Predicting the unpredictable.
Predicting the unpredictable.
复制标题
预测不可预测的事情。
DOI：
10.1016/j.hrthm.2009.10.001
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发表时间：
2010
期刊：
影响因子：
5.5
通讯作者：
P. Lelorier
中科院分区：
文献类型：
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作者：
P. Lelorier
在工业化国家，五分之一的死亡会突然且意外地发生。 1, 2 备受瞩目的猝死一级预防试验主要关注已确诊心肌病的患者，特别是既往患有心肌梗死的患者。不幸的是，目前植入植入式心律转复除颤器 (ICD) 的高危患者仅占猝死受害者的 10% 左右。因此，我们的目标是改善另外 90% 的患者的预后，这些患者通常没有被识别出来，因为他们的先期心脏病通常比高危患者少得多。在家中被捕的人（80% 的猝死发生在家里）2 的预后很差，只有大约 5% 的人能够幸存。 3 家用自动体外除颤器远非万能药，因为 40% 的发作都是无人目睹的，2 导致宝贵的时间被浪费，因为大约 6 到 8 分钟后生存机会急剧下降。Wellens 4 在一篇社论中讨论了开发“心脏骤停装置”的必要性，该装置可以缩短可电击心律出现和实施复苏之间的时间。根据Wellens的说法，这样的理论设备必须提供以下功能：1）连续监测心脏活动，2）选择最好的传感器（心电图、脉搏等），3）无伪影记录，4）无线传输信号，5）可靠的停循环检测，6）小型化，7）低功耗，8）声音警报，9）具有受害者位置的响应者，以及10）能够逮捕到开始复苏和除颤之间的时间间隔。这种设备的工程设计并不牵强，因为它已经以某种形式存在，尽管没有一个化身具有韦伦斯提出的理想设备的所有特征。其局限性较少来自于生物工程，而更多于社会经济方面。 WHO
In industrialized nations, one fifth of deaths will occur suddenly and unexpectedly. 1, 2 High-profile trials of primary prevention of sudden death have focused mostly on the patients with established cardiomyopathy, particularly those with previous myocardial infarctions. Unfortunately, the high-risk patients currently targeted for implantation of implantable cardioverter-defibrillators (ICDs) represent only about 10% of the victims of sudden death. The goal, therefore, would be to improve the prognosis in the other 90% who are typically not identified by virtue of the fact that they usually have much less antecedent cardiac disease than the high-risk patients. The prognosis for the individual who has an arrest at home, where 80% of sudden deaths occur, 2 is dismal, with only about 5% of such individuals surviving. 3 The home automatic external defibrillator has been far from a panacea, as 40% of episodes are unwitnessed, 2 resulting in precious time being lost as the chance of survival decreases precipitously after about 6 to 8 minutes.In an editorial, Wellens 4 discusses the need for development of a “cardiac arrest device” that would shorten the time between onset of a shockable rhythm and delivery of resuscitation. According to Wellens, such a theoretical device would have to provide the following: 1) continuous monitoring of cardiac activity, 2) selection of the best sensors (electrocardiographic, pulsations, etc.), 3) artifact-free recording, 4) wireless transmission of signal, 5) reliable circulatory arrest detection, 6) miniaturization, 7) low power consumption, 8) an audible alarm, 9) responders with a location of the victim, and 10) ability to time intervals between arrest to start of resuscitation and defibrillation. The engineering of such a device is not far fetched, as it already exists in some form or another, although none of the incarnations have all of the characteristics of the ideal device as proposed by Wellens. The limitations are less those of bioengineering, but rather more socioeconomic. Who