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(de)自(zi)然死(si)亡。1979年國際心臟(zang)(zang)病學會、美國心臟(zang)(zang)學會以及1970年世界(jie)衛(wei)生組織定(ding)義的(de)猝死(si)為(wei)：急(ji)性(xing)癥狀發生后即刻或者(zhe)(zhe)情況24小時內發生的(de)意(yi)外(wai)死(si)亡。目前大多數(shu)學者(zhe)(zhe)傾向于將猝死(si)的(de)時間限定(ding)在發病1小時內。其特點有(you)三，①死(si)亡急(ji)驟(zou)，②死(si)亡出人意(yi)料，③自(zi)然死(si)亡或非暴力死(si)亡。
（1）冠心病
冠(guan)心(xin)(xin)(xin)(xin)病(bing)(急性(xing)(xing)缺血(xue)事(shi)件，慢性(xing)(xing)缺血(xue)性(xing)(xing)心(xin)(xin)(xin)(xin)臟(zang)病(bing))是心(xin)(xin)(xin)(xin)臟(zang)性(xing)(xing)猝(cu)死(si)的最常(chang)見的原因。對(dui)心(xin)(xin)(xin)(xin)臟(zang)性(xing)(xing)猝(cu)死(si)的尸檢(jian)發現，大約(yue)80%的患(huan)者具有不同程度(du)的冠(guan)狀動脈病(bing)變，大約(yue)2/3以(yi)上(shang)的患(huan)者為2支或3支以(yi)上(shang)的病(bing)變。心(xin)(xin)(xin)(xin)肌梗死(si)后(hou)伴有左(zuo)心(xin)(xin)(xin)(xin)功能下(xia)降或嚴重(zhong)室性(xing)(xing)心(xin)(xin)(xin)(xin)律失(shi)常(chang)的患(huan)者，心(xin)(xin)(xin)(xin)臟(zang)性(xing)(xing)猝(cu)死(si)的發生率顯著增加(jia)。
（2）心肌病
擴張型心(xin)(xin)(xin)(xin)(xin)(xin)肌(ji)病(bing)的(de)心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)性(xing)(xing)猝(cu)(cu)死率(lv)為2%，在(zai)伴有室性(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)失(shi)常時(shi)心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)性(xing)(xing)猝(cu)(cu)死率(lv)可(ke)明顯增加。而(er)肥厚(hou)性(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)肌(ji)病(bing)患者中心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)性(xing)(xing)猝(cu)(cu)死更(geng)常見(jian)。大(da)多(duo)數(shu)學(xue)者報道，肥厚(hou)性(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)肌(ji)病(bing)的(de)年病(bing)死率(lv)為3%～4%，其中大(da)多(duo)數(shu)為心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)性(xing)(xing)猝(cu)(cu)死。在(zai)肥厚(hou)性(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)肌(ji)病(bing)患者，下(xia)列情形為發生(sheng)心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)性(xing)(xing)猝(cu)(cu)死的(de)高危因素：①年齡較輕，在(zai)30歲以下(xia)。②曾(ceng)有暈厥(jue)病(bing)史(shi)。③既往有心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)性(xing)(xing)猝(cu)(cu)死的(de)家族(zu)史(shi)。此外，各種(zhong)原因產生(sheng)的(de)心(xin)(xin)(xin)(xin)(xin)(xin)肌(ji)病(bing)和致(zhi)心(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)失(shi)常性(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)肌(ji)病(bing)也容易發生(sheng)心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)性(xing)(xing)猝(cu)(cu)死。
（3）心臟(zang)瓣(ban)膜炎癥浸(jin)潤
現已公認(ren)，二尖(jian)瓣脫(tuo)垂(chui)綜合征(zheng)可發生(sheng)心(xin)(xin)臟性(xing)猝死，但發生(sheng)率不高。據Jersaty報道，二尖(jian)瓣脫(tuo)垂(chui)患者伴有下列(lie)情形者易發生(sheng)心(xin)(xin)臟性(xing)猝死：①40歲左(zuo)右的女(nv)性(xing)患者。②有暈厥病史。③心(xin)(xin)電圖上有ST段改(gai)變或有頻(pin)發室性(xing)期(qi)(qi)前收縮等室性(xing)心(xin)(xin)律失常。④有&ldquo；喀啦&rdquo；音(yin)和(he)收縮晚期(qi)(qi)或全收縮期(qi)(qi)雜音(yin)。
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（4）心律失常
一般不易發(fa)生(sheng)心(xin)(xin)臟性(xing)(xing)猝(cu)死，但(dan)在老(lao)年患者，常可(ke)并發(fa)嚴重(zhong)的冠狀動脈狹窄或高血壓(ya)致嚴重(zhong)左心(xin)(xin)室肥厚型(xing)心(xin)(xin)肌病的左心(xin)(xin)室流出道梗阻時，快(kuai)速性(xing)(xing)室上性(xing)(xing)心(xin)(xin)律失常發(fa)作時也易發(fa)生(sheng)心(xin)(xin)臟性(xing)(xing)猝(cu)死。
多(duo)數學(xue)者(zhe)認(ren)為(wei)，嚴重(zhong)的(de)(de)(de)(de)(de)(de)(de)室(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常可(ke)(ke)發(fa)(fa)(fa)生心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)(zang)(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)(cu)(cu)(cu)死(si)，尤(you)其(qi)在(zai)(zai)(zai)患有(you)嚴重(zhong)器質(zhi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)(zang)(zang)(zang)病的(de)(de)(de)(de)(de)(de)(de)老年患者(zhe)。目(mu)前(qian)(qian)(qian)，室(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)期前(qian)(qian)(qian)收縮(suo)在(zai)(zai)(zai)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)(zang)(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)(cu)(cu)(cu)死(si)中(zhong)的(de)(de)(de)(de)(de)(de)(de)意(yi)義(yi)尚存(cun)爭議。有(you)些(xie)學(xue)者(zhe)發(fa)(fa)(fa)現(xian)，室(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)期前(qian)(qian)(qian)收縮(suo)并(bing)不能增(zeng)加(jia)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)(zang)(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)(cu)(cu)(cu)死(si)的(de)(de)(de)(de)(de)(de)(de)發(fa)(fa)(fa)生率(lv)，尤(you)其(qi)是(shi)(shi)無(wu)明(ming)顯器質(zhi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)(zang)(zang)(zang)病基(ji)礎的(de)(de)(de)(de)(de)(de)(de)單(dan)純性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)室(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)期前(qian)(qian)(qian)收縮(suo)。但也(ye)有(you)一些(xie)研究(jiu)提示，室(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)期前(qian)(qian)(qian)收縮(suo)本身即是(shi)(shi)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)(zang)(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)(cu)(cu)(cu)死(si)的(de)(de)(de)(de)(de)(de)(de)危(wei)(wei)險(xian)因(yin)素(su)，特(te)(te)別(bie)是(shi)(shi)嚴重(zhong)的(de)(de)(de)(de)(de)(de)(de)冠狀動(dong)(dong)(dong)脈(mo)病變或(huo)(huo)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)肌(ji)梗死(si)后的(de)(de)(de)(de)(de)(de)(de)患者(zhe)，頻(pin)發(fa)(fa)(fa)室(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)期前(qian)(qian)(qian)收縮(suo)對心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)(zang)(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)(cu)(cu)(cu)死(si)的(de)(de)(de)(de)(de)(de)(de)發(fa)(fa)(fa)生具有(you)一定(ding)的(de)(de)(de)(de)(de)(de)(de)意(yi)義(yi)，特(te)(te)別(bie)是(shi)(shi)合(he)(he)并(bing)有(you)左(zuo)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)室(shi)(shi)(shi)(shi)(shi)(shi)肥厚、室(shi)(shi)(shi)(shi)(shi)(shi)內傳導阻滯和(he)(he)(he)(he)(he)ST-T改變者(zhe)。而室(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)動(dong)(dong)(dong)過速(su)(su)在(zai)(zai)(zai)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)(zang)(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)(cu)(cu)(cu)死(si)中(zhong)的(de)(de)(de)(de)(de)(de)(de)意(yi)義(yi)比室(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)期前(qian)(qian)(qian)收縮(suo)為(wei)大(da)。在(zai)(zai)(zai)臨(lin)床(chuang)中(zhong)，我們常把(ba)室(shi)(shi)(shi)(shi)(shi)(shi)速(su)(su)或(huo)(huo)成對、多(duo)源及頻(pin)發(fa)(fa)(fa)室(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)期前(qian)(qian)(qian)收縮(suo)稱(cheng)為(wei)復雜(za)(za)(za)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)室(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常。Morganroth根(gen)據復雜(za)(za)(za)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)室(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常引起(qi)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)(zang)(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)(cu)(cu)(cu)死(si)的(de)(de)(de)(de)(de)(de)(de)危(wei)(wei)險(xian)程(cheng)度，將復雜(za)(za)(za)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)室(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常分為(wei)良性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)占(zhan)30%，其(qi)左(zuo)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)功能和(he)(he)(he)(he)(he)血流(liu)動(dong)(dong)(dong)力學(xue)均正常，發(fa)(fa)(fa)生心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)(zang)(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)(cu)(cu)(cu)死(si)的(de)(de)(de)(de)(de)(de)(de)危(wei)(wei)險(xian)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)極小(xiao)；潛在(zai)(zai)(zai)惡性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)占(zhan)65%，心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)(zang)(zang)(zang)結(jie)構輕度異常，有(you)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)功能不全和(he)(he)(he)(he)(he)室(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)異位激動(dong)(dong)(dong)，如室(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)期前(qian)(qian)(qian)收縮(suo)和(he)(he)(he)(he)(he)(或(huo)(huo))非(fei)持(chi)續性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)室(shi)(shi)(shi)(shi)(shi)(shi)速(su)(su)，無(wu)血流(liu)動(dong)(dong)(dong)力學(xue)障(zhang)礙，但心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)(zang)(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)(cu)(cu)(cu)死(si)的(de)(de)(de)(de)(de)(de)(de)危(wei)(wei)險(xian)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)增(zeng)加(jia)；惡性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)室(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常占(zhan)5%，幾乎(hu)都有(you)血流(liu)動(dong)(dong)(dong)力學(xue)表(biao)現(xian)和(he)(he)(he)(he)(he)體征(暈(yun)厥(jue)，心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)功能不全，心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)肌(ji)缺血或(huo)(huo)低血壓)其(qi)發(fa)(fa)(fa)生心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)(zang)(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)(cu)(cu)(cu)死(si)的(de)(de)(de)(de)(de)(de)(de)危(wei)(wei)險(xian)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)最(zui)大(da)。臨(lin)床(chuang)上常見5種類型(xing)：①心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)室(shi)(shi)(shi)(shi)(shi)(shi)率(lv)&ge；230bpm的(de)(de)(de)(de)(de)(de)(de)持(chi)續性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)單(dan)形性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)室(shi)(shi)(shi)(shi)(shi)(shi)速(su)(su)。