非持续性室性心动过速诊疗进展.pdf

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1、江苏实用心电学杂志2014年第23卷第1期·5··专题评论·非持续性室性心动过速诊疗进展高运来王如兴[摘要]非持续性室性心动过速(nonsustainedventriculartachycardia，NSVT)在健康个体和心脏病患者均可发生。无心脏病NSVT患者的预后尚不明确。在运动时，尤其是运动后恢复，检测到NSVT，预示几十年内心血管死亡率增加。经常训练的运动员，若停止训练，NSVT的预后一般良好。非sT段抬高急性冠脉综合征患者住院48h后发作的NSVT，特别是缺血发作时出现，心脏性猝死风险增加。急性心肌梗死患者住院13～24h后发生NSVT

2、提示预后不良。接受再灌注治疗并服用B阻滞剂的心肌梗死患者，以左心室射血分数等因素进行多变量分析发现NSVT不是预测远期死亡率的独立因子。NSVT对肥厚型心肌病及大多数离子通道病患者具有预后判断价值，但对缺血性心力衰竭和扩张型心肌病的预后价值不明。治疗NSVT的重点是治疗基础心脏病。[关键词]室性心动过速；非持续性；心脏病；心肌梗死；心肌病；心力衰竭；猝死；预后[中图分类号]R541．7[文献标志码]A[文章编号]1008—0740(2014)01—0005—07Advancesinthediagnosisandtreatmentofnonsust

3、ainedventriculartachycardiaGaoyun—lai，Wangruxing(DepartmentofCardiology，WuxiPeople’SHospitalAffiliatedtoNanjingMedi—calUniversity，WuxiJiangsu214023，China)[Abstract]Nonsustainedventriculartachycardia(NSVT)hasbeenrecordedinawiderangeofconditions，fromapparentlyheahhyindividualst

4、opatientswithheartdiseases．Intheabsenceofheartdisease，theprognosisofNSVTpatientsisdebatable．Itindicatesincreasedcardiovascularnor—talitywithinthenextdecadesifNSVTisdetectedduringexercise，especiallyinexerciserecovery．Intrainedathletes，NSVTisconsideredbenignwhensuppressedbyexer

5、cise．Inacutecoronarysyn-dromepatientswithnon—ST—segmentelevation，NSVToccurringbeyond48hafteradmissionindicatesanincreasedriskofcardiacsuddendeath，especiallywhenassociatedwithmyocardialischemia．Asfaraspatientswithacutemyocardialinfarctionareconcerned，NSVThasanadverseprognosisw

6、hendetectedthefirst13to24hlaterafteradmission．Inpatientswithmyocardialinfarctiontreatedwithreperfusionandbeta—blockers，NSVTisnotanindependentpredictoroflong—termmortalitywhenothercovariatessuchasleftventricularejectionfractionaretakenintoaccount．Inhypertrophiccar—diomyopathya

7、ndmostgeneticchannelopathiespatients，NSVTcarriesprognosticsignificance，whereasitsindependentprognosticabilityinischemicheartfailureanddilatedcardiomyopathyhasnotbeenestablished．ThemanagementofpatientswithNSVTisaimedattreatingtheunderlyingheartdiseases．[Keywords]ventriculartac

8、hycardia；nonsustained；cardiovasculardisease；myocardialinfare—tion；ca