本文選題：肥厚型心肌病 + 植入式除顫器�。� 參考：《安徽醫(yī)科大學》2015年碩士論文

【摘要】：研究背景:肥厚型心肌病(HCM)以心臟非對稱性肥厚為特點,對患者生活質量有較大的影響,心源性猝死(SCD)是其重要的死亡原因,猝死最常見的原因是室性快速心律失常,因而及時終止惡性心律失�？梢杂行У亟档突颊叩拟腊l(fā)生率。越來越多的資料證明,ICD是惡性室性心律失常的首選治療措施,最近ICD越來越多被用于預防肥厚型心肌病患者發(fā)生心臟性猝死,但是單個研究病例數(shù)較少,觀察指標多樣,對其療效以及患者的選擇仍未完全明確,所以我們需要大量的循證醫(yī)學證據證實ICD治療HCM的療效及并發(fā)癥的發(fā)生率。研究目的:使用循證醫(yī)學中通用的系統(tǒng)評價法,對植入式除顫器(ICD)治療肥厚型心肌病(HCM)的相關臨床研究進行Meta分析,以系統(tǒng)闡明植入式除顫器在肥厚型心肌病治療中的臨床獲益,并評估ICD治療HCM的預后。研究方法:遵循循證醫(yī)學方法,系統(tǒng)檢索至2014年8月Pub Med數(shù)據庫,EMbase數(shù)據庫,中國學術期刊全文數(shù)據庫,重慶維普數(shù)據庫,萬方數(shù)據庫。對納入疾病的檢索,中文數(shù)據庫中為“肥厚型心肌病”,外文數(shù)據庫中為“hypertrophic cardiomyopathy”。對治療策略的檢索,中文數(shù)據庫中檢索詞為“植入式除顫器”或“埋藏式心律轉復除顫器”,外文數(shù)據庫中檢索詞為“implantable cardioverter defibrillator”。按照納入與排除標準,由兩人分別閱讀文獻并提取資料,采用stata10.0軟件對數(shù)據進行Meta分析。結果:在Pub Med數(shù)據庫、EMbase數(shù)據庫中共搜索到基于19個ICD治療HCM患者隊列的30個研究報告;而中國學術期刊全文數(shù)據庫、萬方數(shù)據庫及重慶維普均沒有檢索到相關文獻。對ICD干預、死亡率進行提取、合并和分析。2621名患者經過隨訪,心血管年死亡率為0.6%,非心血管年死亡率為0.8%,恰當?shù)腎CD干預率為4.1%/年,不恰當?shù)腎CD干預率為4.9%/年。結論:分析后發(fā)現(xiàn)植入ICD治療肥厚型心肌病后患者的心臟死亡率和非心臟死亡率低,恰當?shù)腎CD干預率為4.1%/年,可以認為植入式除顫器治療肥厚型心肌病能有效預防猝死。
[Abstract]:Background: hypertrophic cardiomyopathy (HCM) is characterized by asymmetric hypertrophy of the heart, which has a great influence on the quality of life. Sudden cardiac death (SCDD) is an important cause of death, and the most common cause of sudden death is ventricular tachyarrhythmia. Therefore, timely termination of malignant arrhythmia can effectively reduce the incidence of sudden death in patients. More and more data show that ICD is the first choice of treatment for malignant ventricular arrhythmia. Recently, ICD has been used more and more to prevent sudden cardiac death in patients with hypertrophic cardiomyopathy. The efficacy and choice of patients are still not fully defined, so we need a large amount of evidence-based medical evidence to confirm the efficacy and incidence of complications of ICD in the treatment of HCM. Objective: to analyze the clinical study of the treatment of hypertrophic cardiomyopathy with implantable defibrillator (ICD) by using the general system evaluation method in evidence-based medicine (Evidence-based medicine). The clinical benefits of implantable defibrillators in the treatment of hypertrophic cardiomyopathy and the prognosis of ICD in the treatment of HCM were systematically elucidated. Methods: according to the method of evidence-based medicine, Pub Med database, full text database of Chinese academic journal, Chongqing Weipu database and Wanfang database were searched to August 2014. The Chinese database was "hypertrophic cardiomyopathy" and the foreign language database was "hypertrophic cardiomyopathy". For the retrieval of treatment strategy, the key words in Chinese database are "implantable defibrillator" or "buried cardioverter defibrillator", and in foreign language database the key word is "implantable cardioverter defibrillator". According to the criteria of inclusion and exclusion, the two people read the literature and extracted the data separately. The data were analyzed by Meta with stata10.0 software. Results: a total of 30 research reports based on 19 ICD treatment cohorts of HCM patients were found in the Pub Med database, while none of the related literatures were found in the full text database of Chinese academic journals, Wanfang database and Chongqing Weipu database. ICD intervention, mortality rate were extracted, followed up by combining and analyzing .2621 patients. The cardiovascular mortality rate was 0.6, the non-cardiovascular mortality rate was 0.8, the appropriate ICD intervention rate was 4.1 per year, and the inappropriate ICD intervention rate was 4.9 per year. Conclusion: the cardiac mortality and non-cardiac mortality of patients with hypertrophic cardiomyopathy treated with ICD implantation are low, and the appropriate intervention rate of ICD is 4.1 / year. It can be concluded that implantable defibrillator can effectively prevent sudden death in patients with hypertrophic cardiomyopathy.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R654.2

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本文編號：1856061