②心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)室(shi)(shi)(shi)(shi)(shi)(shi)率(lv)逐(zhu)漸加(jia)速(su)(su)的(de)(de)(de)(de)(de)(de)(de)室(shi)(shi)(shi)(shi)(shi)(shi)速(su)(su)或(huo)(huo)可(ke)(ke)蛻變為(wei)室(shi)(shi)(shi)(shi)(shi)(shi)撲(pu)和(he)(he)(he)(he)(he)(或(huo)(huo))室(shi)(shi)(shi)(shi)(shi)(shi)顫(zhan)(zhan)趨(qu)勢者(zhe)。③室(shi)(shi)(shi)(shi)(shi)(shi)速(su)(su)伴嚴重(zhong)血流(liu)動(dong)(dong)(dong)力學(xue)障(zhang)礙如暈(yun)厥(jue)，左(zuo)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)功能不全和(he)(he)(he)(he)(he)低血壓。④多(duo)形性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(包(bao)括長Q-T綜合(he)(he)征合(he)(he)并(bing)的(de)(de)(de)(de)(de)(de)(de)尖(jian)端扭轉型(xing))室(shi)(shi)(shi)(shi)(shi)(shi)速(su)(su)。⑤室(shi)(shi)(shi)(shi)(shi)(shi)撲(pu)和(he)(he)(he)(he)(he)(或(huo)(huo))室(shi)(shi)(shi)(shi)(shi)(shi)顫(zhan)(zhan)起(qi)始心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常即為(wei)室(shi)(shi)(shi)(shi)(shi)(shi)撲(pu)和(he)(he)(he)(he)(he)(或(huo)(huo))室(shi)(shi)(shi)(shi)(shi)(shi)顫(zhan)(zhan)(如特(te)(te)發(fa)(fa)(fa)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)室(shi)(shi)(shi)(shi)(shi)(shi)顫(zhan)(zhan)，Brugada綜合(he)(he)征)。臨(lin)床(chuang)表(biao)現(xian)為(wei)阿-斯(si)綜合(he)(he)征發(fa)(fa)(fa)作(zuo)(zuo)。而由心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)電(dian)圖證實的(de)(de)(de)(de)(de)(de)(de)大(da)多(duo)數心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)(zang)(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)(cu)(cu)(cu)死(si)發(fa)(fa)(fa)作(zuo)(zuo)(65%～85%)是(shi)(shi)由心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)室(shi)(shi)(shi)(shi)(shi)(shi)顫(zhan)(zhan)動(dong)(dong)(dong)之類的(de)(de)(de)(de)(de)(de)(de)惡性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)室(shi)(shi)(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常所致。但緩慢性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常也(ye)可(ke)(ke)能是(shi)(shi)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)(zang)(zang)(zang)(zang)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝(cu)(cu)(cu)(cu)死(si)的(de)(de)(de)(de)(de)(de)(de)潛在(zai)(zai)(zai)原因(yin)，并(bing)可(ke)(ke)能在(zai)(zai)(zai)記(ji)錄到緩慢性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常之前(qian)(qian)(qian)就已(yi)轉變為(wei)心(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)(xin)室(shi)(shi)(shi)(shi)(shi)(shi)顫(zhan)(zhan)動(dong)(dong)(dong)。
預激綜合征患者并發(fa)房(fang)室折返性(xing)心(xin)動(dong)過速、心(xin)房(fang)顫動(dong)等快(kuai)速性(xing)心(xin)律失常者占(zhan)40%～80%。但(dan)發(fa)生(sheng)心(xin)臟性(xing)猝(cu)死(si)的危險性(xing)較低，有調查在4%以下，老年患者也未見心(xin)臟性(xing)猝(cu)死(si)增加的報道。
（5）其他
糖尿病除(chu)了增(zeng)加冠心病的(de)發(fa)生(sheng)率(lv)外，本身也(ye)可損傷心肌(ji)而增(zeng)加心臟性(xing)猝(cu)死的(de)發(fa)生(sheng)率(lv)。尤其(qi)女性(xing)患(huan)者的(de)心臟性(xing)猝(cu)死發(fa)生(sheng)率(lv)增(zeng)加更明顯(xian)，較同年齡組而無糖尿病的(de)患(huan)者增(zeng)加3倍。
目前已知，發(fa)生心(xin)臟(zang)(zang)性(xing)(xing)猝死的機制主(zhu)要為(wei)嚴(yan)重的室性(xing)(xing)心(xin)律(lv)失(shi)常，包括室性(xing)(xing)心(xin)動(dong)(dong)過速，心(xin)室顫動(dong)(dong)等(deng)。也有一部分人為(wei)突然(ran)發(fa)生的嚴(yan)重血(xue)流動(dong)(dong)力學障礙(ai)，心(xin)臟(zang)(zang)破裂等(deng)。
一般認為，心(xin)室(shi)(shi)顫動(dong)是(shi)多發的折返小(xiao)波(bo)引起的持續性快(kuai)而不(bu)規則(ze)的心(xin)室(shi)(shi)激動(dong)。心(xin)室(shi)(shi)顫動(dong)的發生必需(xu)包括以下幾個基本條件，即異步和(he)分離的局部波(bo)前興奮，傳(chuan)導(dao)延緩和(he)心(xin)室(shi)(shi)不(bu)應(ying)期(qi)縮(suo)短。這些變(bian)化，在缺血的心(xin)肌中均可出現。
（1）缺血性(xing)室(shi)(shi)(shi)(shi)性(xing)心(xin)(xin)(xin)律(lv)(lv)(lv)失常(chang)(chang)(chang)：包括(kuo)急性(xing)心(xin)(xin)(xin)肌(ji)(ji)(ji)缺血所致(zhi)的室(shi)(shi)(shi)(shi)性(xing)心(xin)(xin)(xin)律(lv)(lv)(lv)失常(chang)(chang)(chang)和心(xin)(xin)(xin)肌(ji)(ji)(ji)梗死(si)(si)后陳舊(jiu)性(xing)病(bing)變并發的室(shi)(shi)(shi)(shi)性(xing)心(xin)(xin)(xin)律(lv)(lv)(lv)失常(chang)(chang)(chang)。如(ru)果(guo)急性(xing)心(xin)(xin)(xin)肌(ji)(ji)(ji)缺血發生(sheng)在心(xin)(xin)(xin)肌(ji)(ji)(ji)梗死(si)(si)后瘢痕愈合的邊緣心(xin)(xin)(xin)肌(ji)(ji)(ji)，則(ze)室(shi)(shi)(shi)(shi)性(xing)心(xin)(xin)(xin)律(lv)(lv)(lv)失常(chang)(chang)(chang)的發生(sheng)率(lv)更高。在急性(xing)心(xin)(xin)(xin)肌(ji)(ji)(ji)缺血時，局部心(xin)(xin)(xin)肌(ji)(ji)(ji)組(zu)織灌注不足，導致(zhi)缺血部位(wei)的心(xin)(xin)(xin)肌(ji)(ji)(ji)能量(liang)(liang)代謝較正常(chang)(chang)(chang)心(xin)(xin)(xin)肌(ji)(ji)(ji)組(zu)織明顯降(jiang)低，大量(liang)(liang)游離脂肪酸(FFA)堆積(ji)，細胞內(nei)乳酸含量(liang)(liang)增(zeng)加，細胞內(nei)鉀、鎂(mei)離子外流，則(ze)靜息電(dian)位(wei)的負(fu)值進(jin)一(yi)步增(zeng)加，形成舒張期電(dian)位(wei)。同時，動(dong)作電(dian)位(wei)的振幅下降(jiang)，去(qu)極化的速(su)度(du)(du)減慢，興奮傳導速(su)度(du)(du)減慢，則(ze)心(xin)(xin)(xin)肌(ji)(ji)(ji)自律(lv)(lv)(lv)性(xing)增(zeng)強(qiang)，并易于形成折返的條件而發生(sheng)室(shi)(shi)(shi)(shi)性(xing)折返性(xing)心(xin)(xin)(xin)律(lv)(lv)(lv)失常(chang)(chang)(chang)及(ji)心(xin)(xin)(xin)室(shi)(shi)(shi)(shi)顫(zhan)動(dong)。而同時存在左(zuo)心(xin)(xin)(xin)功能不全的患者，心(xin)(xin)(xin)臟性(xing)猝死(si)(si)的發生(sheng)率(lv)則(ze)更高，尤其左(zuo)室(shi)(shi)(shi)(shi)射血分數低于30%是心(xin)(xin)(xin)臟性(xing)猝死(si)(si)的最強(qiang)的預(yu)測因素。
現已知再(zai)(zai)(zai)(zai)灌(guan)(guan)注(zhu)(zhu)(zhu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常(chang)是發(fa)(fa)(fa)生心(xin)(xin)(xin)(xin)(xin)臟性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝死(si)的(de)(de)(de)重要(yao)機(ji)(ji)制。再(zai)(zai)(zai)(zai)灌(guan)(guan)注(zhu)(zhu)(zhu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)室(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常(chang)可(ke)見(jian)于(yu)冠(guan)(guan)(guan)狀(zhuang)(zhuang)動(dong)(dong)(dong)(dong)脈痙攣緩(huan)解以后(hou)，也可(ke)見(jian)于(yu)急性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)肌(ji)梗死(si)溶(rong)栓治療(liao)或機(ji)(ji)械性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)粉碎斑塊后(hou)使(shi)完全閉塞(sai)的(de)(de)(de)血(xue)(xue)(xue)管再(zai)(zai)(zai)(zai)通(tong)等情況。常(chang)在(zai)(zai)(zai)冠(guan)(guan)(guan)狀(zhuang)(zhuang)動(dong)(dong)(dong)(dong)脈再(zai)(zai)(zai)(zai)通(tong)后(hou)幾(ji)秒鐘而(er)(er)出現再(zai)(zai)(zai)(zai)灌(guan)(guan)注(zhu)(zhu)(zhu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常(chang)。許(xu)多研(yan)(yan)究(jiu)表明，冠(guan)(guan)(guan)狀(zhuang)(zhuang)動(dong)(dong)(dong)(dong)脈再(zai)(zai)(zai)(zai)通(tong)時，再(zai)(zai)(zai)(zai)灌(guan)(guan)注(zhu)(zhu)(zhu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常(chang)的(de)(de)(de)發(fa)(fa)(fa)生率高(gao)達82%。在(zai)(zai)(zai)再(zai)(zai)(zai)(zai)灌(guan)(guan)注(zhu)(zhu)(zhu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常(chang)的(de)(de)(de)不同類型中(zhong)(zhong)60%～80%為(wei)加速性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)室(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)自(zi)(zi)主心(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)和室(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)期前(qian)收縮(suo)，可(ke)引起(qi)(qi)(qi)心(xin)(xin)(xin)(xin)(xin)臟性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝死(si)的(de)(de)(de)心(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常(chang)為(wei)室(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)動(dong)(dong)(dong)(dong)過速和心(xin)(xin)(xin)(xin)(xin)室(shi)(shi)(shi)(shi)顫(zhan)動(dong)(dong)(dong)(dong)，嚴重的(de)(de)(de)緩(huan)慢性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常(chang)也可(ke)引起(qi)(qi)(qi)心(xin)(xin)(xin)(xin)(xin)臟性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)猝死(si)。而(er)(er)再(zai)(zai)(zai)(zai)灌(guan)(guan)注(zhu)(zhu)(zhu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常(chang)的(de)(de)(de)類型和冠(guan)(guan)(guan)狀(zhuang)(zhuang)動(dong)(dong)(dong)(dong)脈的(de)(de)(de)再(zai)(zai)(zai)(zai)通(tong)部位(wei)有(you)一定的(de)(de)(de)關系。左前(qian)降支和左旋支再(zai)(zai)(zai)(zai)灌(guan)(guan)注(zhu)(zhu)(zhu)時易(yi)發(fa)(fa)(fa)生加速性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)室(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)自(zi)(zi)主心(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)，室(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)動(dong)(dong)(dong)(dong)過速和心(xin)(xin)(xin)(xin)(xin)室(shi)(shi)(shi)(shi)顫(zhan)動(dong)(dong)(dong)(dong)。右冠(guan)(guan)(guan)狀(zhuang)(zhuang)動(dong)(dong)(dong)(dong)脈阻塞(sai)再(zai)(zai)(zai)(zai)灌(guan)(guan)注(zhu)(zhu)(zhu)時易(yi)發(fa)(fa)(fa)生竇(dou)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)動(dong)(dong)(dong)(dong)過緩(huan)，房室(shi)(shi)(shi)(shi)傳導(dao)阻滯。實驗研(yan)(yan)究(jiu)提示，再(zai)(zai)(zai)(zai)灌(guan)(guan)注(zhu)(zhu)(zhu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常(chang)的(de)(de)(de)發(fa)(fa)(fa)生機(ji)(ji)制包括觸(chu)(chu)發(fa)(fa)(fa)激(ji)動(dong)(dong)(dong)(dong)、折返(fan)激(ji)動(dong)(dong)(dong)(dong)和異位(wei)自(zi)(zi)律(lv)(lv)(lv)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)增高(gao)。目前(qian)多數學者認為(wei)，觸(chu)(chu)發(fa)(fa)(fa)激(ji)動(dong)(dong)(dong)(dong)在(zai)(zai)(zai)再(zai)(zai)(zai)(zai)灌(guan)(guan)注(zhu)(zhu)(zhu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常(chang)的(de)(de)(de)發(fa)(fa)(fa)生中(zhong)(zhong)占據(ju)重要(yao)位(wei)置(zhi)。