACEI)是目前(qian)世界上(shang)發(fa)展最快的一(yi)類心血管藥物，目前(qian)在臨床上(shang)得到廣泛應用(yong)，許多(duo)研究(jiu)發(fa)現，ACEI對心肌梗死、高血壓和充(chong)血性心力衰竭等(deng)疾病(bing)可能并(bing)發(fa)的心臟性猝死具有一(yi)定(ding)的防治作(zuo)用(yong)。
目前(qian)，ACEI已發展(zhan)到幾十種(zhong)(zhong)。根據其(qi)含(han)有(you)(you)(you)(you)的(de)(de)(de)(de)(de)基(ji)團不(bu)同(tong)，ACEI可(ke)分(fen)為3種(zhong)(zhong)類(lei)型：A.含(han)巰基(ji)的(de)(de)(de)(de)(de)ACEI。主(zhu)要(yao)有(you)(you)(you)(you)卡托普利(li)(li)(captopril);B.含(han)羥(qian)基(ji)的(de)(de)(de)(de)(de)ACEI。主(zhu)要(yao)有(you)(you)(you)(you)依那普利(li)(li)(enalapril)、雷(lei)米普利(li)(li)(ramipril)、貝那普利(li)(li)(苯拉普利(li)(li))等。C.含(han)磷酰基(ji)的(de)(de)(de)(de)(de)ACEI。主(zhu)要(yao)有(you)(you)(you)(you)福辛普利(li)(li)(fosinopril)等。其(qi)基(ji)本(ben)作用(yong)機制(zhi)是抑制(zhi)血(xue)管(guan)緊(jin)張(zhang)(zhang)(zhang)(zhang)(zhang)素轉(zhuan)換酶，血(xue)管(guan)緊(jin)張(zhang)(zhang)(zhang)(zhang)(zhang)素轉(zhuan)換酶是一種(zhong)(zhong)含(han)有(you)(you)(you)(you)鋅離(li)子(zi)的(de)(de)(de)(de)(de)金屬(shu)蛋白，各(ge)個活(huo)(huo)性(xing)(xing)部位(wei)都含(han)有(you)(you)(you)(you)鋅離(li)子(zi)，ACEI的(de)(de)(de)(de)(de)巰基(ji)、羥(qian)基(ji)或磷酰基(ji)可(ke)與鋅離(li)子(zi)發生牢固的(de)(de)(de)(de)(de)絡合作用(yong)而(er)使血(xue)管(guan)緊(jin)張(zhang)(zhang)(zhang)(zhang)(zhang)素轉(zhuan)換酶失去活(huo)(huo)性(xing)(xing)。結果(guo)血(xue)管(guan)緊(jin)張(zhang)(zhang)(zhang)(zhang)(zhang)素Ⅰ不(bu)能轉(zhuan)變為血(xue)管(guan)緊(jin)張(zhang)(zhang)(zhang)(zhang)(zhang)素Ⅱ，可(ke)導(dao)致血(xue)管(guan)擴張(zhang)(zhang)(zhang)(zhang)(zhang)、醛固酮(tong)分(fen)泌減(jian)少(shao)(shao)和(he)交感神(shen)經張(zhang)(zhang)(zhang)(zhang)(zhang)力降低。此(ci)外，ACEI還可(ke)抑制(zhi)激肽(tai)酶，減(jian)慢緩激肽(tai)的(de)(de)(de)(de)(de)降解，引起血(xue)管(guan)擴張(zhang)(zhang)(zhang)(zhang)(zhang);同(tong)時(shi)，緩激肽(tai)的(de)(de)(de)(de)(de)濃度增高可(ke)激活(huo)(huo)前(qian)磷脂酶而(er)使前(qian)列腺素的(de)(de)(de)(de)(de)生成增加(jia)。ACEI還可(ke)減(jian)少(shao)(shao)鈣離(li)子(zi)內流，使心肌(ji)細胞內鈣離(li)子(zi)超(chao)負荷而(er)引起的(de)(de)(de)(de)(de)心律失常減(jian)少(shao)(shao)。這些作用(yong)對于冠心病、高血(xue)壓(ya)病和(he)充血(xue)性(xing)(xing)心力衰竭等具有(you)(you)(you)(you)治療(liao)價值，還可(ke)增加(jia)心肌(ji)細胞電活(huo)(huo)動的(de)(de)(de)(de)(de)穩定性(xing)(xing)。
