室速药物治疗现状.docVIP

本文作者宋有城先生，中国医学科学院阜外心血管病医院教授。 医院外发生的心脏停搏患者绝大多数不能存活，获救者中也仅有30%可以在住院治疗后幸存出院。单在美国，每年有30~40万人发生心脏性猝死。据美国心脏学会(AHA)报告: 1994年全美大约有95万人死于心血管疾病，占该年因各种原因而死亡人数的42%，其中25万人发生心脏猝死(该年因癌症死亡54万人，意外死亡9万人，爱滋病死亡4.2万人)。Green(1990)报告一个西雅图的前瞻性研究资料显示，绝大多数心脏性猝死为心律失常性的，主要由恶性室性心律失常(持续性室速和室颤，占75%)所致，其次为心脏骤停(20%)和电机械分离(5%)。40%以上持续性室速和室颤发生于器质性心脏病，最常见病因为冠心病，其次为心肌病(扩张型或肥厚型)、瓣膜病、二尖瓣脱垂、原发性电疾病(如长QT综合征)，少数并无明确的结构性心脏病(原发性室颤)。具有结构性心脏病患者的共同特征是Holter心电图监测时，均伴有复杂的室性心律失常(非持续性室速或成对、频发的室性早搏)。Bayes de Luma(1989)分析233例心脏性猝死患者的即时Holter记录，发现49.7%患者为室速或室速蜕变为室颤。急性心肌梗死后头一年死亡率高达10~15%，死因中绝大多数为心源性，尤其是各种高级别(Lown分级)、复杂性室性心律失常与心源性猝死密切相关。由此提出了“心律失常抑制假设”，认为为了减少和防止恶性心律失常，有必要预防性应用抗心律失常药物以降低死亡率。这一假设为心肌梗死(下文简称心梗)后抗心律失常药物治疗的系列药物临床试验提供了有力的依据。但是几个多中心的临床试验结果令人失望，使用类抗心律失常药物如慢心律的IMPACT试验以及氟卡尼、因卡尼、莫雷西嗪的CAST试验表明，即使在完全消除了触发室性心律失常的室性早搏情况下，也并不能改善预后，反而增加死亡率。于是人们的目光开始从减慢传导的类抗心律失常药转向b受体阻滞剂和延长心肌不应期的类抗心律失常药如胺碘酮、索他洛尔。 室速的药物治疗现状 Measures for the routine management of moral education in Middle SchoolsMethod of conventional management of moral education in middle schoolFirst, the guiding ideology:School moral education is an organic whole of the whole education work, always adhere to the school adhere to the moral education, education for this product, and actively promote the quality education, the school building efficient curriculum system of moral education, moral education, improve the sense of attraction and appeal, enhance the moral education work for through and timeliness. Teach everyone, service education and management education, and school moral education work must be with family education and community education closely together, to form a concerted pattern, and strive to create a good atmosphere for education, and to promote the all-round development of students, to establish a scientific moral education full of vigor the For long-term mechanism.Two, the goal of moral education:To guide the students to form the correct world outlook, outlook on life, values, to cultivate students unity and mutual assistance, honest and t