猝死的临床特点(70例临床病理分析)

70例猝死患者中 ,心脏性猝死 48例 (6 8.6 % ) ,以冠心病最多 ,为 2 8例 ,多为老年前期者 ;非心脏性猝死 2 2例 (31.4% ) ,其中急性出血坏死性胰腺炎 14例 ,居第 2位     

心源性猝死的病因、发病机理和抢救

心源性猝死(简称SCD)即循环呼吸骤停,是指平素看来健康的人,或有明确心脏病但临床没有心力衰竭、心源性休克、严重心律火常、电解质紊乱、感染等合并症的患者突然发生心脏停跳,呼吸停止,随即意识丧失等临床死亡表现者。心源性猝死最常见于冠心病患者,尤其是在发生急性冠状动脉供血不足之时。在医院内急性心肌梗塞是发生心源性猝死的最主要病因。在医院外猝死病例中,有65～74%病理发现有急性或陈旧性心肌梗塞,组     

27例老年人心源性猝死临床分析

老年人心源性猝死是由于潜在心脏疾病自然发生意料不到的呼吸循环停止。ＷＨＯ规定发病后 6ｈ内死亡者为猝死 ,但多数学者主张为 1ｈ之内。我们按ＷＨＯ标准 ,收集了 1993年至 1998年 2 7例老年人心源性猝死病例 ,进行临床分析 ,以求了解老年人心源性猝死病因、诱因 ,从而减少猝死发生率。1　资料与方法2 7例中男 2 2例 ,女 5例 ,年龄 61～82岁 ,平均 67 8岁。住院期间猝死者 13例 ,院外猝死者 14例。冠心病 18例 ,占 66 7%。其中急性心肌梗死 8例 ,陈旧性心肌梗死 3例 ,不稳定型心绞痛 7例。扩张型心肌病 3例。肥厚梗阻型心肌病 2例。主动…     

猝死型胰腺炎胰管的病理形态学研究

目的本文旨在探讨猝死型胰腺炎发生猝死的病理学基础．方法应用光镜检查３０例猝死型胰腺炎胰管的病理学改变，另用３０例非胰腺疾患死亡病例的胰腺作对照观察．结果在３０例猝死型胰腺炎中，非炎症性猝死型胰腺炎２９例（９６７％），其中出血坏死型２３例，脂肪坏死型４例，水肿型２例，炎症性猝死型胰腺炎仅见１例．上述类型均出现胰管壁内有胰管存在．对照组３０例，无１例胰管上皮细胞脱落或增生，管腔内未积任何物质，仅见３例胰管壁内有胰管存在．结论胰管结构上的畸异改变，是引起胰腺管道系统遭到破坏，使被激化的蛋白水解酶进入胰腺组织，继之使胰腺组织发生水肿、缺血、出血、坏死的重要原因，也是引起急性胰腺炎猝死的重要原因之一．     

心源性猝死及心肺脑复苏

猝死是指平素身体“健康”,非预料中的突然死亡,由心脏原因引起的,称为心源性猝死。猝死的定义,在发病时间至死亡时间上有分歧,有主张以发病24小时或6小时以内死亡作为标准。目前较多的人,特别是心脏病学家主张以发病后1小时内死亡作为猝死标准。发病至死亡时间愈短,心源性猝死的可能性愈大。有资料表明,发病后1小时内死亡者90%是由冠心病引起,其它尚有梗阻型肥厚性心肌病,急性巨大肺动脉栓塞,巨大动脉瘤破裂,Q-T期间延长综合征,重度电解质紊乱等。心源性猝死的发病机制猝死死于室颤(Vf)者占绝大多数,冠心病监护病房所提供的资料表明,急性心肌梗塞(AMI)患者,约50%的死亡发生在发病后6小时以内,大     

遗传因素与老年心源性猝死的相关性研究进展

老年人心源性猝死(SCD)定义为年龄65岁及以上患者, 在出现症状后1 h内或无症状24 h内突然发生意外死亡, 可能是由于心律失常或血流动力学突变所致。有发病急、进展快、死亡率高的特点。老年人心源性猝死是老年心脏疾病最严重的临床综合征, 心源性猝死占整个猝死病例的80%以上, 多数的老年猝死患者由于心源性猝死引起。临床对心源性猝死的检测手段主要是对家族史、个人史进行筛查, 同时进行体格检查、心电图分析及超声心动图等检查, 但存在针对性不强、检出率低、应用范围相对比较局限等缺点。心源性猝死也具有遗传易感性, 遗传因素在心源性猝死的发生、发展中起着不可忽视的作用。现综述不同心血管疾病基础上猝死与遗传因素间的相关性, 包括基因多态性在老年心源性猝死发生中的作用。     