⑥代謝類藥物：
曲(qu)美他(ta)嗪(萬(wan)爽力)，抑(yi)制心(xin)(xin)肌細胞(bao)線粒體內脂肪(fang)酸的氧(yang)化，加(jia)(jia)速糖原酵解(jie)，增加(jia)(jia)心(xin)(xin)肌細胞(bao)無氧(yang)代謝下(xia)ATP的產生，增強心(xin)(xin)肌細胞(bao)的抗缺血能(neng)力，從而可(ke)預(yu)防心(xin)(xin)臟性(xing)猝(cu)死(si)的發生。
埋(mai)藏式(shi)自動心(xin)臟復律除顫器(ICD)的(de)應用是防治心(xin)臟性猝(cu)死(si)的(de)重要進展，對致命性室(shi)性心(xin)律失常引起的(de)心(xin)臟性猝(cu)死(si)具有肯(ken)定的(de)防治作用。
植入ICD的(de)(de)臨床(chuang)價(jia)值在(zai)(zai)于有(you)效地(di)防治心(xin)(xin)臟猝死。據文獻報(bao)道，美(mei)國每(mei)年因心(xin)(xin)臟驟停(ting)而發生(sheng)心(xin)(xin)臟性猝死的(de)(de)患(huan)者(zhe)達50萬人以(yi)上，歐洲約40萬人。其中75%～80%的(de)(de)患(huan)者(zhe)在(zai)(zai)第1次心(xin)(xin)臟驟停(ting)發作時死亡，經有(you)效心(xin)(xin)肺腦復蘇而幸存(cun)者(zhe)中20%～25%的(de)(de)患(huan)者(zhe)可在(zai)(zai)1年內再次發生(sheng)心(xin)(xin)臟驟停(ting)，因此(ci)，ICD的(de)(de)應用(yong)范圍非常(chang)廣泛(fan)。
也有一(yi)些學者對植(zhi)(zhi)入(ru)ICD的兩種不同方(fang)式進行了對比，結果發現經靜脈植(zhi)(zhi)入(ru)ICD的圍(wei)(wei)術期(qi)病死率(lv)較低，長期(qi)隨訪的存活(huo)率(lv)高，應列為(wei)(wei)首選方(fang)法(fa)(fa)。Saksena等總(zong)結了221例多(duo)中(zhong)心植(zhi)(zhi)入(ru)ICD的結果，開胸法(fa)(fa)植(zhi)(zhi)入(ru)ICD的圍(wei)(wei)術期(qi)病死率(lv)為(wei)(wei)4.2%，經靜脈法(fa)(fa)為(wei)(wei)0.8%，隨訪2年的總(zong)成活(huo)率(lv)分別為(wei)(wei)81.9%和87.6%，并無顯著(zhu)性差異。
為了(le)明(ming)確(que)揭示埋(mai)藏式(shi)心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)復(fu)律(lv)(lv)除(chu)顫(zhan)(zhan)(zhan)器(qi)防(fang)治心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)猝死(si)的(de)價值(zhi)，有(you)學(xue)者進(jin)(jin)行了(le)一些多(duo)中心(xin)(xin)(xin)(xin)(xin)(xin)隨機化前(qian)瞻性(xing)(xing)(xing)對照(zhao)研(yan)究(jiu)(jiu)。