而(er)(er)折返(fan)機(ji)(ji)制的(de)(de)(de)產(chan)生可(ke)能與再(zai)(zai)(zai)(zai)灌(guan)(guan)注(zhu)(zhu)(zhu)后(hou)心(xin)(xin)(xin)(xin)(xin)肌(ji)細(xi)胞(bao)電生理恢(hui)復(fu)不均勻有(you)關。心(xin)(xin)(xin)(xin)(xin)肌(ji)缺血(xue)(xue)(xue)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)損傷使(shi)心(xin)(xin)(xin)(xin)(xin)肌(ji)細(xi)胞(bao)的(de)(de)(de)電生理改變不均勻，血(xue)(xue)(xue)管再(zai)(zai)(zai)(zai)通(tong)后(hou)的(de)(de)(de)再(zai)(zai)(zai)(zai)灌(guan)(guan)注(zhu)(zhu)(zhu)使(shi)血(xue)(xue)(xue)流(liu)恢(hui)復(fu)，但(dan)恢(hui)復(fu)血(xue)(xue)(xue)流(liu)后(hou)的(de)(de)(de)心(xin)(xin)(xin)(xin)(xin)肌(ji)細(xi)胞(bao)血(xue)(xue)(xue)液供應(ying)和代謝恢(hui)復(fu)也不均勻，結果導(dao)致缺血(xue)(xue)(xue)區內(nei)心(xin)(xin)(xin)(xin)(xin)肌(ji)應(ying)激(ji)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)的(de)(de)(de)恢(hui)復(fu)程(cheng)度不一致，則易(yi)于(yu)形成折返(fan)而(er)(er)引起(qi)(qi)(qi)室(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)動(dong)(dong)(dong)(dong)過速和(或)心(xin)(xin)(xin)(xin)(xin)室(shi)(shi)(shi)(shi)顫(zhan)動(dong)(dong)(dong)(dong)。此外，心(xin)(xin)(xin)(xin)(xin)肌(ji)缺血(xue)(xue)(xue)-再(zai)(zai)(zai)(zai)灌(guan)(guan)注(zhu)(zhu)(zhu)損傷也可(ke)引起(qi)(qi)(qi)異位(wei)興奮灶(zao)的(de)(de)(de)自(zi)(zi)律(lv)(lv)(lv)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)增加，引起(qi)(qi)(qi)室(shi)(shi)(shi)(shi)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常(chang)。Pogwizd等用心(xin)(xin)(xin)(xin)(xin)臟三維標測(ce)技(ji)術研(yan)(yan)究(jiu)表明，75%的(de)(de)(de)再(zai)(zai)(zai)(zai)灌(guan)(guan)注(zhu)(zhu)(zhu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常(chang)是由觸(chu)(chu)發(fa)(fa)(fa)激(ji)動(dong)(dong)(dong)(dong)引起(qi)(qi)(qi)的(de)(de)(de)，25%的(de)(de)(de)再(zai)(zai)(zai)(zai)灌(guan)(guan)注(zhu)(zhu)(zhu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)心(xin)(xin)(xin)(xin)(xin)律(lv)(lv)(lv)失(shi)常(chang)是由折返(fan)機(ji)(ji)制引起(qi)(qi)(qi)。
病因不(bu)明(ming)，無明(ming)顯冠狀動脈或(huo)(huo)心(xin)(xin)肌本身的(de)病變，常(chang)常(chang)突然或(huo)(huo)在某些誘(you)因的(de)作用下發(fa)生(sheng)嚴重的(de)室(shi)性(xing)心(xin)(xin)律(lv)失常(chang)和(he)(或(huo)(huo))心(xin)(xin)室(shi)顫(zhan)動，而發(fa)生(sheng)心(xin)(xin)臟性(xing)猝死(si)。研(yan)究表明(ming)，原(yuan)發(fa)性(xing)室(shi)性(xing)心(xin)(xin)律(lv)失常(chang)的(de)發(fa)生(sheng)機制多為觸發(fa)激動，也(ye)有的(de)為折(zhe)返機制。
Raizes等(deng)研究(jiu)表明，非心(xin)(xin)(xin)(xin)(xin)(xin)律(lv)失(shi)常(chang)(chang)引(yin)起(qi)的(de)(de)(de)心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)性(xing)猝(cu)(cu)死(si)只占0.56%，包括心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)或主動(dong)脈破裂，心(xin)(xin)(xin)(xin)(xin)(xin)肌梗死(si)擴(kuo)展，交感神經反射性(xing)抑制，以及各種原因(yin)引(yin)起(qi)的(de)(de)(de)心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)嚴(yan)重(zhong)的(de)(de)(de)機(ji)械性(xing)梗阻等(deng)。尤其伴有(you)左(zuo)心(xin)(xin)(xin)(xin)(xin)(xin)功能(neng)(neng)(neng)(neng)不(bu)全(quan)的(de)(de)(de)患者心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)性(xing)猝(cu)(cu)死(si)的(de)(de)(de)發生率最高。左(zuo)心(xin)(xin)(xin)(xin)(xin)(xin)功能(neng)(neng)(neng)(neng)不(bu)全(quan)又常(chang)(chang)有(you)冠(guan)狀(zhuang)動(dong)脈病(bing)(bing)變(bian)和(he)彌(mi)漫的(de)(de)(de)心(xin)(xin)(xin)(xin)(xin)(xin)肌病(bing)(bing)變(bian)，因(yin)而(er)可(ke)伴有(you)急性(xing)心(xin)(xin)(xin)(xin)(xin)(xin)肌缺血或心(xin)(xin)(xin)(xin)(xin)(xin)肌瘢痕組織所誘發的(de)(de)(de)惡性(xing)心(xin)(xin)(xin)(xin)(xin)(xin)律(lv)失(shi)常(chang)(chang)，從而(er)導(dao)致(zhi)心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)性(xing)猝(cu)(cu)死(si)。在(zai)冠(guan)心(xin)(xin)(xin)(xin)(xin)(xin)病(bing)(bing)合(he)并左(zuo)心(xin)(xin)(xin)(xin)(xin)(xin)室(shi)功能(neng)(neng)(neng)(neng)不(bu)全(quan)致(zhi)心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)性(xing)猝(cu)(cu)死(si)事件中，36%表現為(wei)嚴(yan)重(zhong)心(xin)(xin)(xin)(xin)(xin)(xin)動(dong)過緩(huan)或電(dian)-機(ji)械分離(li)。心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)驟停前并未(wei)伴心(xin)(xin)(xin)(xin)(xin)(xin)力衰竭癥狀(zhuang)的(de)(de)(de)惡化。緩(huan)慢性(xing)心(xin)(xin)(xin)(xin)(xin)(xin)律(lv)失(shi)常(chang)(chang)或電(dian)-機(ji)械分離(li)可(ke)能(neng)(neng)(neng)(neng)因(yin)左(zuo)室(shi)收(shou)縮功能(neng)(neng)(neng)(neng)衰竭終末期心(xin)(xin)(xin)(xin)(xin)(xin)室(shi)壁應激時使心(xin)(xin)(xin)(xin)(xin)(xin)室(shi)內(nei)壓(ya)力和(he)容量突(tu)然增加，而(er)周圍血管收(shou)縮同時出現障礙(ai)(ai)，不(bu)能(neng)(neng)(neng)(neng)維(wei)持(chi)體(ti)循環(huan)血壓(ya)，以至虛脫(tuo)和(he)暈厥。猝(cu)(cu)死(si)則為(wei)血流(liu)動(dong)力學障礙(ai)(ai)所致(zhi)，并非心(xin)(xin)(xin)(xin)(xin)(xin)電(dian)不(bu)穩定事件。另一(yi)部分左(zuo)心(xin)(xin)(xin)(xin)(xin)(xin)功能(neng)(neng)(neng)(neng)不(bu)全(quan)的(de)(de)(de)患者伴有(you)室(shi)性(xing)心(xin)(xin)(xin)(xin)(xin)(xin)動(dong)過速，則可(ke)能(neng)(neng)(neng)(neng)為(wei)心(xin)(xin)(xin)(xin)(xin)(xin)律(lv)失(shi)常(chang)(chang)所致(zhi)。
（2）心臟性猝死后的病生理變化
原發(fa)性(xing)(xing)改變(bian)(bian)：心(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)性(xing)(xing)猝(cu)(cu)死(si)的(de)(de)(de)(de)心(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)病理改變(bian)(bian)資(zi)料主要來自(zi)尸體(ti)解剖。但不(bu)同學者(zhe)(zhe)所報道(dao)的(de)(de)(de)(de)尸體(ti)解剖病理結果有(you)很大的(de)(de)(de)(de)不(bu)一(yi)致(zhi)，且多(duo)數學者(zhe)(zhe)研究為(wei)(wei)冠心(xin)(xin)(xin)(xin)(xin)病猝(cu)(cu)死(si)。從冠心(xin)(xin)(xin)(xin)(xin)病猝(cu)(cu)死(si)的(de)(de)(de)(de)病理資(zi)料來看，主要病理結果為(wei)(wei)冠狀(zhuang)(zhuang)動(dong)脈(mo)狹(xia)窄(zhai)程度(du)重，冠狀(zhuang)(zhuang)動(dong)脈(mo)內(nei)并發(fa)血栓(shuan)形成，心(xin)(xin)(xin)(xin)(xin)肌(ji)出現嚴重的(de)(de)(de)(de)缺血或梗(geng)(geng)死(si)。Schwartz等發(fa)現，1/3以上的(de)(de)(de)(de)冠心(xin)(xin)(xin)(xin)(xin)病猝(cu)(cu)死(si)患(huan)者(zhe)(zhe)的(de)(de)(de)(de)冠狀(zhuang)(zhuang)動(dong)脈(mo)內(nei)有(you)血栓(shuan)形成。國內(nei)外的(de)(de)(de)(de)一(yi)些資(zi)料提示：冠心(xin)(xin)(xin)(xin)(xin)病猝(cu)(cu)死(si)患(huan)者(zhe)(zhe)中急性(xing)(xing)心(xin)(xin)(xin)(xin)(xin)肌(ji)梗(geng)(geng)死(si)的(de)(de)(de)(de)發(fa)生(sheng)(sheng)率(lv)約為(wei)(wei)40%，并且冠心(xin)(xin)(xin)(xin)(xin)病猝(cu)(cu)死(si)患(huan)者(zhe)(zhe)的(de)(de)(de)(de)竇房結和傳導系統并無明(ming)顯的(de)(de)(de)(de)急性(xing)(xing)病變(bian)(bian)，亦證實了冠心(xin)(xin)(xin)(xin)(xin)病猝(cu)(cu)死(si)的(de)(de)(de)(de)發(fa)生(sheng)(sheng)機制為(wei)(wei)心(xin)(xin)(xin)(xin)(xin)電不(bu)穩定所致(zhi)。心(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)性(xing)(xing)猝(cu)(cu)死(si)很少發(fa)生(sheng)(sheng)在沒有(you)器(qi)質(zhi)性(xing)(xing)心(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)病的(de)(de)(de)(de)患(huan)者(zhe)(zhe)。有(you)些患(huan)者(zhe)(zhe)發(fa)生(sheng)(sheng)心(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)性(xing)(xing)猝(cu)(cu)死(si)后，即使心(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)的(de)(de)(de)(de)大體(ti)檢查無明(ming)顯肉(rou)眼病變(bian)(bian)，但可能其心(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)的(de)(de)(de)(de)分子結構和功能也存(cun)在著明(ming)顯的(de)(de)(de)(de)異(yi)常(chang)。如離(li)子通道(dao)、蛋白質(zhi)結構異(yi)常(chang)等。
繼(ji)發性改變：正(zheng)常(chang)心(xin)(xin)臟(zang)做功(gong)所需(xu)能(neng)(neng)量首先(xian)來自脂肪，約占心(xin)(xin)肌(ji)總耗(hao)氧量的(de)(de)(de)67%，其次(ci)來自葡(pu)萄糖和乳酸(suan)(suan)(suan)(suan)，分別占17.9%和16.46%，極少數來自醋酸(suan)(suan)(suan)(suan)、氨基酸(suan)(suan)(suan)(suan)、丙酮(tong)酸(suan)(suan)(suan)(suan)等。同時心(xin)(xin)臟(zang)必須依賴ATP來維持其心(xin)(xin)室壁的(de)(de)(de)張(zhang)(zhang)力和收(shou)縮狀(zhuang)態。研究表明，心(xin)(xin)肌(ji)缺血(xue)缺氧10s即可(ke)代謝底物耗(hao)竭，心(xin)(xin)臟(zang)即完(wan)全失去(qu)收(shou)縮功(gong)能(neng)(neng)。在常(chang)溫下，如(ru)果心(xin)(xin)肌(ji)缺血(xue)3～4min，心(xin)(xin)肌(ji)內(nei)(nei)磷酸(suan)(suan)(suan)(suan)肌(ji)酸(suan)(suan)(suan)(suan)含量減少70%～75%，ATP減少15%。如(ru)在此期內(nei)(nei)進行有(you)(you)效的(de)(de)(de)心(xin)(xin)肺復(fu)(fu)(fu)蘇，心(xin)(xin)肌(ji)供(gong)血(xue)改善，則心(xin)(xin)肌(ji)張(zhang)(zhang)力可(ke)完(wan)全恢(hui)復(fu)(fu)(fu)；缺血(xue)8～10min，心(xin)(xin)肌(ji)內(nei)(nei)磷酸(suan)(suan)(suan)(suan)肌(ji)酸(suan)(suan)(suan)(suan)和ATP將(jiang)全部耗(hao)盡，如(ru)在此期內(nei)(nei)進行有(you)(you)效的(de)(de)(de)心(xin)(xin)肺復(fu)(fu)(fu)蘇，心(xin)(xin)臟(zang)的(de)(de)(de)收(shou)縮和舒張(zhang)(zhang)功(gong)能(neng)(neng)仍可(ke)恢(hui)復(fu)(fu)(fu)，10min后(hou)才進行有(you)(you)效的(de)(de)(de)心(xin)(xin)肺復(fu)(fu)(fu)蘇者，復(fu)(fu)(fu)蘇的(de)(de)(de)成功(gong)機會顯(xian)著減少。
腦(nao)(nao)：腦(nao)(nao)的(de)(de)(de)(de)(de)能(neng)(neng)(neng)(neng)量代謝主要來(lai)自葡(pu)萄糖，但腦(nao)(nao)組(zu)織(zhi)(zhi)本身(shen)對(dui)葡(pu)萄糖的(de)(de)(de)(de)(de)儲備很少，必須依(yi)賴于循(xun)環血(xue)(xue)(xue)液(ye)來(lai)供應。并(bing)且腦(nao)(nao)組(zu)織(zhi)(zhi)的(de)(de)(de)(de)(de)代謝85%～90%為(wei)有氧(yang)代謝，而(er)無氧(yang)酵解只(zhi)占腦(nao)(nao)組(zu)織(zhi)(zhi)代謝的(de)(de)(de)(de)(de)5%～15%，所(suo)以，腦(nao)(nao)組(zu)織(zhi)(zhi)的(de)(de)(de)(de)(de)代謝和(he)生(sheng)(sheng)理(li)功能(neng)(neng)(neng)(neng)的(de)(de)(de)(de)(de)維(wei)持則完全依(yi)賴于有效的(de)(de)(de)(de)(de)血(xue)(xue)(xue)液(ye)供應。血(xue)(xue)(xue)液(ye)供應障礙引起(qi)(qi)腦(nao)(nao)細(xi)胞(bao)(bao)(bao)功能(neng)(neng)(neng)(neng)的(de)(de)(de)(de)(de)改變的(de)(de)(de)(de)(de)基礎是缺(que)(que)血(xue)(xue)(xue)缺(que)(que)氧(yang)引起(qi)(qi)腦(nao)(nao)組(zu)織(zhi)(zhi)的(de)(de)(de)(de)(de)原發(fa)(fa)和(he)繼發(fa)(fa)損(sun)害。原發(fa)(fa)損(sun)害為(wei)腦(nao)(nao)組(zu)織(zhi)(zhi)缺(que)(que)血(xue)(xue)(xue)缺(que)(que)氧(yang)時，ATP不能(neng)(neng)(neng)(neng)合成，細(xi)胞(bao)(bao)(bao)鈉泵功能(neng)(neng)(neng)(neng)喪(sang)失，細(xi)胞(bao)(bao)(bao)內(nei)鈉離(li)子不能(neng)(neng)(neng)(neng)轉運到細(xi)胞(bao)(bao)(bao)外，鉀離(li)子不能(neng)(neng)(neng)(neng)從(cong)細(xi)胞(bao)(bao)(bao)內(nei)逸出(chu)，細(xi)胞(bao)(bao)(bao)膜電(dian)(dian)位發(fa)(fa)生(sheng)(sheng)改變，因(yin)此不能(neng)(neng)(neng)(neng)產生(sheng)(sheng)電(dian)(dian)活(huo)動(dong)，細(xi)胞(bao)(bao)(bao)也(ye)失去了產生(sheng)(sheng)和(he)傳(chuan)導(dao)沖動(dong)的(de)(de)(de)(de)(de)功能(neng)(neng)(neng)(neng)。研究(jiu)表明，在完全缺(que)(que)氧(yang)情(qing)況(kuang)下，20s后大(da)腦(nao)(nao)皮質的(de)(de)(de)(de)(de)生(sheng)(sheng)物(wu)電(dian)(dian)活(huo)動(dong)完全消失，30～90s后小腦(nao)(nao)和(he)延髓(sui)的(de)(de)(de)(de)(de)生(sheng)(sheng)物(wu)電(dian)(dian)活(huo)動(dong)完全消失。而(er)缺(que)(que)血(xue)(xue)(xue)缺(que)(que)氧(yang)所(suo)致的(de)(de)(de)(de)(de)繼發(fa)(fa)損(sun)害包括兩個方(fang)面：