老年心肺复苏过程中常见心律失常的特点

老年病人心搏呼吸骤停的原因很多,其中以心源性猝死为最多见。猝死者大多原有心脏病变和严重心律失常。自从采用心肺复苏措施后,绝大多数的研究报告指出,心源性猝死中,仅20%左右是由于心肌梗塞所引起的;80%左右是由于以慢性心肌病变(主要是冠心病)为基     

92例老年冠心病猝死诸因素分析及防治探讨

老年心源性猝死(SD)病因中以冠心病猝死最为常见,占冠心病(CAO)总死亡数的50—60％。由于其发生突然,死亡率高,因此积极探讨老年人冠心病猝死的病因,对于提高抢救的成功率及早期防治有着重要的意     

农村心源性猝死60例临床分析

农村心源性猝死中以冠心病猝死最为常见。1975～1990年,我院遇及心源性猝死60例,其中男45例、女15例,年龄为18～78岁,平均54.5岁。农民45例,其他15例。有明显诱因者48例(80%),主要为情绪激动、过度用力、饱餐、饮酒过量、排便用力等。60例中冠心病者51例(85%),其中有梗塞史者36例,无梗塞史者15例,可见心源性猝死中以冠心病猝死后首位。猝死前症状无特异性。院内发生的38例均作了心电示波或心电图检查,其中34例     

缺血性J波对心源性猝死预警作用的研究

目的研究警示心源性猝死的缺血性J波,为降低心源性猝死发生率提供参考依据。方法选取我院2015年1月～12月期间收治的40例心源性猝死患者作为研究对象(研究组),对其临床资料进行回顾性分析,另选取同期就诊的40例心源性非猝死患者(对照组),测量并对比分析两组患者的同步12导联心电图缺血性J波的出现率。结果在研究组中有38例出现J波,所占比例是95.0%;在对照组中有11例出现J波,所占比例是27.5%。由此可见,研究组患者心电图出现J波比例显著超出对照组,具有统计学意义(p0.05)。结论在心电图缺血性J波出现率方面,心源性猝死患者显著超出心源性非猝死患者,据此能够提示心电图当中的缺血性J波可以在心源性猝死患者的高危警示方面充当关键性指标。     

106例心脏性猝死的病理和相关因素分析

目的探讨心脏性猝死(SCD)的病理基础及相关因素,为SCD的诊断和防治提供线索。方法回顾性分析我院106例SCD的临床病理资料,分析SCD的病因及年龄,SCD的诱因,各种导致SCD病因的病理改变。结果106例SCD中,冠心病49例,心肌炎15例,心肌病20例,主动脉夹层动脉瘤破裂7例,先天畸形6例,克山病2例,心肌萎缩1例,心脏轻微病变6例。106例SCD中85例具有诱因。冠心病是中老年人SCD的最主要原因。冠心病SCD49例中,冠状动脉粥样硬化血管Ⅳ级狭窄40例,27例呈多支Ⅳ级狭窄;发生急性心肌梗死(简称心梗)10例,其中2例合并陈旧性心梗,单纯陈旧性心梗21例,18例无心梗,仅有心肌缺血。心肌炎和心肌病是中、青年人SCD的主要病因。有6例心脏无明显器质性改变,称之为阴性解剖或青壮年不明原因猝死。结论尽早防治冠心病、监测粥样硬化斑块成分、改善心肌供血是预防中老年SCD的根本措施,减少不良刺激和情感应激对预防SCD有一定意义。在解剖阴性者中进行分子基因筛查,对解释病因和SCD危险分层有重要作用。     

53例心原性猝死的临床病理分析

目的 探讨心原性猝死(SCD)的临床特点、病理基础及致死因素,为防治SCD提供线索.方法 回顾性分析我院53例SCD的临床病理资料.结果 53例SCD患者中,冠心病猝死36例,主动脉夹层动脉瘤破裂者7例,心肌炎7例,心肌病3例.冠心病猝死36例中,陈旧性心肌梗塞(OMI)23例,其中合并急性心肌梗塞(AMI)18例,单纯AMI7例(致心脏破裂4例),心肌缺血6例.尸检发现冠状动脉粥样硬化性狭窄Ⅳ级31例,呈多支Ⅳ级病变者24例.结论　SCD病程短骤、凶险,以老年男性多见,冠心病占首位.其次为主动脉夹层动脉瘤破裂、心肌炎、心肌病.冠状动脉多支重度粥样硬化性狭窄是重要的病理基础.尽早防治冠心病,改善心肌供血是预防SCD的根本措施.长期监测动脉瘤的发展而对有增大或濒临破裂征象者立即手术,也是减少SCD的有效措施.SCD随时随地可以发生,因此普及现场心肺复苏抢救知识及建立完善急救系统十分必要.     