抗心(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)失常藥物(wu)與(yu)埋(mai)藏式(shi)心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)復(fu)律(lv)(lv)除(chu)顫(zhan)(zhan)(zhan)器(qi)對致命(ming)性(xing)(xing)(xing)室性(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)失常復(fu)蘇患者治療(liao)比(bi)較研(yan)究(jiu)(jiu)(AVID)表明(ming)，室顫(zhan)(zhan)(zhan)復(fu)蘇者或有(you)癥狀和血流(liu)動(dong)力學(xue)障礙(ai)的(de)持續性(xing)(xing)(xing)室性(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)動(dong)過速患者，應用埋(mai)藏式(shi)心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)復(fu)律(lv)(lv)除(chu)顫(zhan)(zhan)(zhan)器(qi)與(yu)抗心(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)失常藥物(wu)相比(bi)，可明(ming)顯提高生存率。其他一些多(duo)中心(xin)(xin)(xin)(xin)(xin)(xin)試驗如(ru)多(duo)中心(xin)(xin)(xin)(xin)(xin)(xin)自動(dong)除(chu)顫(zhan)(zhan)(zhan)器(qi)埋(mai)藏試驗(MADIT)、加拿大埋(mai)藏式(shi)除(chu)顫(zhan)(zhan)(zhan)器(qi)研(yan)究(jiu)(jiu)(CIDS)、漢(han)堡心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)驟停研(yan)究(jiu)(jiu)(CASH)、美國心(xin)(xin)(xin)(xin)(xin)(xin)、肺和血液研(yan)究(jiu)(jiu)所埋(mai)藏式(shi)心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)復(fu)律(lv)(lv)除(chu)顫(zhan)(zhan)(zhan)器(qi)(NHLBHCD)等(deng)有(you)的(de)已經(jing)完成，有(you)的(de)正在進(jin)(jin)行，最(zui)后將揭示ICD防(fang)治心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)性(xing)(xing)(xing)猝死(si)的(de)確(que)切價值(zhi)。
從心臟性猝死復蘇過來的幸運者在1年內發生致命性心律失常的復發率達25%～30%。已有試驗表明，ICD能有效轉復心臟性猝死患者的復發性心室顫動。Newman等對心臟驟停復蘇過來的幸存者進行了回顧性研究，60例患者植入ICD而120例患者僅僅使用藥物治療，兩組病例的年齡、左心室射血分數、心律失常類型、基礎心臟病和藥物治療情況相似。結果，ICD植入者的心臟性猝死率降低50%(10%∶5%，P<0.01)，3年實際病死率降低31%(51%∶35%，P<0.01)，5年的生存曲線也有明顯差異。但是，也必須注意，許多心臟性猝死幸存者(20%～70%)最后并不一定死于致命性心律失常，大約5%的心臟性猝死幸存者死于電-機械分離，而ICD對這種類型的心律失常無效。
①經導管(guan)射(she)頻消(xiao)融(rong)治(zhi)(zhi)療室(shi)性(xing)心律(lv)失常(chang)：室(shi)性(xing)心動過(guo)速(su)發作時常(chang)引起(qi)嚴重的(de)(de)(de)(de)(de)血流動力學障礙，心臟性(xing)猝(cu)死(si)的(de)(de)(de)(de)(de)發生(sheng)率高。1988年，Davis首次使用射(she)頻消(xiao)融(rong)治(zhi)(zhi)療室(shi)性(xing)心動過(guo)速(su)成功，開創射(she)頻消(xiao)融(rong)的(de)(de)(de)(de)(de)新領域(yu)，但(dan)至今仍(reng)不如室(shi)上性(xing)心動過(guo)速(su)使用普(pu)遍。室(shi)性(xing)心動過(guo)速(su)的(de)(de)(de)(de)(de)消(xiao)融(rong)，成功的(de)(de)(de)(de)(de)關鍵(jian)之一(yi)是(shi)心動過(guo)速(su)的(de)(de)(de)(de)(de)起(qi)源定位，其(qi)方(fang)法是(shi)進行心內(nei)膜標測(ce)，一(yi)般(ban)根據Josephson提出的(de)(de)(de)(de)(de)18個點標測(ce)，左心室(shi)12，右心室(shi)6個，標測(ce)方(fang)法有3種(zhong)：