A.細(xi)胞內電解(jie)質紊亂和各種代謝產(chan)物的堆積而(er)使腦組織腫(zhong)脹和腦水腫(zhong)。
B.腦(nao)(nao)組(zu)織(zhi)的(de)(de)(de)局部循環(huan)功能障礙進一(yi)步加重(zhong)。已有(you)研究(jiu)提(ti)示(shi)，心(xin)(xin)臟驟停引起的(de)(de)(de)腦(nao)(nao)組(zu)織(zhi)缺(que)血缺(que)氧(yang)時，病變主(zhu)要在大腦(nao)(nao)海馬(ma)回先出現，如(ru)缺(que)血進一(yi)步加重(zhong)，則(ze)迅速(su)波及(ji)全腦(nao)(nao)，包括腦(nao)(nao)干和(he)延髓。而患者發生心(xin)(xin)臟性猝死后(hou)，如(ru)果能及(ji)時、有(you)效地進行心(xin)(xin)肺(fei)復(fu)蘇(su)，則(ze)腦(nao)(nao)組(zu)織(zhi)的(de)(de)(de)血流有(you)可能恢復(fu)，但(dan)腦(nao)(nao)組(zu)織(zhi)由于受(shou)到完全缺(que)血缺(que)氧(yang)的(de)(de)(de)影響(xiang)，腦(nao)(nao)水(shui)腫和(he)微循環(huan)障礙將繼(ji)續發展。腦(nao)(nao)組(zu)織(zhi)的(de)(de)(de)缺(que)血缺(que)氧(yang)時間長短(duan)直(zhi)接影響(xiang)大腦(nao)(nao)功能的(de)(de)(de)恢復(fu)及(ji)患者的(de)(de)(de)臨床預后(hou)。
腎：
心臟驟停時，腎臟的(de)血流供(gong)應和濾過功能完(wan)全停止。首先受累(lei)的(de)是腎小管，引起腎小管細胞壞死(si)，并逐步累(lei)及基底(di)(di)膜及整個腎單位。如果(guo)發生(sheng)(sheng)時間(jian)(jian)短，基底(di)(di)膜可(ke)保持相(xiang)對完(wan)整，腎臟功能可(ke)恢復，但(dan)缺血缺氧的(de)時間(jian)(jian)過長(chang)，腎小管及腎小球產生(sheng)(sheng)廣泛的(de)嚴重(zhong)破壞，則(ze)易發生(sheng)(sheng)急(ji)性腎功能衰竭。
肺(fei)：發(fa)(fa)生心臟性猝死后，肺(fei)可(ke)(ke)發(fa)(fa)生淤血(xue)(xue)、水(shui)腫。顯(xian)微鏡下其主(zhu)要特征是肺(fei)間(jian)質(zhi)(zhi)水(shui)腫，并(bing)可(ke)(ke)見微血(xue)(xue)栓(shuan)形(xing)成。長時間(jian)的肺(fei)缺血(xue)(xue)缺氧容易發(fa)(fa)生彌漫(man)性血(xue)(xue)管內凝(ning)血(xue)(xue)，不僅可(ke)(ke)通過機械堵塞使(shi)肺(fei)部(bu)缺血(xue)(xue)缺氧進一(yi)步(bu)加重，而且還可(ke)(ke)引(yin)起血(xue)(xue)小板聚集，釋放5-HT等(deng)物質(zhi)(zhi)產(chan)生終末氣(qi)道痙攣(luan)，結果(guo)血(xue)(xue)液(ye)-氣(qi)體(ti)交換(huan)障礙進一(yi)步(bu)惡化。
（3）與心(xin)臟(zang)性猝死發(fa)生的相關因素(su)
自主(zhu)(zhu)神(shen)(shen)(shen)經(jing)系(xi)統在(zai)心(xin)(xin)臟性(xing)(xing)猝死的(de)(de)(de)發(fa)(fa)生(sheng)(sheng)(sheng)中具有重要作用。臨床觀察(cha)發(fa)(fa)現，冠心(xin)(xin)病患者(zhe)(zhe)的(de)(de)(de)心(xin)(xin)臟性(xing)(xing)猝死常發(fa)(fa)生(sheng)(sheng)(sheng)在(zai)凌晨至午間(jian)這段時(shi)間(jian)，與自主(zhu)(zhu)神(shen)(shen)(shen)經(jing)活(huo)動的(de)(de)(de)晝夜節律(lv)性(xing)(xing)變化相一致。此時(shi)間(jian)段，交感神(shen)(shen)(shen)經(jing)活(huo)動較高(gao)，血壓(ya)與心(xin)(xin)率增(zeng)加，血小板聚集性(xing)(xing)也增(zeng)加。實驗研究表明(ming)，刺(ci)激心(xin)(xin)臟的(de)(de)(de)交感神(shen)(shen)(shen)經(jing)可(ke)降低室(shi)顫(zhan)(zhan)閾(yu)值，增(zeng)加室(shi)顫(zhan)(zhan)發(fa)(fa)生(sheng)(sheng)(sheng)的(de)(de)(de)危險性(xing)(xing)；刺(ci)激迷(mi)走(zou)神(shen)(shen)(shen)經(jing)，可(ke)降低室(shi)顫(zhan)(zhan)發(fa)(fa)生(sheng)(sheng)(sheng)的(de)(de)(de)危險性(xing)(xing)。所(suo)以交感神(shen)(shen)(shen)經(jing)的(de)(de)(de)過(guo)度興(xing)奮可(ke)促進惡性(xing)(xing)室(shi)性(xing)(xing)心(xin)(xin)律(lv)失常的(de)(de)(de)發(fa)(fa)生(sheng)(sheng)(sheng)，而興(xing)奮迷(mi)走(zou)神(shen)(shen)(shen)經(jing)則具有保護心(xin)(xin)臟及抗室(shi)顫(zhan)(zhan)的(de)(de)(de)作用。但是，對下后(hou)壁(bi)急性(xing)(xing)心(xin)(xin)肌缺(que)(que)(que)血或缺(que)(que)(que)血性(xing)(xing)再灌注的(de)(de)(de)患者(zhe)(zhe)，因迷(mi)走(zou)神(shen)(shen)(shen)經(jing)的(de)(de)(de)傳入受體(ti)多(duo)數(shu)分布在(zai)心(xin)(xin)室(shi)的(de)(de)(de)下后(hou)壁(bi)，該(gai)部(bu)位發(fa)(fa)生(sheng)(sheng)(sheng)心(xin)(xin)肌缺(que)(que)(que)血或缺(que)(que)(que)血后(hou)再灌注，可(ke)觸(chu)發(fa)(fa)Bezold-Jarish反射(she)，導致或加重緩慢性(xing)(xing)心(xin)(xin)律(lv)失常，如(ru)嚴重竇性(xing)(xing)心(xin)(xin)動過(guo)緩，高(gao)度房(fang)室(shi)傳導阻滯(zhi)，周圍血管擴張(zhang)和低血壓(ya)，嚴重者(zhe)(zhe)可(ke)發(fa)(fa)生(sheng)(sheng)(sheng)心(xin)(xin)臟驟停。
許多心(xin)(xin)臟(zang)性猝死的(de)(de)患者發生在睡(shui)眠中。其(qi)機(ji)制(zhi)主要(yao)為睡(shui)眠時(shi)迷走神經興奮，冠狀動(dong)(dong)脈(mo)痙攣，心(xin)(xin)臟(zang)傳導系(xi)統(tong)發生缺氧，心(xin)(xin)電不穩(wen)定(ding)，發生室(shi)顫(zhan)而引起心(xin)(xin)臟(zang)性猝死。但目前尚未能(neng)提(ti)供冠狀動(dong)(dong)脈(mo)痙攣的(de)(de)形態(tai)學依據。
（1）心(xin)臟(zang)病發作前，身體上例如頸(jing)、后背、頭皮、手心(xin)或者腳掌(zhang)都會大量(liang)出汗，此時應提高警惕，當心(xin)猝死發生，最好停止活(huo)動休息，及時服用藥(yao)物(wu)，必要時應立即撥打120。
（2）在(zai)無激烈運動、缺少(shao)睡(shui)眠或(huo)者生病等誘因的情(qing)況下，連續幾(ji)天、幾(ji)周(zhou)甚至幾(ji)月出(chu)現極度疲勞感，伴有焦(jiao)慮(lv)、失眠、無癥狀驚(jing)醒(xing)等癥狀，此時應考慮(lv)心臟出(chu)現問題(ti)。
（3）心臟病患者(zhe)經常感到肩膀(bang)、頸部、下巴、手臂疼痛(tong)，這是心肌(ji)缺血的信號，因為(wei)心肌(ji)缺血疼痛(tong)在(zai)傳遞(di)至大腦中樞神經時，會(hui)同(tong)時反映在(zai)水平相同(tong)的脊髓段區域。
（4）心(xin)臟病發(fa)作前(qian)的(de)典型癥(zheng)狀是(shi)突然、或者無緣由的(de)心(xin)跳加劇，一旦發(fa)生心(xin)室(shi)性心(xin)搏過速，則極(ji)有可能在(zai)短時(shi)間內突然死亡(wang)。
（5）很多心(xin)源(yuan)性(xing)猝死(si)(si)患者在(zai)死(si)(si)亡(wang)前都(dou)反(fan)復出(chu)現(xian)胃(wei)腸(chang)道(dao)癥(zheng)狀(zhuang)，不少(shao)人(ren)生前并(bing)沒有胃(wei)病病史，這是(shi)心(xin)臟病發作(zuo)的信號之一，腸(chang)胃(wei)不適(shi)是(shi)因為心(xin)血管出(chu)現(xian)異(yi)常。動脈由于脂肪沉積物堵塞將會減少(shao)甚至阻(zu)斷(duan)血液(ye)傳輸給心(xin)臟，而這會引起(qi)心(xin)絞痛。
心(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)性(xing)(xing)猝死的經過大體(ti)上(shang)可(ke)分(fen)為4 個(ge)時期。即(ji)前(qian)(qian)(qian)驅期，終末事件開始，心(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)驟(zou)停(ting)和生物(wu)學死亡(wang)。不(bu)同的患(huan)(huan)者(zhe)(zhe)各(ge)期表現(xian)也有(you)(you)明顯差異。在發(fa)生心(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)性(xing)(xing)猝死的前(qian)(qian)(qian)數天(tian)到數月，有(you)(you)些患(huan)(huan)者(zhe)(zhe)可(ke)出(chu)現(xian)心(xin)(xin)(xin)(xin)(xin)前(qian)(qian)(qian)區不(bu)適、心(xin)(xin)(xin)(xin)(xin)悸、氣短、乏力等(deng)非特(te)異性(xing)(xing)表現(xian)。但亦可(ke)無前(qian)(qian)(qian)驅表現(xian)，直接發(fa)生心(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)驟(zou)停(ting)。而有(you)(you)些報道(dao)佩帶動態心(xin)(xin)(xin)(xin)(xin)電圖的猝死患(huan)(huan)者(zhe)(zhe)，當(dang)時心(xin)(xin)(xin)(xin)(xin)電記錄(lu)多為心(xin)(xin)(xin)(xin)(xin)室顫動，說明心(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)驟(zou)停(ting)時多為心(xin)(xin)(xin)(xin)(xin)室顫動。部分(fen)患(huan)(huan)者(zhe)(zhe)先有(you)(you)心(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)缺血(xue)或(huo)左室功能不(bu)全癥狀，迅即(ji)發(fa)生心(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)驟(zou)停(ting)。心(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)驟(zou)停(ting)前(qian)(qian)(qian)未訴(su)有(you)(you)不(bu)適感覺者(zhe)(zhe)，是否(fou)有(you)(you)無癥狀心(xin)(xin)(xin)(xin)(xin)肌缺血(xue)則不(bu)能確(que)定。心(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)驟(zou)停(ting)后腦血(xue)流(liu)銳減(jian)，可(ke)導(dao)致意(yi)識突然喪(sang)失(shi)。下(xia)列(lie)體(ti)征有(you)(you)助于判(pan)斷(duan)是否(fou)發(fa)生心(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)(zang)驟(zou)停(ting)：意(yi)識喪(sang)失(shi)，頸、股(gu)動脈搏動消失(shi)，呼吸斷(duan)續或(huo)停(ting)止，皮膚蒼白或(huo)明顯發(fa)紺。如(ru)聽診(zhen)心(xin)(xin)(xin)(xin)(xin)音消失(shi)更可(ke)確(que)立(li)診(zhen)斷(duan)。經檢查(cha)確(que)立(li)診(zhen)斷(duan)后，應立(li)即(ji)進行有(you)(you)效的心(xin)(xin)(xin)(xin)(xin)肺(fei)復蘇(su)。
（1）心電圖
目前已知，心(xin)(xin)肌肥厚是心(xin)(xin)臟性猝死的(de)(de)標志性心(xin)(xin)電圖。QRS波(bo)群高電壓和側壁導聯(lian)明顯的(de)(de)間(jian)隔部Q波(bo)的(de)(de)出現可能是猝死的(de)(de)危險因素。大面積(ji)前壁心(xin)(xin)肌梗死的(de)(de)患(huan)者，心(xin)(xin)電圖出現右束支阻滯(zhi)，6個月的(de)(de)猝死風險約30%。
（2）動態(tai)心電圖(Holter)
動態(tai)心(xin)(xin)(xin)電圖可使39%～82%的(de)室(shi)(shi)(shi)性(xing)(xing)心(xin)(xin)(xin)律(lv)失(shi)(shi)常(chang)患者得到診斷(duan)，并能了解室(shi)(shi)(shi)性(xing)(xing)心(xin)(xin)(xin)律(lv)失(shi)(shi)常(chang)的(de)頻度(du)(du)、復雜(za)程度(du)(du)、晝夜節律(lv)等變化，尤(you)其(qi)是心(xin)(xin)(xin)肌(ji)梗死和嚴重的(de)冠心(xin)(xin)(xin)病患者。動態(tai)心(xin)(xin)(xin)電圖發(fa)現的(de)室(shi)(shi)(shi)性(xing)(xing)心(xin)(xin)(xin)律(lv)失(shi)(shi)常(chang)對心(xin)(xin)(xin)臟(zang)性(xing)(xing)猝死的(de)發(fa)生(sheng)有明確的(de)預測價值。心(xin)(xin)(xin)臟(zang)性(xing)(xing)猝死的(de)危險性(xing)(xing)隨著(zhu)室(shi)(shi)(shi)性(xing)(xing)心(xin)(xin)(xin)律(lv)失(shi)(shi)常(chang)的(de)復雜(za)性(xing)(xing)和頻發(fa)性(xing)(xing)而(er)增加。
（3）運動試驗
有(you)研究(jiu)表明(ming)，運動試驗對心肌梗死(si)后的患者發生(sheng)心臟性(xing)猝死(si)有(you)一定(ding)的預測價值。
（4）心室晚電位
(ventricular late potential，VLP) 心(xin)(xin)(xin)室(shi)晚電(dian)位是體表記錄(lu)到(dao)的(de)(de)局部心(xin)(xin)(xin)室(shi)延遲碎裂(lie)電(dian)活(huo)動，一般(ban)出現(xian)在(zai)QRS終末部并可延伸到(dao)ST內，呈高頻(20～80Hz)、低(di)幅(25V=碎裂(lie)波)，持續(xu)10s以上(shang)。從目前已(yi)有的(de)(de)資料來看，心(xin)(xin)(xin)室(shi)晚電(dian)位在(zai)預測患(huan)者(zhe)發生致命性(xing)快(kuai)速性(xing)心(xin)(xin)(xin)律失常方面具有一定的(de)(de)價(jia)值。Brethard等(deng)報道(dao)，冠心(xin)(xin)(xin)病(bing)患(huan)者(zhe)伴有心(xin)(xin)(xin)室(shi)晚電(dian)位陽性(xing)者(zhe)，發生心(xin)(xin)(xin)臟(zang)性(xing)猝死的(de)(de)危(wei)險性(xing)比心(xin)(xin)(xin)室(shi)晚電(dian)位陰性(xing)者(zhe)高3.3倍。
臨床上須與暈(yun)厥、癔癥或癲癇相鑒別。
