猝死型胰腺炎5例尸检及临床病理分析

猝死型胰腺炎或称重症急性坏死性胰腺炎(猝死型) ,是一进展极为迅猛、凶险,病死率为10 0 %的临床急症。患者以猝死为特征。本文报告5例猝死型胰腺炎尸检材料。1　材料与方法5例猝死型胰腺炎尸检病例病史及病理切片。男性3例,女性2例。年龄15岁- 5 0岁。于死后12小时至4 0小时开     

91例猝死患者尸体解剖病理和临床的回顾性分析

目的探讨猝死的病因、病理基础及防治措施。方法回顾性分析我院91例猝死患者的临床病理资料。结果91例猝死患者中,老年人62例,占681%,非老年人29例,占319%。心源性猝死68例,占747%,其中冠心病43例,患者主要有冠状动脉多支严重病变;非心源性猝死23例,其中以急性出血坏死型胰腺炎所占比例最高,有10例。结论猝死以老年男性多见,有广泛严重冠状动脉病变的冠心病患者猝死发生率高。防治冠心病、改善心肌缺血等综合治疗对预防猝死十分必要。胰源性猝死主要为急性出血坏死型胰腺炎所致,误诊率较高。     

43例老年冠心病患者猝死的临床病理观察

一、材料　　自本教研室 195 8年～ 1998年受理的法医病理学尸检资料中 ,按下述标准筛选老年人冠心病猝死 (ｓｕｄｄｅｎｃｏｒｏｎａｒｙｄｅａｔｈ ,ＳＣＤ)病例 :(1)经全面系统尸检或对送检主要器官组织作法医病理学检查 ,排除了机械性损伤、机械性窒息等暴力死 ,其中部分病例还进行常见毒物分析 ,排除中毒死亡的可能 ;(2 )有冠心病病变 ,并排除其他自然疾病死亡的可能 ;(3)猝死时间按ＷＨＯ的规定 ,从症状发作至死亡在 2 4ｈ内。　　二、结果　　 41年间共行老年人尸检 130例 ,其中猝死 72例 ,因心血管系统疾病猝死 5 3例 ,占 73 6 1%。…     

冠心病猝死的危险因素(附30例临床分析)

本文通过对冠心病30例猝死与30例存活的对比分析,显示冠心病猝死与复杂性室早、心脏扩大、心肌缺血、左心功能不全、低血压或休克、低血钾、抗心律失常无效等因素相关。及早消除上述各种危险因素,对预防冠心病猝死发生有一定意义。     

急性出血坏死性胰腺炎猝死的临床病理特征

目的探讨急性出血坏死性胰腺炎所致胰性猝死者的临床和病理改变间的关系。方法尸检证实的急性胰腺出血坏死１１０例，对全身系统脏器作病理组织观察。结果无痛、昏迷、休克为主要表现，多器官损害为其特征，以肺水肿最突出占８９１％，心脏受累７３６％，脑水肿２４５％。脂餐、饮酒、胆石不是主要诱因，药物及多种应激因素应予重视。结论低容量休克、呼吸窘迫、急性心力衰竭、脑水肿是猝死的重要原因。有效抢救措施有待深入研究     

猝死患者32例临床救治体会

院前急救和急诊室经常抢救危重患者,尽管患者死亡原因各种各样,其中猝死病例不乏其数,心源性病变是仍猝死最常见原因之一。抢救成功最重要的是对患者进行及时、有效的心肺复苏,高级复苏即循环复苏和脑复苏则是整个复苏过程的关键。本文就我院2006年8月至2012年12月对32例猝死患者的救治体会总结报告如下。     

第三讲 急性胰腺炎的病理

急性胰腺炎的病因复杂，分类方法很多，有病因分类法、病理分类法、临床分类法等。这里仅介绍病理分类法，这种分类法是以疾病发展过程中的病理学变化为基础的，主要是将急性胰腺炎分为两大类：①急性水肿性胰腺炎（或称急性间质水肿性胰腺炎）；②急性坏死性胰腺炎（或称急性出血坏死性胰腺炎）。前者病理学上胰腺间质水肿，偶见部分坏死及胰周坏死，     

Sudden Coronary Death in Middle Age and Characteristics of Its Victims in Finland: A Prospective Population Study

ABSTRACT. A total of 77 sudden coronary deaths (SCD) in men and seven in women occurred during a 6-year follow-up in a population comprising 6510 men and 5800 women aged 30–59 years in four areas of Finland. About 60% of all coronary deaths in men aged 40 and over were SCDs. The most common place of death was home; only six cases reached hospital. The most common time for SCD was at 7 a.m. -3 p.m. and the most common day was Friday. Deaths were evenly distributed over the year. At the time of the baseline study—3 1/2 years before death on an average—male SCD victims showed more symptoms and signs suggestive of coronary disease than those who suffered a non-sudden coronary death or a non-fatal myocardial infarction. More than half of the SCD victims had probable coronary disease at the time of the baseline study. Heart disease was a more common cause of death among the mothers of male SCD victims than among the adult Finnish female population as a whole. This study indicates that the majority of candidates for later SCD can be detected early enough for secondary prevention to be attempted.     