A.竇性心律(lv)時的標測：
在竇性心律下，在心室的不同部位尋找有明顯延遲碎裂電位的部位。延遲破裂電位是缺血區殘存心肌纖維的非同步除極，常常被大量結締組織所包繞，彼此連接較少，因此傳導很慢，形成緩慢傳導區，成為室性心動過速折返環的重要組成部分。在低倍放大條件下，延遲碎裂電位表現為高頻成分組成的低振幅波(<1mV)，持續100ms以上。但必須注意，延遲破裂電位僅僅表示該部位有傳導延緩。并不表示一定為室性心動過速的起源部位，因此，竇性心律下的標測是不可靠的。
B.起搏標測：
用電極在心(xin)室(shi)的(de)(de)不同(tong)(tong)部位作心(xin)內膜起(qi)搏，起(qi)搏頻(pin)率(lv)與(yu)心(xin)動(dong)(dong)過速(su)的(de)(de)頻(pin)率(lv)相同(tong)(tong)，記錄12導聯(lian)心(xin)電圖(tu)，若11個以(yi)上導聯(lian)的(de)(de)圖(tu)形與(yu)心(xin)動(dong)(dong)過速(su)發(fa)作時的(de)(de)相同(tong)(tong)，可認(ren)為該(gai)起(qi)搏部位即(ji)是(shi)心(xin)動(dong)(dong)過速(su)的(de)(de)起(qi)源部位，但(dan)起(qi)搏標測也不可靠(kao)。
C.心動過速時的標測：
有心(xin)(xin)(xin)動(dong)(dong)過速(su)發作時(shi)，在心(xin)(xin)(xin)室內不同(tong)部(bu)(bu)位記錄心(xin)(xin)(xin)內膜電圖(tu)，比較哪一部(bu)(bu)位的(de)(de)心(xin)(xin)(xin)室激動(dong)(dong)時(shi)間比體表心(xin)(xin)(xin)電圖(tu)的(de)(de)QRS波提(ti)前(qian)，則最早激動(dong)(dong)的(de)(de)部(bu)(bu)位是(shi)心(xin)(xin)(xin)動(dong)(dong)過速(su)的(de)(de)起源點。心(xin)(xin)(xin)運過速(su)的(de)(de)標(biao)測是(shi)室性心(xin)(xin)(xin)動(dong)(dong)過速(su)定位的(de)(de)較可(ke)靠方法。
準確(que)定位后，行射頻消融，一般(ban)用(yong)30～40W，10～30s。成功的(de)(de)因(yin)素是(shi)：精(jing)確(que)的(de)(de)起搏標測;最早的(de)(de)局部心(xin)(xin)室激動(dong)(dong);導管電極(ji)(ji)與心(xin)(xin)內膜(mo)密(mi)切接觸(chu)。失敗的(de)(de)因(yin)素是(shi)：消融電極(ji)(ji)未到達起源點;導管電極(ji)(ji)與心(xin)(xin)內膜(mo)接觸(chu)不緊密(mi);室性心(xin)(xin)動(dong)(dong)過速的(de)(de)起源點位于心(xin)(xin)肌內或(huo)心(xin)(xin)外膜(mo)。
不同類型的(de)(de)(de)室(shi)(shi)速(su)(su)，消(xiao)(xiao)融(rong)(rong)的(de)(de)(de)療效(xiao)不同，其(qi)中(zhong)，無器質(zhi)心(xin)臟病的(de)(de)(de)特發性(xing)室(shi)(shi)速(su)(su)，成(cheng)功(gong)率(lv)(lv)達94%。束(shu)支折返(fan)性(xing)心(xin)動過(guo)(guo)(guo)速(su)(su)，是由希氏-心(xin)肌(ji)傳導系統參與的(de)(de)(de)大(da)折返(fan)，消(xiao)(xiao)融(rong)(rong)右束(shu)即可終(zhong)止(zhi)室(shi)(shi)速(su)(su)，成(cheng)功(gong)率(lv)(lv)超過(guo)(guo)(guo)90%。目前(qian)較困難的(de)(de)(de)是梗(geng)死后室(shi)(shi)性(xing)心(xin)動過(guo)(guo)(guo)速(su)(su)成(cheng)功(gong)率(lv)(lv)不高，一(yi)(yi)般在(zai)(zai)45%～93%，差異較大(da)，其(qi)原因(yin)在(zai)(zai)于梗(geng)死性(xing)心(xin)動過(guo)(guo)(guo)速(su)(su)的(de)(de)(de)機(ji)制較復雜所致。梗(geng)死后室(shi)(shi)性(xing)心(xin)動過(guo)(guo)(guo)速(su)(su)的(de)(de)(de)射頻消(xiao)(xiao)融(rong)(rong)，包括以下幾種情形：a.瘢(ban)痕周圍折返(fan)：必須(xu)在(zai)(zai)瘢(ban)痕組織周圍產(chan)(chan)生較大(da)損傷，折返(fan)才能(neng)終(zhong)止(zhi);b.瘢(ban)痕內折返(fan)：大(da)部(bu)分(fen)病例可用(yong)射頻消(xiao)(xiao)融(rong)(rong)成(cheng)功(gong);c.功(gong)能(neng)性(xing)折返(fan)：射頻消(xiao)(xiao)融(rong)(rong)常(chang)常(chang)無效(xiao)。有時，射頻消(xiao)(xiao)融(rong)(rong)術后可在(zai)(zai)功(gong)能(neng)性(xing)上(shang)折返(fan)的(de)(de)(de)基礎上(shang)，增加一(yi)(yi)個解剖(pou)性(xing)因(yin)素(su)而產(chan)(chan)生更(geng)為頑(wan)固的(de)(de)(de)折返(fan)性(xing)心(xin)律失常(chang)。
②經皮球(qiu)囊冠狀動(dong)脈成(cheng)(cheng)形(xing)術治(zhi)療冠心(xin)病。從理論上(shang)講，經皮球(qiu)囊冠狀動(dong)脈形(xing)成(cheng)(cheng)術治(zhi)療冠心(xin)病應能有效降低心(xin)臟性(xing)猝死的發生率(lv)。當迄(qi)今(jin)未(wei)見到多(duo)中心(xin)隨機(ji)臨床觀(guan)察資料。
①室性(xing)心(xin)律失(shi)常的外科治療：
近10幾年來，用手(shou)(shou)術切割、冷(leng)凍或激光等(deng)手(shou)(shou)段可成(cheng)功地控(kong)制(zhi)或根治(zhi)室性心動過速/或心室顫動，從而(er)減少心臟性猝死的發生率。
A.內膜病灶切除術：
這種治療方(fang)(fang)法于(yu)1979年由(you)Harken用(yong)于(yu)臨床(chuang)，其(qi)方(fang)(fang)法是(shi)首先進(jin)行病(bing)灶(zao)定(ding)位(wei)。Harken等的方(fang)(fang)法是(shi)在(zai)常溫(wen)體外循環(huan)下，用(yong)手持(chi)移動電極在(zai)心(xin)(xin)內(nei)膜(mo)面進(jin)行標(biao)測(ce)，找出(chu)最早心(xin)(xin)室(shi)激動部(bu)位(wei)，經左(zuo)心(xin)(xin)室(shi)切口對標(biao)測(ce)出(chu)來的最早心(xin)(xin)室(shi)激動部(bu)位(wei)作(zuo)直徑2～3cm厚約數毫(hao)米的盤(pan)狀切除。心(xin)(xin)內(nei)膜(mo)病(bing)灶(zao)切除術適用(yong)于(yu)病(bing)灶(zao)局限，尤其(qi)適用(yong)于(yu)位(wei)于(yu)室(shi)壁(bi)瘤邊(bian)緣而(er)遠離心(xin)(xin)臟傳導(dao)系統和乳頭肌的病(bing)灶(zao)。
B.心(xin)內膜環形心(xin)室肌切除術：