（1）心(xin)(xin)(xin)臟性(xing)(xing)(xing)猝(cu)死的(de)(de)緊急治療(liao)：①心(xin)(xin)(xin)肺復蘇(CPR)。早期、有效的(de)(de)措施至關重(zhong)(zhong)要(yao)(具體措施請參閱心(xin)(xin)(xin)肺復蘇)。②進一步(bu)的(de)(de)心(xin)(xin)(xin)臟生命支持(ACLS)。早期除顫對改善存活至關重(zhong)(zhong)要(yao)。大約40%心(xin)(xin)(xin)臟性(xing)(xing)(xing)猝(cu)死患者在醫(yi)務人員到達時發現有心(xin)(xin)(xin)室顫動。目前至少有兩個正在進行的(de)(de)前瞻性(xing)(xing)(xing)隨機臨床實(shi)驗，研究(jiu)胺碘酮(tong)在院(yuan)外心(xin)(xin)(xin)臟性(xing)(xing)(xing)猝(cu)死患者對電擊難治性(xing)(xing)(xing)心(xin)(xin)(xin)室顫動中的(de)(de)作用。有一個實(shi)驗的(de)(de)初步(bu)結(jie)果提示(shi)胺碘酮(tong)是這類(lei)患者急診治療(liao)的(de)(de)有效藥物(wu)。
（2）心臟性猝死的預(yu)防性治(zhi)療
一級預防治療：
可(ke)聯合使用(yong)心臟性猝死(si)的多種預測因素。
鑒于(yu)大多數心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)性(xing)猝(cu)死(si)發生在(zai)冠心(xin)(xin)(xin)(xin)(xin)(xin)病(bing)的(de)(de)(de)患者(zhe)(zhe)，減(jian)(jian)(jian)輕心(xin)(xin)(xin)(xin)(xin)(xin)肌(ji)(ji)缺(que)血(xue)，預(yu)防(fang)心(xin)(xin)(xin)(xin)(xin)(xin)肌(ji)(ji)梗死(si)或(huo)縮小梗死(si)范圍，改(gai)變(bian)心(xin)(xin)(xin)(xin)(xin)(xin)肌(ji)(ji)梗死(si)后心(xin)(xin)(xin)(xin)(xin)(xin)室(shi)重(zhong)(zhong)構的(de)(de)(de)藥(yao)物應能(neng)減(jian)(jian)(jian)少心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)性(xing)猝(cu)死(si)的(de)(de)(de)發生率。早期研究(jiu)(jiu)(jiu)顯示與藥(yao)物治(zhi)療相(xiang)比，外科血(xue)管(guan)(guan)(guan)(guan)重(zhong)(zhong)建，使3支血(xue)管(guan)(guan)(guan)(guan)病(bing)變(bian)及左心(xin)(xin)(xin)(xin)(xin)(xin)室(shi)功(gong)能(neng)不全的(de)(de)(de)冠心(xin)(xin)(xin)(xin)(xin)(xin)病(bing)患者(zhe)(zhe)的(de)(de)(de)心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)性(xing)猝(cu)死(si)下降。最(zui)近的(de)(de)(de)研究(jiu)(jiu)(jiu)顯示，應用(yong)溶栓藥(yao)和(或(huo))經皮介入治(zhi)療可(ke)獲得心(xin)(xin)(xin)(xin)(xin)(xin)肌(ji)(ji)再灌注和血(xue)管(guan)(guan)(guan)(guan)重(zhong)(zhong)建。已有研究(jiu)(jiu)(jiu)證(zheng)實β-阻滯(zhi)劑(ji)在(zai)預(yu)防(fang)心(xin)(xin)(xin)(xin)(xin)(xin)肌(ji)(ji)梗死(si)存活者(zhe)(zhe)心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)性(xing)猝(cu)死(si)及降低其總死(si)亡率方(fang)面(mian)是有效的(de)(de)(de)。血(xue)管(guan)(guan)(guan)(guan)緊(jin)張素轉換(huan)酶(mei)抑制劑(ji)(ACEI)在(zai)這方(fang)面(mian)的(de)(de)(de)證(zheng)據(ju)要(yao)少一(yi)些(xie)，但有少數研究(jiu)(jiu)(jiu)提示，血(xue)管(guan)(guan)(guan)(guan)緊(jin)張素轉換(huan)酶(mei)抑制劑(ji)(ACEI)使左心(xin)(xin)(xin)(xin)(xin)(xin)室(shi)功(gong)能(neng)不全的(de)(de)(de)患者(zhe)(zhe)的(de)(de)(de)心(xin)(xin)(xin)(xin)(xin)(xin)臟(zang)性(xing)猝(cu)死(si)減(jian)(jian)(jian)少。
已有幾個(ge)隨(sui)機試驗(yan)開始實(shi)施，以比較ICD和藥物對心(xin)(xin)(xin)臟性猝死一(yi)級預(yu)防(fang)的(de)效(xiao)果。在多(duo)中心(xin)(xin)(xin)自動(dong)心(xin)(xin)(xin)臟復律除顫(zhan)器植入試驗(yan)(MADIT)中，對非持續性室性心(xin)(xin)(xin)動(dong)過(guo)速(su)、心(xin)(xin)(xin)肌梗死后左室功能差以及電(dian)(dian)生理檢(jian)查時(shi)可誘發(fa)出用普魯(lu)卡因胺不(bu)能抑制(zhi)的(de)室性心(xin)(xin)(xin)動(dong)過(guo)速(su)患(huan)者，ICD比常(chang)規抗心(xin)(xin)(xin)律失(shi)常(chang)藥物更有效(xiao)。但最近報道(dao)的(de)冠狀動(dong)脈旁(pang)路移(yi)植(CABG)補片試驗(yan)(patch trail)證明給(gei)伴左室功能不(bu)全和信(xin)號(hao)平均(jun)心(xin)(xin)(xin)電(dian)(dian)圖(tu)異常(chang)的(de)患(huan)者做CABG時(shi)，預(yu)防(fang)性植入ICD，并不(bu)能改善(shan)存活。
二級預防治療：
①抗心律失常藥(yao)：
心(xin)臟性(xing)猝死的(de)發生機制(zhi)主(zhu)要是(shi)心(xin)室顫動，從理論上講，使用抗心(xin)律失(shi)常(chang)(chang)藥物控制(zhi)或(huo)消除各種室性(xing)心(xin)律失(shi)常(chang)(chang)具有防治心(xin)臟性(xing)猝死的(de)作用，但是(shi)，不(bu)同(tong)(tong)抗心(xin)律失(shi)常(chang)(chang)藥物的(de)臨床使用結果卻不(bu)盡(jin)相同(tong)(tong)。
Ⅰ類抗(kang)心律(lv)(lv)失(shi)常藥(yao)物一度使(shi)用十分廣泛，但到目前為(wei)止(zhi)，一些(xie)大規模隨機(ji)臨床(chuang)試驗的(de)(de)結果表明，許多Ⅰ類抗(kang)心律(lv)(lv)失(shi)常藥(yao)物的(de)(de)使(shi)用并不能(neng)降低心臟性猝(cu)死的(de)(de)發生率(lv)，相(xiang)反(fan)卻使(shi)心臟性猝(cu)死的(de)(de)發生率(lv)升高，其(qi)中，比較典型的(de)(de)是CAST。
CAST即心(xin)(xin)(xin)(xin)律(lv)(lv)失(shi)(shi)(shi)(shi)常(chang)(chang)抑(yi)(yi)制實驗(yan)(Cardiac arrhythmic suppression trial，CAST)，是(shi)(shi)一(yi)項由美國國立心(xin)(xin)(xin)(xin)肺血(xue)液研究組織的(de)(de)(de)隨機、雙盲對照(zhao)的(de)(de)(de)多中心(xin)(xin)(xin)(xin)臨(lin)床試(shi)驗(yan)。旨在(zai)確定(ding)抗心(xin)(xin)(xin)(xin)律(lv)(lv)失(shi)(shi)(shi)(shi)常(chang)(chang)藥(yao)(yao)(yao)物抑(yi)(yi)制心(xin)(xin)(xin)(xin)肌梗死(si)后(hou)無癥(zheng)狀或伴有(you)輕度癥(zheng)狀的(de)(de)(de)室(shi)性心(xin)(xin)(xin)(xin)律(lv)(lv)失(shi)(shi)(shi)(shi)常(chang)(chang)，并了解能(neng)否降低(di)(di)心(xin)(xin)(xin)(xin)律(lv)(lv)失(shi)(shi)(shi)(shi)常(chang)(chang)所致的(de)(de)(de)病死(si)率(lv)。1989年報道的(de)(de)(de)CASTⅠ結果發(fa)表(biao)在(zai)《新英格蘭醫院學雜志》第321卷上。這些研究結果表(biao)明(ming)，Ⅰc類(lei)抗心(xin)(xin)(xin)(xin)律(lv)(lv)失(shi)(shi)(shi)(shi)常(chang)(chang)藥(yao)(yao)(yao)物不僅不能(neng)降低(di)(di)心(xin)(xin)(xin)(xin)肌梗死(si)后(hou)心(xin)(xin)(xin)(xin)律(lv)(lv)失(shi)(shi)(shi)(shi)常(chang)(chang)的(de)(de)(de)發(fa)生率(lv)，相(xiang)反卻可(ke)使患(huan)者(zhe)的(de)(de)(de)心(xin)(xin)(xin)(xin)臟猝死(si)率(lv)增加。其原(yuan)因可(ke)能(neng)與(yu)下列2個因素有(you)關，一(yi)是(shi)(shi)Ⅰ類(lei)抗心(xin)(xin)(xin)(xin)律(lv)(lv)失(shi)(shi)(shi)(shi)常(chang)(chang)藥(yao)(yao)(yao)物本身具有(you)促心(xin)(xin)(xin)(xin)律(lv)(lv)失(shi)(shi)(shi)(shi)常(chang)(chang)作(zuo)用;二(er)是(shi)(shi)Ⅰc類(lei)抗心(xin)(xin)(xin)(xin)律(lv)(lv)失(shi)(shi)(shi)(shi)常(chang)(chang)藥(yao)(yao)(yao)物具有(you)不同程度的(de)(de)(de)心(xin)(xin)(xin)(xin)肌抑(yi)(yi)制作(zuo)用，可(ke)使患(huan)者(zhe)的(de)(de)(de)心(xin)(xin)(xin)(xin)功能(neng)進(jin)一(yi)步(bu)減(jian)退，射(she)血(xue)分數進(jin)一(yi)步(bu)降低(di)(di)。但是(shi)(shi)，CAST僅僅是(shi)(shi)在(zai)心(xin)(xin)(xin)(xin)肌梗死(si)后(hou)的(de)(de)(de)室(shi)性心(xin)(xin)(xin)(xin)律(lv)(lv)失(shi)(shi)(shi)(shi)常(chang)(chang)患(huan)者(zhe)中進(jin)行的(de)(de)(de)，在(zai)非心(xin)(xin)(xin)(xin)律(lv)(lv)失(shi)(shi)(shi)(shi)常(chang)(chang)的(de)(de)(de)患(huan)者(zhe)發(fa)生的(de)(de)(de)室(shi)性心(xin)(xin)(xin)(xin)律(lv)(lv)失(shi)(shi)(shi)(shi)常(chang)(chang)中，Ⅰc類(lei)抗心(xin)(xin)(xin)(xin)律(lv)(lv)失(shi)(shi)(shi)(shi)常(chang)(chang)藥(yao)(yao)(yao)物能(neng)否降低(di)(di)心(xin)(xin)(xin)(xin)臟性猝死(si)的(de)(de)(de)發(fa)生率(lv)，目(mu)前尚不清楚(chu)。
在(zai)抗(kang)(kang)心(xin)(xin)律(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)(chang)(chang)(chang)(chang)藥(yao)(yao)物(wu)(wu)(wu)中(zhong)(zhong)，目前(qian)Ⅲ類(lei)(lei)抗(kang)(kang)心(xin)(xin)律(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)(chang)(chang)(chang)(chang)藥(yao)(yao)物(wu)(wu)(wu)是(shi)最受推崇的(de)(de)(de)(de)(de)(de)(de)，其(qi)原因(yin)是(shi)這些藥(yao)(yao)物(wu)(wu)(wu)不僅能(neng)有效(xiao)控(kong)制各種室(shi)(shi)性(xing)心(xin)(xin)律(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)(chang)(chang)(chang)(chang)，而且一(yi)些多(duo)中(zhong)(zhong)心(xin)(xin)隨(sui)機(ji)臨床(chuang)試(shi)(shi)驗(yan)(yan)結(jie)果表(biao)明(ming)(ming)胺(an)(an)(an)碘(dian)酮(tong)(tong)(tong)(tong)(tong)(tong)，長期口服(fu)時能(neng)增加各種心(xin)(xin)肌(ji)(ji)組(zu)(zu)(zu)(zu)織的(de)(de)(de)(de)(de)(de)(de)動(dong)作(zuo)電(dian)位時程和(he)(he)(he)(he)有效(xiao)不應(ying)期，對各種室(shi)(shi)上(shang)(shang)性(xing)和(he)(he)(he)(he)室(shi)(shi)性(xing)心(xin)(xin)律(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)(chang)(chang)(chang)(chang)，包括(kuo)心(xin)(xin)房顫動(dong)、心(xin)(xin)房撲(pu)動(dong)和(he)(he)(he)(he)室(shi)(shi)上(shang)(shang)性(xing)心(xin)(xin)動(dong)過(guo)速等(deng)都有較好(hao)的(de)(de)(de)(de)(de)(de)(de)效(xiao)果。口服(fu)劑量為(wei)200～800mg/d，，胺(an)(an)(an)碘(dian)酮(tong)(tong)(tong)(tong)(tong)(tong)除(chu)了Ⅲ類(lei)(lei)抗(kang)(kang)心(xin)(xin)律(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)(chang)(chang)(chang)(chang)藥(yao)(yao)物(wu)(wu)(wu)的(de)(de)(de)(de)(de)(de)(de)特性(xing)外，還(huan)(huan)有Ⅰ類(lei)(lei)抗(kang)(kang)心(xin)(xin)律(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)(chang)(chang)(chang)(chang)藥(yao)(yao)物(wu)(wu)(wu)作(zuo)用(yong)，表(biao)現為(wei)使用(yong)依賴性(xing)動(dong)力學(xue)特征(zheng)，并具有一(yi)定的(de)(de)(de)(de)(de)(de)(de)阻(zu)滯作(zuo)用(yong)和(he)(he)(he)(he)鈣通道阻(zu)滯作(zuo)用(yong)，其(qi)主要代謝(xie)產物(wu)(wu)(wu)脫(tuo)乙基胺(an)(an)(an)腆酮(tong)(tong)(tong)(tong)(tong)(tong)仍具有抗(kang)(kang)心(xin)(xin)律(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)(chang)(chang)(chang)(chang)作(zuo)用(yong)。胺(an)(an)(an)腆酮(tong)(tong)(tong)(tong)(tong)(tong)和(he)(he)(he)(he)Ⅰc類(lei)(lei)抗(kang)(kang)心(xin)(xin)律(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)(chang)(chang)(chang)(chang)藥(yao)(yao)物(wu)(wu)(wu)不同，除(chu)了發揮抗(kang)(kang)心(xin)(xin)律(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)(chang)(chang)(chang)(chang)作(zuo)用(yong)之(zhi)外，還(huan)(huan)有冠狀(zhuang)動(dong)脈擴張作(zuo)用(yong)、抗(kang)(kang)交感神經的(de)(de)(de)(de)(de)(de)(de)激活作(zuo)用(yong)和(he)(he)(he)(he)抗(kang)(kang)甲狀(zhuang)腺(xian)作(zuo)用(yong)。近年來，一(yi)些研究發現胺(an)(an)(an)碘(dian)酮(tong)(tong)(tong)(tong)(tong)(tong)還(huan)(huan)有抗(kang)(kang)氧(yang)化作(zuo)用(yong)和(he)(he)(he)(he)拮抗(kang)(kang)鈣調節(jie)蛋白的(de)(de)(de)(de)(de)(de)(de)作(zuo)用(yong)。在(zai)心(xin)(xin)肌(ji)(ji)缺血時，胺(an)(an)(an)腆酮(tong)(tong)(tong)(tong)(tong)(tong)能(neng)保護(hu)線粒體的(de)(de)(de)(de)(de)(de)(de)完(wan)(wan)整性(xing)和(he)(he)(he)(he)高能(neng)磷酸鹽的(de)(de)(de)(de)(de)(de)(de)功能(neng)。因(yin)此(ci)，從理論上(shang)(shang)講，胺(an)(an)(an)碘(dian)酮(tong)(tong)(tong)(tong)(tong)(tong)在(zai)室(shi)(shi)性(xing)心(xin)(xin)律(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)(chang)(chang)(chang)(chang)的(de)(de)(de)(de)(de)(de)(de)防治(zhi)(zhi)(zhi)中(zhong)(zhong)具有自己獨特的(de)(de)(de)(de)(de)(de)(de)治(zhi)(zhi)(zhi)療(liao)(liao)(liao)價值。