Alpert Martin A
Division of Cardiovascular Medicine, School of Medicine, University of Missouri, Columbia, Missouri, USA.
Hemodial Int. 2011 Oct;15 Suppl 1:S22-9. doi: 10.1111/j.1542-4758.2011.00598.x.
Sudden cardiac death is the most common cause of death in dialysis patients and is usually preceded by sudden cardiac arrest due to ventricular tachycardia or ventricular fibrillation. A variety of risk factors have been identified that predispose the sudden cardiac arrest and sudden cardiac death in dialysis patients. Primary prevention of sudden cardiac arrest in dialysis patients may be accomplished by avoiding the use of low potassium dialysate. Pharmacotherapy with beta-blockers angiotensin converting enzyme inhibitors and angiotensin receptor blockers and use of implantable cardioverter defibrillators (ICDs) may also prevent sudden cardiac arrest and sudden cardiac death in high-risk dialysis patients. Secondary prevention of sudden cardiac death may be accomplished by similar pharmacotherapy and by the use of ICDs. Indications for ICD use in dialysis patients are similar to those for nondialysis patients; however, survival rates following ICD implantation in dialysis patients are substantially lower than in non-dialysis patients.
心脏性猝死是透析患者最常见的死亡原因，通常在因室性心动过速或心室颤动导致的心搏骤停之前发生。已确定多种危险因素会使透析患者易发生心搏骤停和心脏性猝死。避免使用低钾透析液可能实现对透析患者心搏骤停的一级预防。使用β受体阻滞剂、血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂进行药物治疗以及植入式心脏复律除颤器（ICD）的使用也可能预防高危透析患者的心搏骤停和心脏性猝死。心脏性猝死的二级预防可通过类似的药物治疗和ICD的使用来实现。透析患者使用ICD的指征与非透析患者相似；然而，透析患者植入ICD后的生存率远低于非透析患者。