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.     

Alcohol Consumption and Sudden Coronary Death in Middle-aged Finnish Men

ABSTRACT. Suhonen O, Aromaa A, Reunanen A, Knekt P (Research Institute for Social Security, the Social Insurance Institution, Helsinki, Finland). Alcohol consumption and sudden coronary death in middle-aged Finnish men. The association between consumption of alcoholic beverages (spirits, beer and wine) and coronary heart disease (CHD) mortality, especially the incidence of sudden coronary death (SCD), was investigated in a 5-year prospective population study comprising 4532 men aged 40–64 years. The amount of alcohol used was estimated on the basis of answers to a self-filled structured questionnaire. The incidence of SCD was statistically significantly lower among abstainers than among alcohol consumers. The relative risk of SCD of alcohol consumers in comparison with abstainers was largest in the oldest age group and it became more apparent after a follow-up of a couple of years. Only the consumption of spirits was positively associated with the incidence of SCD. Among non-smokers the incidence of SCD was statistically significantly higher in consumers than in abstainers, a similar but not significant trend was observed among current smokers. The positive association between alcohol consumption and incidence of SCD was detected both in CHD-free men and in men with prior CHD. Consumption of alcoholic beverages, and in particular of spirits, is associated with an increased risk of SCD in Finnish men.     

Risk Factors for Sudden and Non-Sudden Coronary Death

ABSTRACT The impact of risk factors for sudden and non-sudden coronary death was investigated in 3589 Finnish men aged 40–59 years at entry from a prospective population survey. During a mean follow-up time of 11 years, 234 coronary deaths occurred, 150 of which were sudden, i.e. ensuing within 1 hour of the onset of symptoms. The severity of the manifestations of CHD at baseline investigation appeared to be a powerful predictor of sudden coronary death. Smoking and high serum cholesterol were significant predictors of sudden coronary death. High serum cholesterol was an equally significant predictor of sudden and non-sudden coronary death. High blood pressure did not appear to significantly increase sudden coronary death but increased the incidence of non-sudden death significantly. Obesity and diabetes did not appear to be independent risk factors for sudden coronary death. Smoking and high serum cholesterol were significant risk factors for sudden coronary death in men with manifestations of coronary heart disease. The results suggest that reduction of primary risk factors, especially smoking and high serum cholesterol, is important even after coronary heart disease has become manifest.     

Four-year Incidence of Myocardial Infarction and Sudden Coronary Death in Twelve Finnish Population Cohorts

ABSTRACT. Suhonen O, Reunanen A, Aromaa A, Knekt P, PyÖrÄlÄ K. (Research Institute for Social Security, Social Insurance Institution, Helsinki, Finland.) Four-year incidence of myocardial infarction and sudden coronary death in twelve Finnish population cohorts. The incidence of myocardial infarction (MI) and sudden coronary death in four years was studied in 6510 men and 5800 women, aged 30–59 years, derived from 12 Finnish population cohorts constituting the invited population to a prospective study. The incidence of all fatal coronary events in four years was 13.0/1000 in men and 1.8/1000 in women. The incidence of sudden coronary death was 7.8/1000 in men and 0.7/1000 in women. The incidence of non-fatal MI was 22.2/1000 in men and 7.3/1000 in women. Coronary mortality was significantly higher in non-participants in the initial survey than in participants. The incidence of MI was highest in men from eastern Finland (North Karelia), intermediate in men from central and western Finland and lowest in men from southwestern Finland. There were no significant regional differences in the incidence of MI in women. The incidence of MI in this study was in good agreement with that recorded in the myocardial community registers.     

Sudden Death

Sudden death is probably the greatest challenge in modern cardiology. After reviewing its history, we describe the epidemiology of sudden death and its associated diseases. We highlight its physiopathologic aspects, including the factors that act on vulnerable myocardium triggering the final arrhythmia, mainly ventricular fibrillation and, to a lesser extent, bradycardia and sudden death. We emphasize the relevance of acute ischemia, ventricular dysfunction and genetic factors, not only in genetic heart disease, but also as triggers of sudden death in acute and chronic ischemic heart disease. Finally, we describe the best way to identify candidates at risk, discuss how to prevent sudden death, and outline the best approach to managing a patient resuscitated from cardiac arrest.     

Sudden Death in the Community

About one fifth of all deaths occur suddenly and unexpectedly, often as the first manifestation of heart disease. Several tests have been developed during the past 2 decades for risk stratification of such an event, but only a minority of victims can be identified as being at high risk before sudden death occurs. Improving the results of out-of-hospital resuscitation attempts is of crucial importance. Use of the automated external defibrillator is rapidly increasing worldwide. However, the defibrillator must be used within minutes after the onset of cardiac arrest, and rapid recognition and localization of the victim are essential. The development of a device that constantly monitors vital signs and can diagnose cardiac arrest, generate an alarm, and transmit the location of the victim could be an important step in improving the results of cardiac resuscitation. (J Cardiovasc Electrophysiol, