Andresen D
Medizinische Klinik I, Vivantes Klinikum am Urban, Dieffenbacher Str. 1, 10967 Berlin, Germany.
Z Kardiol. 2004;93 Suppl 1:I4-6. doi: 10.1007/s00392-004-1102-0.
Sudden cardiac death is mainly caused by arrhythmic events, triggered by ischemia. About half of the affected persons had no previous diagnosis of coronary heart disease, thus rendering them practically unreachable for specific preventive measures. This fact makes it necessary to optimize reanimation conditions. The establishment of international reanimation standards (ILCOR) has stimulated an intensified scientific evaluation of therapeutic options. While the use of vasopressin, adrenaline and reanimation by bystanders is being evaluated at the moment, amiodarone has not fulfilled the expectation of reducing mortality. Secondary prevention of sudden cardiac death after cardiac events is based on betablockers, ACE inhibitors and antilipemic therapy. Guidelines on prevention of sudden cardiac death also recommend aldosterone blockade and n-3-fatty acids. Persons at highest risk gain most from the use of ICDs, yet it has not been shown that their use immediately after myocardial infarction reduces mortality.
心脏性猝死主要由缺血引发的心律失常事件所致。约半数患者此前未被诊断出患有冠心病,因此他们实际上无法采取特定的预防措施。这一事实使得优化复苏条件成为必要。国际复苏标准(ILCOR)的制定促使人们对治疗方案展开更深入的科学评估。目前正在评估血管加压素、肾上腺素的使用以及旁观者进行的复苏情况,而胺碘酮并未达到降低死亡率的预期。心脏事件后心脏性猝死的二级预防基于β受体阻滞剂、血管紧张素转换酶抑制剂和降脂治疗。心脏性猝死预防指南还推荐醛固酮阻断和n-3脂肪酸。风险最高的人群从植入式心律转复除颤器(ICD)的使用中获益最大,但尚未证实心肌梗死后立即使用ICD能降低死亡率。