“巴塞爾(er)心(xin)(xin)肌(ji)(ji)梗(geng)(geng)幸存者(zhe)(zhe)(zhe)的(de)(de)(de)(de)(de)(de)(de)抗(kang)(kang)心(xin)(xin)律(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)(chang)(chang)(chang)(chang)研究(Basel antiarrhythmic study of infarction survival，BASIS)”在(zai)臨床(chuang)實踐中(zhong)(zhong)提示胺(an)(an)(an)碘(dian)酮(tong)(tong)(tong)(tong)(tong)(tong)在(zai)心(xin)(xin)臟(zang)性(xing)猝死(si)防治(zhi)(zhi)(zhi)中(zhong)(zhong)的(de)(de)(de)(de)(de)(de)(de)價值。BASIS由(you)瑞士學(xue)者(zhe)(zhe)(zhe)完(wan)(wan)成(cheng)，入選病(bing)例(li)為(wei)心(xin)(xin)肌(ji)(ji)梗(geng)(geng)死(si)后(hou)(hou)8～24天并伴(ban)有室(shi)(shi)性(xing)期前(qian)收(shou)縮在(zai)Lown氏(shi)分(fen)級4～6級的(de)(de)(de)(de)(de)(de)(de)患者(zhe)(zhe)(zhe)。321例(li)患者(zhe)(zhe)(zhe)被隨(sui)機(ji)分(fen)為(wei)2組(zu)(zu)(zu)(zu)，分(fen)別用(yong)安(an)慰(wei)(wei)劑、胺(an)(an)(an)碘(dian)酮(tong)(tong)(tong)(tong)(tong)(tong)和(he)(he)(he)(he)其(qi)他抗(kang)(kang)心(xin)(xin)律(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)(chang)(chang)(chang)(chang)藥(yao)(yao)物(wu)(wu)(wu)治(zhi)(zhi)(zhi)療(liao)(liao)(liao)，結(jie)果胺(an)(an)(an)腆酮(tong)(tong)(tong)(tong)(tong)(tong)治(zhi)(zhi)(zhi)療(liao)(liao)(liao)組(zu)(zu)(zu)(zu)的(de)(de)(de)(de)(de)(de)(de)心(xin)(xin)臟(zang)性(xing)猝死(si)率(lv)為(wei)5%，顯著低于安(an)慰(wei)(wei)劑治(zhi)(zhi)(zhi)療(liao)(liao)(liao)組(zu)(zu)(zu)(zu)的(de)(de)(de)(de)(de)(de)(de)11.4%t和(he)(he)(he)(he)其(qi)他抗(kang)(kang)心(xin)(xin)律(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)(chang)(chang)(chang)(chang)藥(yao)(yao)物(wu)(wu)(wu)治(zhi)(zhi)(zhi)療(liao)(liao)(liao)組(zu)(zu)(zu)(zu)的(de)(de)(de)(de)(de)(de)(de)9%。此(ci)外，另外兩項大規模(mo)隨(sui)機(ji)臨床(chuang)試(shi)(shi)驗(yan)(yan)“加拿(na)大胺(an)(an)(an)碘(dian)酮(tong)(tong)(tong)(tong)(tong)(tong)心(xin)(xin)肌(ji)(ji)梗(geng)(geng)死(si)心(xin)(xin)律(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)(chang)(chang)(chang)(chang)試(shi)(shi)驗(yan)(yan)(Canadian amiodarone myocardial infarction arrhythmia trial，CAMIAT)”和(he)(he)(he)(he)歐洲心(xin)(xin)肌(ji)(ji)梗(geng)(geng)死(si)胺(an)(an)(an)碘(dian)酮(tong)(tong)(tong)(tong)(tong)(tong)試(shi)(shi)驗(yan)(yan)“European myocardial infarction amiodarone trial，EMIAT)”正在(zai)進行，最后(hou)(hou)結(jie)果尚未揭曉。CAMLAT有21個(ge)醫(yi)學(xue)中(zhong)(zhong)心(xin)(xin)參加，計劃入選心(xin)(xin)肌(ji)(ji)梗(geng)(geng)死(si)后(hou)(hou)6～45天伴(ban)室(shi)(shi)性(xing)期前(qian)收(shou)縮10次(ci)(ci)/h以(yi)上(shang)(shang)或室(shi)(shi)性(xing)心(xin)(xin)動(dong)過(guo)速1次(ci)(ci)以(yi)上(shang)(shang)的(de)(de)(de)(de)(de)(de)(de)患者(zhe)(zhe)(zhe)，隨(sui)機(ji)分(fen)為(wei)胺(an)(an)(an)碘(dian)酮(tong)(tong)(tong)(tong)(tong)(tong)治(zhi)(zhi)(zhi)療(liao)(liao)(liao)組(zu)(zu)(zu)(zu)和(he)(he)(he)(he)安(an)慰(wei)(wei)劑治(zhi)(zhi)(zhi)療(liao)(liao)(liao)組(zu)(zu)(zu)(zu)，預(yu)試(shi)(shi)完(wan)(wan)成(cheng)77例(li)，20個(ge)月(yue)的(de)(de)(de)(de)(de)(de)(de)觀察表(biao)明(ming)(ming)，胺(an)(an)(an)碘(dian)酮(tong)(tong)(tong)(tong)(tong)(tong)治(zhi)(zhi)(zhi)療(liao)(liao)(liao)組(zu)(zu)(zu)(zu)的(de)(de)(de)(de)(de)(de)(de)病(bing)死(si)率(lv)4%而安(an)慰(wei)(wei)劑治(zhi)(zhi)(zhi)療(liao)(liao)(liao)組(zu)(zu)(zu)(zu)的(de)(de)(de)(de)(de)(de)(de)病(bing)死(si)率(lv)14%。EMIAT由(you)61個(ge)醫(yi)學(xue)中(zhong)(zhong)心(xin)(xin)參加，計劃入選心(xin)(xin)肌(ji)(ji)梗(geng)(geng)死(si)后(hou)(hou)5～21天、左心(xin)(xin)室(shi)(shi)射血分(fen)數在(zai)40%以(yi)下的(de)(de)(de)(de)(de)(de)(de)室(shi)(shi)性(xing)心(xin)(xin)律(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)(chang)(chang)(chang)(chang)患者(zhe)(zhe)(zhe)，隨(sui)機(ji)分(fen)為(wei)安(an)慰(wei)(wei)劑治(zhi)(zhi)(zhi)療(liao)(liao)(liao)組(zu)(zu)(zu)(zu)和(he)(he)(he)(he)胺(an)(an)(an)碘(dian)酮(tong)(tong)(tong)(tong)(tong)(tong)治(zhi)(zhi)(zhi)療(liao)(liao)(liao)組(zu)(zu)(zu)(zu)。中(zhong)(zhong)期結(jie)果表(biao)明(ming)(ming)，胺(an)(an)(an)腆酮(tong)(tong)(tong)(tong)(tong)(tong)可(ke)顯著降低心(xin)(xin)肌(ji)(ji)梗(geng)(geng)死(si)后(hou)(hou)室(shi)(shi)性(xing)心(xin)(xin)律(lv)(lv)(lv)失(shi)(shi)(shi)(shi)(shi)常(chang)(chang)(chang)(chang)(chang)(chang)患者(zhe)(zhe)(zhe)的(de)(de)(de)(de)(de)(de)(de)心(xin)(xin)臟(zang)性(xing)猝死(si)率(lv)。
索(suo)(suo)他洛爾(er)(er)(sotalol)與胺碘酮(tong)相似，也具有(you)混合性抗(kang)心律(lv)(lv)失常(chang)作用。許多(duo)(duo)學(xue)者的臨床觀察表明(ming)，索(suo)(suo)他洛爾(er)(er)對心律(lv)(lv)失常(chang)患(huan)者的生存有(you)益(yi)，但還缺乏長(chang)期多(duo)(duo)中心臨床試驗(yan)的結(jie)果。
②β-腎(shen)上腺(xian)素受體(ti)阻滯(zhi)(zhi)藥(yao)：β-腎(shen)上腺(xian)能(neng)(neng)受體(ti)阻滯(zhi)(zhi)藥(yao)的(de)作用在于競爭心臟(zang)，血管(guan)和支氣(qi)管(guan)等組織(zhi)器官β腎(shen)上的(de)腺(xian)素能(neng)(neng)受體(ti)，使受體(ti)不能(neng)(neng)恢復到高親和力(li)狀態而與激動劑(ji)結合，從(cong)而抑(yi)制β腎(shen)上腺(xian)素能(neng)(neng)受體(ti)的(de)活(huo)性(xing)而發揮一(yi)系列的(de)藥(yao)理作用。
β受體阻(zu)滯(zhi)藥(yao)在(zai)心臟性(xing)猝死中的應用(yong)價值仍有爭議，但多(duo)數學(xue)者認為在(zai)一些心臟的某一亞組可使心臟性(xing)猝死的發(fa)生率降低。
到目前(qian)為止，已有大量的(de)(de)研究(jiu)提示(shi)，心(xin)(xin)(xin)肌(ji)(ji)梗(geng)(geng)(geng)死(si)(si)后的(de)(de)患者接(jie)受(shou)β受(shou)體阻滯劑治(zhi)療非常有益，特別是在降(jiang)低(di)心(xin)(xin)(xin)臟性猝(cu)死(si)(si)方(fang)面有較(jiao)顯(xian)著(zhu)的(de)(de)意義，并(bing)且還有人發現，在一定范(fan)圍(wei)內(nei)(nei)心(xin)(xin)(xin)率(lv)降(jiang)得越(yue)慢效果越(yue)明顯(xian)。已有2項多中(zhong)心(xin)(xin)(xin)隨機臨床試驗-(MIAMI)和(ISIS-I)觀察了β受(shou)體阻滯劑在胸痛(tong)發作(zuo)(zuo)12～24h內(nei)(nei)早期干(gan)預的(de)(de)作(zuo)(zuo)用。MIAMI入(ru)選胸痛(tong)發作(zuo)(zuo)24h以內(nei)(nei)的(de)(de)心(xin)(xin)(xin)肌(ji)(ji)梗(geng)(geng)(geng)死(si)(si)患者5778例，首先使用美(mei)托洛爾(er)15mg靜(jing)脈注(zhu)射，然后200mg/d口服(fu)，1周(zhou)病死(si)(si)率(lv)下降(jiang)13%。ISIS-I入(ru)選胸痛(tong)發作(zuo)(zuo)12h內(nei)(nei)的(de)(de)心(xin)(xin)(xin)肌(ji)(ji)梗(geng)(geng)(geng)死(si)(si)患者16000例，首先靜(jing)脈注(zhu)射阿替洛爾(er)5～10mg，然后每周(zhou)口服(fu)100mg，1周(zhou)內(nei)(nei)心(xin)(xin)(xin)血(xue)(xue)管(guan)病死(si)(si)率(lv)下降(jiang)15%。β-受(shou)體阻滯藥的(de)(de)作(zuo)(zuo)用主要是降(jiang)低(di)了心(xin)(xin)(xin)室顫(zhan)動或(huo)心(xin)(xin)(xin)臟破裂的(de)(de)發生率(lv)。在心(xin)(xin)(xin)肌(ji)(ji)梗(geng)(geng)(geng)死(si)(si)的(de)(de)后期，使用β-受(shou)體阻滯藥可使心(xin)(xin)(xin)血(xue)(xue)管(guan)總(zong)病死(si)(si)率(lv)降(jiang)低(di)20%～25%，但對(dui)心(xin)(xin)(xin)臟性猝(cu)死(si)(si)發生率(lv)的(de)(de)影(ying)響尚不清楚。
在高血壓患者(zhe)中，β-受體(ti)阻滯(zhi)(zhi)藥(yao)治(zhi)療也對心臟(zang)性(xing)(xing)猝死具有(you)(you)(you)(you)防治(zhi)作(zuo)用。但更多的學者(zhe)認為，只有(you)(you)(you)(you)脂(zhi)溶(rong)性(xing)(xing)的β-受體(ti)阻滯(zhi)(zhi)藥(yao)如美(mei)(mei)托(tuo)洛(luo)爾(er)才能有(you)(you)(you)(you)效(xiao)地降低心臟(zang)性(xing)(xing)猝死的發(fa)生率。脂(zhi)溶(rong)性(xing)(xing)β-受體(ti)阻滯(zhi)(zhi)藥(yao)在消化道易于(yu)吸收，易于(yu)通過(guo)血腦屏障，在中樞神(shen)經(jing)系統可以(yi)達到較(jiao)高的血藥(yao)濃度。一(yi)些小樣本研究提示，選擇性(xing)(xing)β-受體(ti)阻滯(zhi)(zhi)藥(yao)美(mei)(mei)托(tuo)洛(luo)爾(er)和阿替爾(er)對心臟(zang)性(xing)(xing)猝死的防治(zhi)有(you)(you)(you)(you)效(xiao)。
③正性肌(ji)力藥(yao)物：
在(zai)充(chong)血性(xing)心(xin)(xin)(xin)(xin)力(li)衰(shuai)竭(jie)(jie)(jie)患(huan)(huan)者中(zhong)(zhong)(zhong)，心(xin)(xin)(xin)(xin)臟性(xing)猝死(si)(si)的(de)發(fa)生(sheng)很高。1993年，Goldman等報道，冠心(xin)(xin)(xin)(xin)病(bing)引起的(de)充(chong)血性(xing)心(xin)(xin)(xin)(xin)力(li)衰(shuai)竭(jie)(jie)(jie)患(huan)(huan)者中(zhong)(zhong)(zhong)44%死(si)(si)于心(xin)(xin)(xin)(xin)臟性(xing)猝死(si)(si);非冠心(xin)(xin)(xin)(xin)病(bing)引起的(de)充(chong)血性(xing)心(xin)(xin)(xin)(xin)力(li)衰(shuai)竭(jie)(jie)(jie)患(huan)(huan)者中(zhong)(zhong)(zhong)，心(xin)(xin)(xin)(xin)臟性(xing)猝死(si)(si)的(de)發(fa)生(sheng)率為48%。因此，正性(xing)肌力(li)藥物在(zai)心(xin)(xin)(xin)(xin)臟性(xing)猝死(si)(si)防治中(zhong)(zhong)(zhong)的(de)價(jia)值受到人們的(de)關注。
正性肌力藥物主要包括兩(liang)類(lei)，即洋地黃類(lei)藥物和cAMP依賴性強心劑。
洋地(di)(di)(di)黃類(lei)藥(yao)(yao)物仍是(shi)目(mu)前(qian)治療心(xin)(xin)力(li)(li)(li)衰竭(jie)的(de)(de)(de)基(ji)本(ben)藥(yao)(yao)物。近年來的(de)(de)(de)研(yan)究(jiu)表明(ming)，洋地(di)(di)(di)黃類(lei)藥(yao)(yao)物不(bu)僅能增強心(xin)(xin)肌(ji)收(shou)縮力(li)(li)(li)、減慢心(xin)(xin)率和(he)傳(chuan)導(dao)，而且具有(you)神(shen)經內分泌調節作(zuo)用，可(ke)改善心(xin)(xin)力(li)(li)(li)衰竭(jie)患者(zhe)的(de)(de)(de)壓力(li)(li)(li)感(gan)受器功能低下和(he)交感(gan)神(shen)經系統(tong)、腎素(su)-血(xue)管(guan)緊(jin)張(zhang)素(su)-醛固酮系統(tong)的(de)(de)(de)功能亢進，并(bing)可(ke)提高心(xin)(xin)鈉素(su)的(de)(de)(de)分泌，降(jiang)低心(xin)(xin)臟前(qian)負荷。盡管(guan)洋地(di)(di)(di)黃的(de)(de)(de)應用已有(you)200多年的(de)(de)(de)歷(li)史(shi)，但他(ta)在充血(xue)性心(xin)(xin)力(li)(li)(li)衰竭(jie)治療中是(shi)否(fou)能降(jiang)低心(xin)(xin)臟性猝死(si)的(de)(de)(de)發生率仍不(bu)十分清(qing)楚。1998年以來，已有(you)幾項大規模隨機臨(lin)床試驗結(jie)果可(ke)直接或間(jian)接反(fan)映地(di)(di)(di)高辛治療心(xin)(xin)力(li)(li)(li)衰竭(jie)是(shi)有(you)效的(de)(de)(de)，不(bu)僅能改善充血(xue)性心(xin)(xin)力(li)(li)(li)衰竭(jie)的(de)(de)(de)癥狀，而且可(ke)以提高患者(zhe)的(de)(de)(de)運動量和(he)心(xin)(xin)功能，但均(jun)未闡明(ming)地(di)(di)(di)高辛對心(xin)(xin)臟性猝死(si)的(de)(de)(de)防治作(zuo)用。
CAMP依賴性(xing)強(qiang)心(xin)劑(ji)(ji)包括：受體激(ji)動劑(ji)(ji)和(he)(he)磷(lin)酸二酯酶(mei)Ⅲ抑制劑(ji)(ji)。前者主要多巴酚丁(ding)胺(an)、沙丁(ding)胺(an)醇等；后者包括氨力農。米力農。臨床實踐(jian)的結果(guo)表(biao)明，cAMP依賴性(xing)強(qiang)心(xin)劑(ji)(ji)在增強(qiang)心(xin)肌收縮力和(he)(he)改善(shan)患者的癥狀方面具(ju)有一度的療效，但口服給藥的不良(liang)反應較多，而且(qie)可增加(jia)心(xin)臟(zang)性(xing)猝(cu)死的發生率。因(yin)此，氨力農和(he)(he)米力農等藥物的口服給藥已經禁止采用。
④抗血小板藥：
A.臨床常用的抗血小板藥物及其作用原理：
