急诊猝死患者尸检的特点及诊断对比分析

目的 探讨在急诊科猝死患者的特点及尸体解剖诊断及与死亡前临床诊断的区别.方法 该研究对北京大学第三医院急诊科2002年1月1日至2009年12月15 日猝死的非儿科患者进行了回顾性分析,并将患者区分为尸检组和未尸检组,用t检验和x2检验进行两组比较.对尸检组患者病史及尸体解剖资料进行分析、比较死亡前临床诊断与尸体解剖诊断.结果 该研究共入选了2420例患者,尸检组8例,未尸检组2412例.与未尸检组相比,尸检组年龄较轻[(35.5±12.4)岁vs.(68.9±15.8)岁,t=5.973,P＜0.001],性别分布差异无统计学意义(P＞0.05).8例患者,其中3例患者为突发意识丧失而被送来诊.2例患者死亡前临床诊断与尸体解剖诊断基本相符.1例患者主要诊断不相符.5例患者通过尸体解刮明确了主要诊断.8例尸检患者中,尸体解剖诊断为心血管原因的5例、感染性的2例和其它原因1例.结论 在急诊室死亡的患者中,尸体解剖仍是明确病冈的主要手段,生前临床诊断有相当的误诊和漏诊.猝死的主要原因仍为心脏性的.

Characteristics of patients before sudden death in emergency department and autopsy examination with comparison between ante-mortem diagnosis and autopsy diagnosis

Objective To identify the causes of discrepancy and to compare the clinical diagnosis and postmortem examination diagnosis in patients of sudden death with unknown etiology or with disputed causes in the emergeney department,and to analyze the discrepancy between them.Method The data of adult patients of sudden death in the emergency department of Beijing University Third Hospital,from January 1,21302 to December 15,2009,were tetrospectire reviewed.All patients were divided into the autopsy group,oup and non-autopsy group.The gender and age of the two groups were compared with Student t-test and Chi-squme test,and ante-mortem diagnoses were compared with autopsy diagnoses in autopsy group.Results A total of 2420 patients were eligible for inclusion in the study.There were 8 victims received the autopsy examination after death,while 2412 victims did not.Compsred with the non-antopsy pauents,the autopsy patients had yoanger ages[(35.5±12.4)vs.(68.9±15.8)years,t=5.973,P＜0.01],but there was no significant difference in number between two genders.Three of the autopsy patients were sent to hospital by passer-by because of patients in aetate of unconsciousness.Of two patients,the ant-mortem diagnoses were consistent with the autopsy findings.There was one patient with a discrepancy between major ante-mortem diagnosis and the autopsy finding.And the major diagnoses in 5 patients were identified by autopsy examination.In all the 8 autopsy patients,the causes of death were detennined as cardiovaseular(5/8),infectious(2/8)and other(1/8).Conclusions As a last resort,autopsy is used to anthenticate the precise causes of fatal patients died in emergency department.There is a significant discrepancy rate between the ante-mortem diagnoses and autopsy findings.The major cause of sudden death in emergency department is cardiovascular disorder.