Pathophysiology of plaque rupture and the concept of plaque stabilization

Atherosclerotic coronary artery disease is the major cause of death, in men and women, in the United States and in much of the Western world. Atherosclerosis is responsible for coronary heart disease, limb ischemia, and most strokes. Although luminal narrowing by an atherosclerotic plaque and exaggerated or anomalous vasoconstriction contribute to some of the clinical manifestations of atherosclerotic arterial disease, it is the superim-position of a thrombus over an underlying ruptured or eroded plaque that results in the acute coronary syndromes (unstable angina, acute myocardial infarction, and sudden death) that are the most serious clinical manifestations of this disease.     

Sudden coronary death in Glasgow: nature and frequency of acute coronary lesions

A detailed pathological study of the coronary arteries was carried out on 130 random white subjects (91 male and 39 female) who died suddenly in the Glasgow area. In 30 there was a clearly defined cause of death that was not due to ischaemic heart disease. In eight subjects the cause of death was in doubt. Ninety two of the 130 showed coronary stenosis resulting in a loss of more than 75% of coronary artery cross sectional area and/or acute coronary events with no other cause of death. Of these 92 subjects considered to have died suddenly of ischaemic heart disease, 64% showed plaque rupture and thrombosis which occurred at sites of previous high grades of stenosis. Twenty two subjects had intraluminal thrombosis unrelated to plaque fissuring. Thirty eight (41%) showed histological evidence of recent myocardial necrosis; acute coronary events occurred in 34 of these. There was no correlation between the duration of symptoms before death and the occurrence of acute coronary events. Acute coronary events, mainly in the form of plaque rupture, are a common finding in sudden coronary death when a careful study is made of the whole coronary arterial tree.     

Sudden coronary death in Glasgow: nature and frequency of acute coronary lesions.

A detailed pathological study of the coronary arteries was carried out on 130 random white subjects (91 male and 39 female) who died suddenly in the Glasgow area. In 30 there was a clearly defined cause of death that was not due to ischaemic heart disease. In eight subjects the cause of death was in doubt. Ninety two of the 130 showed coronary stenosis resulting in a loss of more than 75% of coronary artery cross sectional area and/or acute coronary events with no other cause of death. Of these 92 subjects considered to have died suddenly of ischaemic heart disease, 64% showed plaque rupture and thrombosis which occurred at sites of previous high grades of stenosis. Twenty two subjects had intraluminal thrombosis unrelated to plaque fissuring. Thirty eight (41%) showed histological evidence of recent myocardial necrosis; acute coronary events occurred in 34 of these. There was no correlation between the duration of symptoms before death and the occurrence of acute coronary events. Acute coronary events, mainly in the form of plaque rupture, are a common finding in sudden coronary death when a careful study is made of the whole coronary arterial tree.     

Echocardiography and Coronary CT Angiography Imaging of Variations in Coronary Anatomy and Coronary Abnormalities in Athletic Children: Detection of Coronary Abnormalities that Create a Risk for Sudden Death

In a recent publication, Maron et al. reported the causes of sudden death in athletes from data collected in the US National Registry of Sudden Death in Athletes at the Minneapolis Heart Institute Registry. It is not surprising that in this study, cardiovascular disease is reported as the most common cause of sudden death in athletes (56%). The most frequently encountered cardiac pathology was hypertrophic cardiomyopathy (36% of the population who died of cardiac disease). Coronary artery anomalies of wrong sinus origin were next in frequency (17%). Less common causes attributed to coronary pathology were Kawasaki disease, origin of the left coronary artery from the pulmonary artery, atherosclerotic coronary artery disease, and myocardial bridging of the left anterior descending artery. Echocardiographic imaging along with color and pulsed‐wave Doppler has been widely employed to visualize the anatomy and function of the heart and proves to be a valuable instrument in the identification of coronary artery abnormalities. Moreover, coronary CT angiography provides additional confirmatory information. This article will discuss the scope, importance, and implications of echocardiographic and coronary CT angiography imaging of the major coronary anomalies and abnormalities in young athletes who are at risk of sudden death and who otherwise have a structurally normal heart.     

老年重症心脏瓣膜置换联合冠状动脉旁路移植术23例临床分析

目的探讨老年重症风湿性心脏瓣膜病并发冠状动脉病变的临床特点及外科治疗经验.方法对23例60岁以上重症风湿性心脏瓣膜病并发冠状动脉病变的患者,实施心脏瓣膜置换并冠状动脉旁路移植术(CABG),就其临床特点、外科治疗经验进行总结分析.结果本组23例中,治愈20例(87%),死亡3例(13%).结论老年重症风湿性心脏瓣膜病并发冠状动脉病变患者,实施心脏瓣膜置换并CABG,围术期处理恰当,可获得满意疗效.     

Forensic Pathological Study of 1656 Cases of Sudden Cardiac Death in Southern China

Sudden cardiac death (SCD) is progressively threatening the lives of young people throughout the world. We conducted a retrospective study of SCD cases identified among sudden death cases based on comprehensive autopsies and pathological examinations in the Center for Medicolegal Expertise of Sun Yat-Sen University to investigate the exact etiological distribution and epidemiological features of SCD. One thousand six hundred fifty-six cases were identified, and SCD accounted for 43.0% of these sudden death cases. The mean age of the SCD cases—where the data of definite ages were accessible—was 38.2 years, and the highest incidence occurred among the 31- to 40-year-old cases (25.6%). The male-to-female ratio among SCD cases was 4.3:1, and this ratio peaked in the 41- to 50-year-old group (7.7:1). The places of death were confirmed in 1411 cases, and predominantly in hospitals (46.3%) and at home (33.8%). SCD occurred throughout the year with a marginally increase in April and May. The major causes of SCD were coronary atherosclerotic disease (CAD, 41.6%), unexplained sudden death (15.1%), and myocarditis (11.8%). Our data indicated that in the age group of younger affected persons (below 35 years old), sudden unexplained death and myocarditis were much more prevalent than CAD. According to anatomical examinations of the CAD-related SCD cases, the proportion of cases with coronary artery stenosis exceeding 75% (grade IV) was 67.2%. Moreover, the percentages of higher grades of coronary atherosclerosis increased with age. Among all branches of the coronary arteries, the left anterior descending branch was the most prone to atherosclerosis; atherosclerosis was present in this branch in 95.4% of the cases with atherosclerosis. Additionally, lesions of multiple branches of the coronary artery were associated with ageing. This is the first study to report the causes of death and basic epidemiological data related to SCD in Southern China.     

Out-of-hospital sudden coronary death: separate acute coronary syndrome or the mode of death due to ischemic (coronary) heart disease?

BACKGROUND: The existing data on the morphological substrate of out-of-hospital sudden death due to ischemic (coronary) heart disease (IHD) and its relationship to other acute coronary syndromes are not sufficient and even controversial. MATERIAL AND METHODS: We analyzed clinical and pathological data from 170 men who died suddenly (within 6 h) of IHD out of hospital, as well as 54 men who died in hospital a documented acute myocardial infarction (AMI). RESULTS AND CONCLUSIONS: Majority (92,9%) of out-of-hospital sudden coronary deaths were due to AMI and 7,1%t - due to disseminated myocardial micronecroses. Death occurred mostly at early stages of AMI, and predominantly in the presence of morphological signs of acute left ventricular failure (alveolar pulmonary edema). Ruptures of atherosclerotic plaques or endothelial erosions with the intraplaque and superimposed luminal thrombosis were found in 88,8% of AMI cases. In 73,6% of cases plaque ruptures or erosions were located in 75% or greater stenoses mostly in proximal segments of coronary arteries. Acute coronary artery pathology could be identified by examination of serial histological sections, while early irreversible ischemic myocardial injury (early infarction) was detected by light and polarized light microscopy of histotopogrammes of the whole myocardium with due consideration of the complex of signs of cardiomyocyte alteration as well as early inflammatory reaction.     

Epidemiology of sudden coronary death: population at risk

Sudden coronary death is a major manifestation of clinical coronary artery disease which doubles in incidence with each decade of life after age 45, with women lagging behind men in incidence by 20 years. Some 14% of heart attacks present as sudden death, and 41% of deaths from coronary disease are sudden deaths. Half of all sudden coronary deaths occur in persons without prior overt coronary artery disease. Persons with established coronary disease are at a three- to fourfold increased risk of sudden death, but the proportion of coronary deaths due to sudden death is no higher. This report examines how sudden death evolves over the long term in the general population and in persons with overt coronary artery disease, and attempts to delineate prime candidates and modifiable predisposing factors using the Framingham Heart Study. In asymptomatic persons the risk of sudden death varies over a wide range in relation to risk factors such as systolic blood pressure, serum cholesterol, cigarette smoking, heart rate, electrocardiographic abnormality and relative weight. Multivariate combination of these risk factors identifies 38.6% of sudden deaths in men and 43.8% of sudden deaths in women in the upper quintile of multivariate risk, which are, respectively, 6.0 and 5.8 times greater than the proportion of sudden deaths in the lowest quintile. When overt coronary artery disease is manifest, the major risk factors have less influence on sudden death risk, which becomes determined chiefly by indicators of intrinsic myocardial damage. With cardiac failure there is an eightfold increased risk of sudden death in men, and cardiac failure without concomitant coronary artery disease imposes a 2.7-fold increased risk.(ABSTRACT TRUNCATED AT 250 WORDS)