抗血(xue)小(xiao)(xiao)板(ban)藥物(wu)(wu)是指能阻礙血(xue)小(xiao)(xiao)板(ban)黏附、聚集和(he)釋放反應，以防止血(xue)栓形成的藥物(wu)(wu)。根據作用(yong)的環節(jie)，常用(yong)的抗血(xue)小(xiao)(xiao)板(ban)藥物(wu)(wu)包括(kuo)以下幾類：
a.環氧化酶抑制藥：
包(bao)括阿司匹林(aspirin)、磺吡酮(苯(ben)磺唑酮)等(deng)。阿司匹林是一種非甾體抗炎藥，1971年發(fa)現它有抑(yi)制環氧(yang)化(hua)酶(mei)的作用，目前已成為最(zui)常用的抗血小板藥物(wu)。
花生(sheng)四烯酸(suan)在(zai)環(huan)氧(yang)化(hua)(hua)酶(mei)(即前列(lie)(lie)腺(xian)素合成酶(mei))的作用下(xia)形(xing)成不(bu)穩(wen)定(ding)的環(huan)內(nei)(nei)過氧(yang)化(hua)(hua)物(wu)，即前列(lie)(lie)腺(xian)素C2(PGG2)和前列(lie)(lie)腺(xian)素H2(PGH2)。環(huan)內(nei)(nei)過氧(yang)化(hua)(hua)物(wu)在(zai)血小板微粒(li)體中血栓烷合酶(mei)的作用下(xia)生(sheng)成血栓素A2(TXA2)，但TXA2不(bu)穩(wen)定(ding)，半衰(shuai)期(qi)為30s，迅速轉變為穩(wen)定(ding)的TXB2。在(zai)血管壁微粒(li)體中，環(huan)內(nei)(nei)過氧(yang)化(hua)(hua)物(wu)在(zai)6(9)-環(huan)氧(yang)化(hua)(hua)酶(mei)作用下(xia)合成前列(lie)(lie)腺(xian)素I2(PGl2)，然后代謝為6-酮-PGFla。TAX2使(shi)血管收縮，降低血小板cAMP，促進(jin)血小板聚集(ji)和血栓形(xing)成。
阿(a)司(si)匹(pi)(pi)林(lin)(lin)主(zhu)要抑制環氧化酶，使其(qi)活性基團(tuan)乙酰化，從而阻止TXA2和PGI2的(de)生(sheng)成。由于(yu)阿(a)司(si)匹(pi)(pi)林(lin)(lin)在抑制TXB2的(de)同時，也對(dui)PGI2造成了抑制，則阿(a)司(si)匹(pi)(pi)林(lin)(lin)使用(yong)的(de)有(you)益作用(yong)被(bei)削弱(ruo)或抵消。大(da)量研(yan)究表明，75～325mg/d的(de)阿(a)司(si)匹(pi)(pi)林(lin)(lin)給藥對(dui)PGI2的(de)影響(xiang)較弱(ruo)或幾乎沒有(you)影響(xiang)，而對(dui)TXB2的(de)仍有(you)明顯(xian)的(de)抑制作用(yong)。
磺吡(bi)酮(苯(ben)磺唑酮)是保太松類藥物的衍生物，1950年(nian)被用(yong)于(yu)治療痛風(feng)，1965年(nian)發現(xian)它對血(xue)小板(ban)功能具有(you)明顯影響。現(xian)已(yi)知道，主要抑制(zhi)血(xue)小板(ban)的環氧化酶而(er)抑制(zhi)TXA2的合(he)成，并可(ke)抑制(zhi)血(xue)小板(ban)的聚集(ji)和釋(shi)放反應。對血(xue)管內(nei)皮細胞合(he)成的PGI2影響極(ji)小。
b.磷酸(suan)二酯酶抑制藥：
包括雙(shuang)嘧達(da)莫(persantine)等。雙(shuang)嘧達(da)莫又叫(jiao)潘生(sheng)丁(ding)，是一種廣泛應(ying)用于臨床的抗(kang)血(xue)(xue)小(xiao)板(ban)藥物，其機制(zhi)(zhi)是抑(yi)制(zhi)(zhi)血(xue)(xue)小(xiao)板(ban)的磷酸二酯(zhi)酶(mei)(mei)，使血(xue)(xue)小(xiao)板(ban)的cAMP含量升高(gao)。同時，雙(shuang)嘧達(da)莫(潘生(sheng)丁(ding))還(huan)可(ke)通(tong)過增加血(xue)(xue)液的腺(xian)苷濃度而抑(yi)制(zhi)(zhi)血(xue)(xue)小(xiao)板(ban)的聚集和釋放反(fan)應(ying)。潘生(sheng)丁(ding)可(ke)抑(yi)制(zhi)(zhi)紅細胞(bao)和心、肺等組織細胞(bao)對血(xue)(xue)中腺(xian)苷的攝取。則(ze)腺(xian)苷不(bu)能被腺(xian)苷脫胺酶(mei)(mei)所破壞(huai)，血(xue)(xue)液中腺(xian)苷水平增加，一般(ban)口服(fu)給(gei)藥，每次400mg，1～2次/d。主(zhu)要不(bu)良(liang)反(fan)應(ying)為(wei)胃腸道癥狀(zhuang)。
c.血栓(shuan)合(he)成酶抑制(zhi)藥(yao)：
包括水楊酸咪(mi)(mi)唑(zuo)(咪(mi)(mi)唑(zuo))、達唑(zuo)氧苯(ben)(dazoxiben)、對乙酰氨基酚(fen)(APA)等。
d.腺苷酸環化酶激活(huo)劑：
依前(qian)列醇(前(qian)列腺素I2)和前(qian)列地爾(er)(前(qian)列腺素E1) 等。
e.其他：
噻(sai)(sai)氯匹定(ding)(噻(sai)(sai)氯吡啶)、舒(shu)洛地爾(suloctidil)等。
B.抗血小板藥物防(fang)治心(xin)臟(zang)性猝死(si)的價值(zhi)：
在抗血小板藥物(wu)的(de)(de)(de)研究中(zhong)，較(jiao)多(duo)(duo)的(de)(de)(de)資料為阿(a)(a)(a)(a)司(si)匹(pi)(pi)林。許多(duo)(duo)研究表(biao)明(ming)，阿(a)(a)(a)(a)司(si)匹(pi)(pi)林在穩定性(xing)(xing)和不(bu)(bu)(bu)穩定性(xing)(xing)心(xin)(xin)絞痛患者(zhe)中(zhong)的(de)(de)(de)應用(yong)(yong)后(hou)，可顯(xian)著降低(di)致(zhi)死(si)(si)性(xing)(xing)和非(fei)致(zhi)死(si)(si)性(xing)(xing)心(xin)(xin)肌(ji)(ji)梗死(si)(si)的(de)(de)(de)發(fa)生率(lv);在心(xin)(xin)肌(ji)(ji)梗死(si)(si)患者(zhe)應用(yong)(yong)后(hou)，可顯(xian)著降低(di)再(zai)梗死(si)(si)的(de)(de)(de)發(fa)生率(lv)。但是(shi)，有關阿(a)(a)(a)(a)司(si)匹(pi)(pi)林防(fang)治心(xin)(xin)臟(zang)(zang)病(bing)猝(cu)死(si)(si)的(de)(de)(de)價值，不(bu)(bu)(bu)同學(xue)者(zhe)的(de)(de)(de)報道不(bu)(bu)(bu)盡一致(zhi)。德國-奧地利多(duo)(duo)中(zhong)心(xin)(xin)研究結(jie)果提示，阿(a)(a)(a)(a)司(si)匹(pi)(pi)林對心(xin)(xin)臟(zang)(zang)性(xing)(xing)猝(cu)死(si)(si)的(de)(de)(de)防(fang)治有一定作用(yong)(yong)。Elwood等報道用(yong)(yong)阿(a)(a)(a)(a)司(si)匹(pi)(pi)林治療心(xin)(xin)肌(ji)(ji)梗死(si)(si)進行隨機(ji)、雙盲(mang)大宗(zong)病(bing)例研究的(de)(de)(de)結(jie)果，發(fa)現在心(xin)(xin)肌(ji)(ji)梗死(si)(si)后(hou)6周以內使(shi)用(yong)(yong)阿(a)(a)(a)(a)司(si)匹(pi)(pi)林者(zhe)，33個月隨訪期間(jian)的(de)(de)(de)心(xin)(xin)臟(zang)(zang)性(xing)(xing)猝(cu)死(si)(si)率(lv)在阿(a)(a)(a)(a)司(si)匹(pi)(pi)林組為7.8%、安慰劑組為13.5%，阿(a)(a)(a)(a)司(si)匹(pi)(pi)林組心(xin)(xin)臟(zang)(zang)性(xing)(xing)猝(cu)死(si)(si)的(de)(de)(de)發(fa)生率(lv)降低(di)了42%。如果阿(a)(a)(a)(a)司(si)匹(pi)(pi)林的(de)(de)(de)使(shi)用(yong)(yong)時間(jian)較(jiao)晚則對心(xin)(xin)臟(zang)(zang)性(xing)(xing)猝(cu)死(si)(si)的(de)(de)(de)發(fa)生率(lv)無明(ming)顯(xian)作用(yong)(yong)。
雙嘧(mi)達莫(mo)(mo)(潘(pan)生(sheng)丁)在(zai)心(xin)(xin)臟性猝(cu)死防治中的(de)評價研究多為(wei)與阿司匹林(lin)聯合應(ying)用。雙嘧(mi)達莫(mo)(mo)(潘(pan)生(sheng)丁)和阿司匹林(lin)的(de)再梗死研究(PARIS)的(de)結果(guo)提示，雙嘧(mi)達莫(mo)(mo)(潘(pan)生(sheng)丁)和阿司匹林(lin)合用可降(jiang)低心(xin)(xin)肌梗死后的(de)總(zong)病死率和心(xin)(xin)臟性猝(cu)死發生(sheng)率。
磺(huang)(huang)吡(bi)酮(tong)(苯(ben)磺(huang)(huang)唑酮(tong))在(zai)(zai)心(xin)臟性(xing)猝死防治中的價值研(yan)究不多。美國磺(huang)(huang)吡(bi)酮(tong)(苯(ben)磺(huang)(huang)唑酮(tong))研(yan)究組報道，在(zai)(zai)6個(ge)月內，磺(huang)(huang)吡(bi)酮(tong)(苯(ben)磺(huang)(huang)唑酮(tong))可顯著(zhu)降低(di)心(xin)臟性(xing)猝死的發生率;而在(zai)(zai)6個(ge)月后對心(xin)臟性(xing)猝死的發生率無(wu)明(ming)顯影響。
⑤血管緊(jin)張素轉換酶(mei)抑(yi)制藥：
血(xue)管緊張素轉(zhuan)換酶抑制藥(angiotensin converting enzyme inhibitor，ACEI)是目(mu)前(qian)世(shi)界上(shang)發(fa)(fa)展最(zui)快的一(yi)類(lei)心血(xue)管藥物，目(mu)前(qian)在臨床(chuang)上(shang)得到廣泛應(ying)用(yong)，許多研究(jiu)發(fa)(fa)現，ACEI對心肌梗(geng)死(si)(si)、高血(xue)壓和(he)充血(xue)性心力衰竭等疾(ji)病可能并發(fa)(fa)的心臟性猝死(si)(si)具有一(yi)定的防治作用(yong)。
目前(qian)，ACEI已(yi)發(fa)展(zhan)到幾十種。根據(ju)其含有(you)(you)的(de)(de)(de)基(ji)團不(bu)同，ACEI可(ke)(ke)分(fen)為(wei)3種類型：A.含巰(qiu)(qiu)基(ji)的(de)(de)(de)ACEI。主(zhu)要(yao)有(you)(you)卡(ka)托普(pu)利(li)(captopril);B.含羥(qian)(qian)基(ji)的(de)(de)(de)ACEI。主(zhu)要(yao)有(you)(you)依那普(pu)利(li)(enalapril)、雷(lei)米普(pu)利(li)(ramipril)、貝(bei)那普(pu)利(li)(苯拉普(pu)利(li))等。C.含磷酰基(ji)的(de)(de)(de)ACEI。主(zhu)要(yao)有(you)(you)福辛普(pu)利(li)(fosinopril)等。其基(ji)本作用(yong)機制是抑制血(xue)(xue)(xue)管緊張素轉(zhuan)換(huan)酶(mei)(mei)，血(xue)(xue)(xue)管緊張素轉(zhuan)換(huan)酶(mei)(mei)是一種含有(you)(you)鋅(xin)(xin)離子(zi)的(de)(de)(de)金屬(shu)蛋白，各個活性(xing)部(bu)位都含有(you)(you)鋅(xin)(xin)離子(zi)，ACEI的(de)(de)(de)巰(qiu)(qiu)基(ji)、羥(qian)(qian)基(ji)或磷酰基(ji)可(ke)(ke)與鋅(xin)(xin)離子(zi)發(fa)生牢(lao)固的(de)(de)(de)絡合(he)作用(yong)而(er)使血(xue)(xue)(xue)管緊張素轉(zhuan)換(huan)酶(mei)(mei)失去活性(xing)。結果(guo)血(xue)(xue)(xue)管緊張素Ⅰ不(bu)能轉(zhuan)變為(wei)血(xue)(xue)(xue)管緊張素Ⅱ，可(ke)(ke)導致血(xue)(xue)(xue)管擴張、醛固酮分(fen)泌減(jian)(jian)少和交感(gan)神經張力(li)降(jiang)低(di)。此(ci)外，ACEI還(huan)可(ke)(ke)抑制激(ji)(ji)肽(tai)酶(mei)(mei)，減(jian)(jian)慢緩激(ji)(ji)肽(tai)的(de)(de)(de)降(jiang)解，引起血(xue)(xue)(xue)管擴張;同時，緩激(ji)(ji)肽(tai)的(de)(de)(de)濃度(du)增高可(ke)(ke)激(ji)(ji)活前(qian)磷脂酶(mei)(mei)而(er)使前(qian)列(lie)腺素的(de)(de)(de)生成增加。ACEI還(huan)可(ke)(ke)減(jian)(jian)少鈣離子(zi)內流，使心(xin)肌細(xi)胞(bao)內鈣離子(zi)超負荷而(er)引起的(de)(de)(de)心(xin)律失常減(jian)(jian)少。這些(xie)作用(yong)對于(yu)冠心(xin)病、高血(xue)(xue)(xue)壓病和充(chong)血(xue)(xue)(xue)性(xing)心(xin)力(li)衰竭(jie)等具有(you)(you)治療價值，還(huan)可(ke)(ke)增加心(xin)肌細(xi)胞(bao)電活動(dong)的(de)(de)(de)穩定性(xing)。
⑥代謝類藥物：
曲美他嗪(qin)(萬爽(shuang)力(li))，抑制(zhi)心(xin)肌細胞(bao)線(xian)粒(li)體內(nei)脂(zhi)肪酸的氧化，加速糖原酵解(jie)，增(zeng)加心(xin)肌細胞(bao)無(wu)氧代謝下ATP的產生(sheng)，增(zeng)強心(xin)肌細胞(bao)的抗缺血能(neng)力(li)，從而可預防心(xin)臟性猝死(si)的發(fa)生(sheng)。
埋藏式自動(dong)心(xin)臟復律除顫器(ICD)的(de)應(ying)用(yong)是防治心(xin)臟性(xing)(xing)(xing)猝(cu)死的(de)重要進展，對致命性(xing)(xing)(xing)室性(xing)(xing)(xing)心(xin)律失常(chang)引起的(de)心(xin)臟性(xing)(xing)(xing)猝(cu)死具(ju)有肯(ken)定的(de)防治作用(yong)。
植(zhi)入ICD的(de)(de)(de)臨床價值(zhi)在于有效地(di)防(fang)治心(xin)(xin)臟猝死(si)。據文獻報道，美國(guo)每年因心(xin)(xin)臟驟(zou)停而發(fa)生心(xin)(xin)臟性(xing)猝死(si)的(de)(de)(de)患者(zhe)(zhe)達50萬(wan)人以上，歐洲約40萬(wan)人。其中(zhong)75%～80%的(de)(de)(de)患者(zhe)(zhe)在第1次(ci)心(xin)(xin)臟驟(zou)停發(fa)作時(shi)死(si)亡，經有效心(xin)(xin)肺腦復蘇(su)而幸存者(zhe)(zhe)中(zhong)20%～25%的(de)(de)(de)患者(zhe)(zhe)可在1年內(nei)再次(ci)發(fa)生心(xin)(xin)臟驟(zou)停，因此(ci)，ICD的(de)(de)(de)應用范圍(wei)非常廣泛。
也有一些學者對(dui)植(zhi)入ICD的(de)(de)(de)兩種不同方式進行了對(dui)比，結(jie)果發現經(jing)靜脈植(zhi)入ICD的(de)(de)(de)圍術(shu)期病(bing)死率較低，長期隨訪(fang)的(de)(de)(de)存活(huo)率高，應列(lie)為(wei)首選方法。Saksena等總結(jie)了221例(li)多中心植(zhi)入ICD的(de)(de)(de)結(jie)果，開胸法植(zhi)入ICD的(de)(de)(de)圍術(shu)期病(bing)死率為(wei)4.2%，經(jing)靜脈法為(wei)0.8%，隨訪(fang)2年的(de)(de)(de)總成活(huo)率分別為(wei)81.9%和(he)87.6%，并無顯(xian)著(zhu)性差(cha)異。