對于有室(shi)(shi)壁瘤而伴發室(shi)(shi)性心(xin)(xin)動過速(su)的(de)(de)患者可在(zai)室(shi)(shi)壁瘤邊緣的(de)(de)正(zheng)常心(xin)(xin)內膜(mo)作弧形切口(kou)，深達心(xin)(xin)肌層，直(zhi)到(dao)僅留一層靠近心(xin)(xin)外膜(mo)的(de)(de)肌橋。該法由Guiraudon等于1987年首創。因術(shu)后(hou)左室(shi)(shi)受損，現(xian)已少用(yong)。
C.心室隔離術：
僅適用于右心室(shi)游離(li)(li)壁或右心室(shi)流出道的(de)病灶。其方法是以右房溝為基底，圍繞某一分支血管對(dui)可疑心室(shi)壁做半島狀切(qie)開，使它(ta)和右心室(shi)壁的(de)其余部分分離(li)(li)。
D.外科冷凍(dong)消(xiao)融(rong)術(shu)：
對于靠(kao)近心臟傳(chuan)導系統(tong)或腱索的(de)病灶，直接進(jin)行外科手(shou)術切除(chu)術可發生嚴重的(de)并發癥，則宜在外科手(shou)術直視下進(jin)行冷凍治療，使病灶降溫至(zhi)0℃持續(xu)(xu)1min。如果有(you)效(xiao)則降溫至(zhi)-60℃持續(xu)(xu)2min。
E.外科激光消融(rong)術：
用激光代替冷凍(dong)而(er)消除心律失常的病灶。
②冠狀動脈旁路術：
對于嚴重冠(guan)(guan)(guan)狀(zhuang)(zhuang)動(dong)脈(mo)病變的(de)(de)患者進行冠(guan)(guan)(guan)狀(zhuang)(zhuang)動(dong)脈(mo)旁路(lu)術(shu)可有效的(de)(de)改善心(xin)肌供(gong)血，減輕(qing)或消(xiao)除心(xin)絞(jiao)痛的(de)(de)癥狀(zhuang)(zhuang)。已(yi)有一(yi)些多中心(xin)研究結果顯示，冠(guan)(guan)(guan)狀(zhuang)(zhuang)動(dong)脈(mo)旁路(lu)術(shu)可延長冠(guan)(guan)(guan)心(xin)病患者的(de)(de)生存期，但對心(xin)臟性猝死(si)發生率的(de)(de)影(ying)響，所見(jian)報(bao)道(dao)極少。
（1）判斷意識
拍雙肩，喚雙耳，搭脈(mo)搏，10秒(miao)鐘內完成(cheng)
（2）呼救（撥打(da)120）
完成第一步后，馬上(shang)拔打120，給病人爭取救(jiu)治的第一時間。
（3）擺放仰臥體位
（4）胸外(wai)按壓30次（兒(er)童(tong)15次）
位置：胸部正中，兩(liang)乳頭連線中點；
姿勢：肩關(guan)節、肘關(guan)節、腕關(guan)節垂直成(cheng)一條直線。
雙手掌重疊，手指抬(tai)起；掌根(gen)用力。
力(li)度：按(an)下去至少(shao)5cm；
頻率：至(zhi)少100次(ci)/分鐘；
（5）開放氣道（仰頭舉頦法）
（6）人工(gong)吹(chui)氣2次(ci)（兒童1次(ci)）捏鼻(bi)，口包口，吹(chui)氣
（7）重(zhong)復第四、五、六步
（8）注意事項(xiang)：研究發(fa)現，倒地1分(fen)鐘內(nei)(nei)進(jin)行心肺復蘇，救活的概(gai)率為(wei)(wei)90%；2分(fen)鐘內(nei)(nei)60%；4分(fen)鐘內(nei)(nei)40%；8分(fen)鐘內(nei)(nei)為(wei)(wei)20%；超過10分(fen)鐘，基本上就(jiu)是零了。為(wei)(wei)了預防(fang)心源(yuan)性(xing)猝死，中、老年人(ren)和肥胖者(zhe)、糖尿病者(zhe)、應(ying)定期到醫院檢查，發(fa)現潛在性(xing)心血管病就(jiu)及時治(zhi)療，并應(ying)防(fang)止(zhi)各種(zhong)誘(you)發(fa)因素。
飲食適宜
建議適當限制(zhi)辛辣生冷刺激性(xing)食物。缺(que)血性(xing)心臟病常伴(ban)有(you)高血壓高血脂糖尿病，如果(guo)你同時(shi)伴(ban)有(you)以上疾病，可針對給(gei)予(yu)低(di)鹽(yan)低(di)脂低(di)糖飲食。
