15例严重急性呼吸综合征患者心脏骤停原因的探讨

目的 探讨严重急性呼吸综合征(SARS)患心脏骤停的原因。方法 对15例SARS心脏骤停病例的流行病学、临床表现、实验室检查、影像学检查及治疗措施，进行回顾性分析。结果 15例SARS心脏骤停病例，平均年龄60岁；8例有明确的sARS患接触史，其中6例属于家庭内密切接触发病；8例无基础疾病；8例精神异常紧张；9例心脏骤停于病情稳定时；4例于排便后心脏骤停；10例患心肌酶异常；13例双侧肺部有斑片状阴影；5例心脏骤停前有心肌缺血及心律失常的心电图表现。结论 SARS患心脏骤停的原因可能为：(1)SARS病毒损伤肺组织引起机体缺氧，导致心电不稳定。(2)SARS病毒直接损伤心肌细胞和(或)心脏传导系统。(3)SARS病毒感染加重原有心肌病变及传导障碍。(4)精神异常紧张，儿茶酚胺过度释放，导致心电不稳定。(5)排便加重缺氧，诱发心律失常(心室颤动等)而导致心脏骤停。

Cardiac arrest in severe acute respiratory syndrome:analysis of 15 cases

Objective To investigate the causes for cardiac arrest in severe acute respiratory syndrome(SARS) patients Methods Retrospective analysis of the epidemiological history,clinical presentation,the change of laboratory tests,chest radiography,and treatment of 15 SARS patients with cardiac arrest Results The average age of the patients was 60 years Eight had a history of exposure to SARS patients,among them 6 were household contacts Eight patients had no underlying diseases,and another 8 complained of extreme anxiety Abnormalities of cardiac enzymes were present in 10 patients Myocardial ischemia and arrhythmia were present in 5 patients. Bilateral,multifocal lung infiltrates were present in 13 of the 15 patients Four patients died after defecation and 9 died during relatively stable periods Conclusions It was suggested that the causes for cardiac arrest in SARS patients may include: (1)the lung injury caused by the SARS virus leads to hypoxemia and thus an unsteady state of the myocardial electricity;(2)SARS virus directly causes injury to the myocardial cells and/or the conduct system;(3) SARS infection aggravates the original myocardial pathological change,worsening the conduct block;(4)extreme anxiety leads to extra secretion of catecholamine,which causes instability of myocardial electricity;(5)defecation worsens hypoxemia,which induces arrhythmia (ventricular fibrillation) and causes cardiac arrest