為了(le)明確揭示埋(mai)(mai)藏(zang)式心(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)復律(lv)除(chu)顫(zhan)器(qi)防治心(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)猝(cu)死的(de)價值(zhi)，有學者進行(xing)了(le)一些(xie)多(duo)中(zhong)心(xin)(xin)(xin)(xin)(xin)隨機化(hua)前瞻性(xing)(xing)對照研(yan)究(jiu)(jiu)。抗(kang)心(xin)(xin)(xin)(xin)(xin)律(lv)失(shi)常藥(yao)物與(yu)埋(mai)(mai)藏(zang)式心(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)復律(lv)除(chu)顫(zhan)器(qi)對致(zhi)命性(xing)(xing)室(shi)(shi)性(xing)(xing)心(xin)(xin)(xin)(xin)(xin)律(lv)失(shi)常復蘇患者治療(liao)比(bi)(bi)較(jiao)研(yan)究(jiu)(jiu)(AVID)表明，室(shi)(shi)顫(zhan)復蘇者或有癥狀和血流動力學障礙的(de)持續性(xing)(xing)室(shi)(shi)性(xing)(xing)心(xin)(xin)(xin)(xin)(xin)動過速患者，應用埋(mai)(mai)藏(zang)式心(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)復律(lv)除(chu)顫(zhan)器(qi)與(yu)抗(kang)心(xin)(xin)(xin)(xin)(xin)律(lv)失(shi)常藥(yao)物相比(bi)(bi)，可明顯(xian)提高生存(cun)率。其他一些(xie)多(duo)中(zhong)心(xin)(xin)(xin)(xin)(xin)試驗(yan)如多(duo)中(zhong)心(xin)(xin)(xin)(xin)(xin)自動除(chu)顫(zhan)器(qi)埋(mai)(mai)藏(zang)試驗(yan)(MADIT)、加拿大(da)埋(mai)(mai)藏(zang)式除(chu)顫(zhan)器(qi)研(yan)究(jiu)(jiu)(CIDS)、漢堡心(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)驟停(ting)研(yan)究(jiu)(jiu)(CASH)、美(mei)國心(xin)(xin)(xin)(xin)(xin)、肺和血液研(yan)究(jiu)(jiu)所埋(mai)(mai)藏(zang)式心(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)復律(lv)除(chu)顫(zhan)器(qi)(NHLBHCD)等有的(de)已(yi)經完成，有的(de)正在進行(xing)，最后將揭示ICD防治心(xin)(xin)(xin)(xin)(xin)臟(zang)(zang)性(xing)(xing)猝(cu)死的(de)確切價值(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經導管射(she)頻消融治(zhi)療室(shi)(shi)性(xing)(xing)(xing)心(xin)律失常：室(shi)(shi)性(xing)(xing)(xing)心(xin)動(dong)過速發(fa)作時常引起(qi)嚴重的(de)(de)(de)(de)血(xue)流動(dong)力學(xue)障礙，心(xin)臟性(xing)(xing)(xing)猝死的(de)(de)(de)(de)發(fa)生率(lv)高。1988年，Davis首次使(shi)用(yong)射(she)頻消融治(zhi)療室(shi)(shi)性(xing)(xing)(xing)心(xin)動(dong)過速成功(gong)，開創射(she)頻消融的(de)(de)(de)(de)新領域(yu)，但至今仍不如室(shi)(shi)上性(xing)(xing)(xing)心(xin)動(dong)過速使(shi)用(yong)普遍。室(shi)(shi)性(xing)(xing)(xing)心(xin)動(dong)過速的(de)(de)(de)(de)消融，成功(gong)的(de)(de)(de)(de)關(guan)鍵之一(yi)是心(xin)動(dong)過速的(de)(de)(de)(de)起(qi)源定位，其方(fang)法是進行心(xin)內膜標(biao)測(ce)，一(yi)般(ban)根據Josephson提出的(de)(de)(de)(de)18個(ge)點標(biao)測(ce)，左心(xin)室(shi)(shi)12，右心(xin)室(shi)(shi)6個(ge)，標(biao)測(ce)方(fang)法有3種：
A.竇性(xing)心律時的標測(ce)：
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(dian)(dian)極在(zai)心(xin)(xin)室的(de)不(bu)同(tong)部位(wei)作心(xin)(xin)內膜起(qi)搏，起(qi)搏頻率與心(xin)(xin)動過(guo)速(su)(su)(su)的(de)頻率相(xiang)同(tong)，記錄12導聯(lian)心(xin)(xin)電(dian)(dian)圖，若11個以(yi)上導聯(lian)的(de)圖形與心(xin)(xin)動過(guo)速(su)(su)(su)發作時的(de)相(xiang)同(tong)，可(ke)認為該(gai)起(qi)搏部位(wei)即是心(xin)(xin)動過(guo)速(su)(su)(su)的(de)起(qi)源部位(wei)，但起(qi)搏標測也不(bu)可(ke)靠。
C.心動過速時(shi)的標測：
有心(xin)動過(guo)速(su)發作時(shi)，在心(xin)室內(nei)不(bu)同(tong)部位(wei)(wei)記錄(lu)心(xin)內(nei)膜(mo)電圖，比較(jiao)哪一部位(wei)(wei)的(de)(de)(de)(de)心(xin)室激動時(shi)間比體(ti)表心(xin)電圖的(de)(de)(de)(de)QRS波提前，則最(zui)早(zao)激動的(de)(de)(de)(de)部位(wei)(wei)是心(xin)動過(guo)速(su)的(de)(de)(de)(de)起源點。心(xin)運過(guo)速(su)的(de)(de)(de)(de)標(biao)測(ce)是室性心(xin)動過(guo)速(su)定位(wei)(wei)的(de)(de)(de)(de)較(jiao)可靠方法。
準(zhun)確定位后，行射頻(pin)消融，一般用30～40W，10～30s。成功的(de)因素(su)是：精確的(de)起(qi)搏標(biao)測;最早的(de)局部心(xin)室激動;導管(guan)電(dian)極與心(xin)內(nei)膜密(mi)切(qie)接(jie)觸。失(shi)敗的(de)因素(su)是：消融電(dian)極未到達起(qi)源(yuan)點(dian);導管(guan)電(dian)極與心(xin)內(nei)膜接(jie)觸不緊密(mi);室性心(xin)動過速的(de)起(qi)源(yuan)點(dian)位于心(xin)肌(ji)內(nei)或心(xin)外膜。
不同類(lei)型的(de)(de)(de)室(shi)速(su)，消融(rong)(rong)的(de)(de)(de)療(liao)效不同，其(qi)中，無(wu)(wu)器質心(xin)臟病(bing)的(de)(de)(de)特發性(xing)(xing)(xing)(xing)(xing)(xing)室(shi)速(su)，成功(gong)(gong)(gong)率(lv)達94%。束(shu)支折(zhe)(zhe)(zhe)(zhe)返(fan)(fan)性(xing)(xing)(xing)(xing)(xing)(xing)心(xin)動(dong)過(guo)速(su)，是由希氏-心(xin)肌傳導系統(tong)參與(yu)的(de)(de)(de)大折(zhe)(zhe)(zhe)(zhe)返(fan)(fan)，消融(rong)(rong)右束(shu)即可終止(zhi)室(shi)速(su)，成功(gong)(gong)(gong)率(lv)超過(guo)90%。目(mu)前較(jiao)困難(nan)的(de)(de)(de)是梗(geng)死后(hou)室(shi)性(xing)(xing)(xing)(xing)(xing)(xing)心(xin)動(dong)過(guo)速(su)成功(gong)(gong)(gong)率(lv)不高，一般(ban)在45%～93%，差異較(jiao)大，其(qi)原因在于梗(geng)死性(xing)(xing)(xing)(xing)(xing)(xing)心(xin)動(dong)過(guo)速(su)的(de)(de)(de)機制較(jiao)復雜所致。梗(geng)死后(hou)室(shi)性(xing)(xing)(xing)(xing)(xing)(xing)心(xin)動(dong)過(guo)速(su)的(de)(de)(de)射(she)頻消融(rong)(rong)，包括以下(xia)幾種情形：a.瘢痕(hen)(hen)周(zhou)圍折(zhe)(zhe)(zhe)(zhe)返(fan)(fan)：必須(xu)在瘢痕(hen)(hen)組織周(zhou)圍產(chan)生較(jiao)大損傷，折(zhe)(zhe)(zhe)(zhe)返(fan)(fan)才能(neng)終止(zhi);b.瘢痕(hen)(hen)內折(zhe)(zhe)(zhe)(zhe)返(fan)(fan)：大部分病(bing)例可用射(she)頻消融(rong)(rong)成功(gong)(gong)(gong);c.功(gong)(gong)(gong)能(neng)性(xing)(xing)(xing)(xing)(xing)(xing)折(zhe)(zhe)(zhe)(zhe)返(fan)(fan)：射(she)頻消融(rong)(rong)常常無(wu)(wu)效。有時，射(she)頻消融(rong)(rong)術后(hou)可在功(gong)(gong)(gong)能(neng)性(xing)(xing)(xing)(xing)(xing)(xing)上(shang)折(zhe)(zhe)(zhe)(zhe)返(fan)(fan)的(de)(de)(de)基礎(chu)上(shang)，增加一個解(jie)剖性(xing)(xing)(xing)(xing)(xing)(xing)因素而產(chan)生更為(wei)頑固(gu)的(de)(de)(de)折(zhe)(zhe)(zhe)(zhe)返(fan)(fan)性(xing)(xing)(xing)(xing)(xing)(xing)心(xin)律失常。
②經皮球(qiu)囊冠(guan)狀(zhuang)動脈(mo)成(cheng)形(xing)術(shu)(shu)治(zhi)療冠(guan)心病。從理論上講，經皮球(qiu)囊冠(guan)狀(zhuang)動脈(mo)形(xing)成(cheng)術(shu)(shu)治(zhi)療冠(guan)心病應(ying)能有效降(jiang)低(di)心臟(zang)性猝死的發生(sheng)率。當迄(qi)今(jin)未(wei)見到(dao)多中心隨機臨床觀察資料。
①室(shi)性(xing)心律失常的外科(ke)治療：
近10幾年來，用手術(shu)切割(ge)、冷凍或激光等手段可成(cheng)功地控制或根治室(shi)(shi)性心(xin)動過速/或心(xin)室(shi)(shi)顫動，從(cong)而減少心(xin)臟性猝死(si)的發(fa)生(sheng)率。
A.內(nei)膜病灶切除術：
這種治療方法(fa)(fa)于1979年由Harken用(yong)于臨床，其方法(fa)(fa)是首先進(jin)行(xing)病(bing)灶(zao)定位。Harken等的(de)(de)方法(fa)(fa)是在常溫體外循環(huan)下，用(yong)手持移(yi)動電極在心(xin)(xin)內膜面進(jin)行(xing)標測，找出(chu)(chu)最(zui)早心(xin)(xin)室(shi)激(ji)動部位，經左(zuo)心(xin)(xin)室(shi)切口對標測出(chu)(chu)來(lai)的(de)(de)最(zui)早心(xin)(xin)室(shi)激(ji)動部位作直徑(jing)2～3cm厚(hou)約數毫米的(de)(de)盤(pan)狀(zhuang)切除。心(xin)(xin)內膜病(bing)灶(zao)切除術適用(yong)于病(bing)灶(zao)局限，尤其適用(yong)于位于室(shi)壁瘤邊緣而遠(yuan)離心(xin)(xin)臟傳導系(xi)統和乳頭肌的(de)(de)病(bing)灶(zao)。
B.心(xin)內膜環形心(xin)室肌切除術：
對(dui)于有室壁(bi)瘤(liu)而(er)伴發室性(xing)心(xin)動(dong)過速的(de)患者可在室壁(bi)瘤(liu)邊緣的(de)正常心(xin)內膜(mo)作弧形切(qie)口，深(shen)達心(xin)肌層(ceng)，直到僅留一(yi)層(ceng)靠(kao)近心(xin)外膜(mo)的(de)肌橋。該(gai)法由(you)Guiraudon等于1987年首創(chuang)。因術后左(zuo)室受損(sun)，現已少用。
C.心室隔(ge)離術：
僅適用于右(you)心(xin)(xin)室(shi)(shi)游離壁或(huo)右(you)心(xin)(xin)室(shi)(shi)流出道的病灶。其(qi)方法是(shi)以右(you)房(fang)溝為基底，圍(wei)繞(rao)某一(yi)分(fen)支血(xue)管對可疑心(xin)(xin)室(shi)(shi)壁做半島狀(zhuang)切開，使它和右(you)心(xin)(xin)室(shi)(shi)壁的其(qi)余部分(fen)分(fen)離。
D.外(wai)科冷凍消融術：
對于靠近心臟傳導系統或腱(jian)索的病灶，直接進(jin)行外科(ke)手(shou)術(shu)切除術(shu)可發生嚴重的并發癥(zheng)，則宜在(zai)外科(ke)手(shou)術(shu)直視下進(jin)行冷凍治療，使病灶降(jiang)溫(wen)至(zhi)0℃持(chi)續1min。如(ru)果有效則降(jiang)溫(wen)至(zhi)-60℃持(chi)續2min。
E.外科激光(guang)消融術：
用激光代替冷凍(dong)而消除心(xin)律(lv)失常(chang)的病(bing)灶(zao)。
②冠狀動脈旁路術：
對(dui)于嚴重冠(guan)(guan)狀(zhuang)動(dong)脈(mo)病變的(de)患者進行冠(guan)(guan)狀(zhuang)動(dong)脈(mo)旁路術(shu)可(ke)有效的(de)改善心肌供血，減輕(qing)或消除心絞痛的(de)癥狀(zhuang)。已有一(yi)些多中心研究結果顯(xian)示，冠(guan)(guan)狀(zhuang)動(dong)脈(mo)旁路術(shu)可(ke)延(yan)長冠(guan)(guan)心病患者的(de)生(sheng)存期(qi)，但對(dui)心臟性猝死發生(sheng)率的(de)影響，所見報道極(ji)少。
（1）判斷意識
拍雙肩，喚(huan)雙耳，搭脈搏，10秒鐘內完成(cheng)
（2）呼(hu)救（撥打120）
完成第(di)一(yi)步后，馬上拔(ba)打120，給病人爭取(qu)救治的(de)第(di)一(yi)時間。
（3）擺放(fang)仰臥(wo)體位
（4）胸外(wai)按壓30次(ci)（兒童(tong)15次(ci)）
位置：胸(xiong)部(bu)正中(zhong)，兩(liang)乳頭連線(xian)中(zhong)點；
姿(zi)勢：肩關(guan)(guan)節、肘關(guan)(guan)節、腕關(guan)(guan)節垂直(zhi)成一(yi)條(tiao)直(zhi)線。
雙(shuang)手(shou)掌重疊，手(shou)指抬起；掌根用力。
力(li)度：按(an)下去至少5cm；
頻率：至(zhi)少(shao)100次/分鐘；
（5）開放(fang)氣道(dao)（仰頭舉頦(ke)法）
（6）人工吹(chui)(chui)氣2次（兒童1次）捏(nie)鼻，口包口，吹(chui)(chui)氣
（7）重復第四(si)、五、六步
（8）注意事項：研究(jiu)發現(xian)，倒地1分(fen)(fen)鐘(zhong)內(nei)進行心肺復蘇，救活的概(gai)率為(wei)90%；2分(fen)(fen)鐘(zhong)內(nei)60%；4分(fen)(fen)鐘(zhong)內(nei)40%；8分(fen)(fen)鐘(zhong)內(nei)為(wei)20%；超過10分(fen)(fen)鐘(zhong)，基本上就是(shi)零了(le)。為(wei)了(le)預(yu)防心源(yuan)性猝(cu)死，中、老年人和(he)肥胖(pang)者、糖尿病(bing)者、應定期(qi)到(dao)醫院檢查，發現(xian)潛在性心血管病(bing)就及時治(zhi)療，并應防止各種誘發因素。
飲食適宜
建議(yi)適當限(xian)制辛辣生冷刺激性食(shi)物。缺血性心臟病(bing)常伴有高(gao)血壓高(gao)血脂(zhi)糖(tang)尿病(bing)，如果你同時伴有以上疾病(bing)，可(ke)針對給予低(di)鹽低(di)脂(zhi)低(di)糖(tang)飲食(shi)。
建議平時飲食清(qing)淡，不(bu)可集(ji)中食用過多蔬(shu)菜或高(gao)脂(zhi)食物，低鹽低脂(zhi)飲食，少吃動物的內臟，多喝水，避(bi)免辛辣(la)和(he)生冷，戒煙酒，適當(dang)運動鍛煉，保持樂觀舒暢(chang)的心(xin)情，保持良(liang)好的睡眠，不(bu)要長時間熬夜，放松精(jing)神，心(xin)態平和(he)。
飲食禁忌
紅肉：這些肉類含有大量(liang)阻塞動脈的飽和脂肪，不利于(yu)心(xin)臟健(jian)康。
汽(qi)水：汽(qi)水含有大量單糖和熱量，是(shi)引起兒童和成人(ren)肥胖的食品(pin)之一。
薯條：薯條含(han)有飽和(he)脂(zhi)(zhi)肪(fang)和(he)轉(zhuan)脂(zhi)(zhi)肪(fang)，會引起人們肥胖，增加心臟病(bing)風(feng)險。
（1）定期體(ti)檢(jian)：老年(nian)人(ren)本身是心臟病及(ji)(ji)各種疾病的高發人(ren)群，應(ying)定期到醫院進(jin)(jin)行體(ti)檢(jian)。青、中年(nian)人(ren)工作(zuo)緊(jin)張、生活節奏快、工作(zuo)生活壓(ya)(ya)力大也容(rong)易患冠心病、高血(xue)壓(ya)(ya)等(deng)疾病。定期體(ti)檢(jian)及(ji)(ji)早(zao)檢(jian)查便于及(ji)(ji)時發現疾病，及(ji)(ji)早(zao)進(jin)(jin)行治療，減少猝死風險(xian)。
（2）避免(mian)過(guo)度疲勞和(he)精(jing)(jing)神緊張：過(guo)度疲勞和(he)精(jing)(jing)神緊張會使(shi)機(ji)體處(chu)于應(ying)激(ji)狀(zhuang)態(tai)，使(shi)血壓升高，心(xin)臟(zang)負擔加重，使(shi)原有(you)心(xin)臟(zang)病(bing)加重。即使(shi)原來沒有(you)器質(zhi)性心(xin)臟(zang)病(bing)也(ye)會引發(fa)室顫的發(fa)生(sheng)。所以，每個人(ren)應(ying)該對(dui)自己的工作(zuo)、生(sheng)活有(you)所安排，控制(zhi)工作(zuo)節奏和(he)工作(zuo)時間，不可過(guo)快過(guo)長。
（3）戒煙、限酒、平(ping)衡(heng)膳食、控制(zhi)體(ti)重、適當運動，保持良(liang)好(hao)的生活習慣會減(jian)少(shao)心腦血管(guan)疾病的發生。
（4）注意過(guo)度(du)疲勞的危險(xian)信號(hao)及重視(shi)發(fa)病的前(qian)兆癥狀：長(chang)期過(guo)度(du)疲勞會引發(fa)身體出(chu)現(xian)一些(xie)改變。如焦慮(lv)易怒、記憶力減(jian)退、注意力不集中、失眠及睡(shui)眠質量(liang)差(cha)、頭痛頭暈耳鳴、性功(gong)能減(jian)退、脫發(fa)明顯等。當機體出(chu)現(xian)這些(xie)情況，應調整(zheng)工作節(jie)(jie)奏、適當休息，調整(zheng)節(jie)(jie)奏，保(bao)持愉快(kuai)的心情。讓機體功(gong)能得以恢復。如不能緩解，應立即(ji)前(qian)往醫院救治(zhi)。
（5）對已患有冠心病、高(gao)血(xue)壓等疾病的患者應在醫生指導下堅持(chi)服藥(yao)治(zhi)療。
（6）注意對室(shi)性心(xin)(xin)(xin)律失常進(jin)行(xing)危險評(ping)估，包括進(jin)行(xing)常規心(xin)(xin)(xin)電(dian)圖、動態心(xin)(xin)(xin)電(dian)圖、其他(ta)心(xin)(xin)(xin)電(dian)學(xue)技術(shu)、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)律失常類型(xing)，評(ping)估心(xin)(xin)(xin)臟(zang)猝死風險，做出治療決策(ce)。
（7）注意加(jia)強心梗后心臟(zang)猝死的預防。
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