建議平(ping)時飲食清淡，不(bu)可集中食用過多蔬(shu)菜或(huo)高脂(zhi)食物，低鹽低脂(zhi)飲食，少吃(chi)動物的(de)內臟，多喝水，避免(mian)辛辣和生冷，戒煙酒，適當運(yun)動鍛煉，保持(chi)樂(le)觀舒(shu)暢(chang)的(de)心情，保持(chi)良好的(de)睡眠(mian)，不(bu)要長時間熬夜，放松(song)精(jing)神，心態平(ping)和。
飲食禁忌
紅肉(rou)：這些(xie)肉(rou)類含有(you)大量(liang)阻塞動脈的飽和脂肪，不利于(yu)心臟健康。
汽(qi)水：汽(qi)水含有(you)大量單糖和熱量，是引起兒童和成(cheng)人肥胖的食品之一。
薯條：薯條含有飽(bao)和脂(zhi)肪和轉脂(zhi)肪，會引起人們肥胖，增(zeng)加(jia)心臟病風險。
（1）定期體檢：老年人(ren)本身是心臟(zang)病(bing)(bing)(bing)及各種(zhong)疾病(bing)(bing)(bing)的高發人(ren)群，應(ying)定期到醫院進(jin)(jin)行體檢。青、中年人(ren)工作緊張、生(sheng)活(huo)節奏快、工作生(sheng)活(huo)壓力大也容(rong)易患冠心病(bing)(bing)(bing)、高血壓等疾病(bing)(bing)(bing)。定期體檢及早檢查(cha)便于及時發現疾病(bing)(bing)(bing)，及早進(jin)(jin)行治療，減少猝死風險。
（2）避免過度(du)疲勞(lao)(lao)和(he)精神(shen)緊張(zhang)：過度(du)疲勞(lao)(lao)和(he)精神(shen)緊張(zhang)會(hui)使(shi)機體(ti)處于(yu)應(ying)激狀態，使(shi)血壓升高(gao)，心臟負擔加重(zhong)，使(shi)原有(you)心臟病加重(zhong)。即使(shi)原來沒(mei)有(you)器(qi)質性心臟病也會(hui)引(yin)發室顫(zhan)的發生。所以(yi)，每個人應(ying)該對自己(ji)的工作、生活有(you)所安排，控(kong)制(zhi)工作節奏和(he)工作時間，不可(ke)過快過長。
（3）戒煙、限酒、平衡膳食、控制體重(zhong)、適當(dang)運動，保(bao)持良好的生活習(xi)慣會(hui)減(jian)少(shao)心腦血管(guan)疾病的發生。
（4）注意過度(du)疲(pi)勞的危險信(xin)號及重(zhong)視(shi)發(fa)病的前(qian)(qian)兆癥狀：長期過度(du)疲(pi)勞會引發(fa)身(shen)體(ti)出(chu)現一些改變(bian)。如焦慮易怒、記(ji)憶力減退、注意力不(bu)(bu)集中(zhong)、失眠(mian)及睡眠(mian)質量差、頭痛頭暈(yun)耳鳴、性功能(neng)減退、脫發(fa)明顯等。當(dang)機體(ti)出(chu)現這些情況，應(ying)調(diao)整工作節(jie)奏(zou)(zou)、適當(dang)休息，調(diao)整節(jie)奏(zou)(zou)，保(bao)持愉快的心情。讓機體(ti)功能(neng)得以恢復(fu)。如不(bu)(bu)能(neng)緩解(jie)，應(ying)立即前(qian)(qian)往醫院救(jiu)治。
（5）對已患(huan)有(you)冠心病(bing)、高血壓(ya)等(deng)疾病(bing)的(de)患(huan)者(zhe)應在醫(yi)生指導(dao)下(xia)堅(jian)持服藥治療。
（6）注(zhu)意(yi)對(dui)室性心(xin)(xin)(xin)律失常進行危(wei)險(xian)評估，包括進行常規心(xin)(xin)(xin)電(dian)圖、動態心(xin)(xin)(xin)電(dian)圖、其(qi)他心(xin)(xin)(xin)電(dian)學技(ji)術、超聲心(xin)(xin)(xin)動圖、心(xin)(xin)(xin)內電(dian)生理檢(jian)查等檢(jian)查，以明確心(xin)(xin)(xin)律失常類(lei)型，評估心(xin)(xin)(xin)臟(zang)猝死風險(xian)，做出治療(liao)決策。
（7）注意加(jia)強心(xin)(xin)梗后心(xin)(xin)臟猝(cu)死的預防(fang)。
科布斯
沙漠綠洲漆
中廣歐特斯
萬嘉
如魚得水
龍勝
格蘭
頂上
來斯奧
美爾固
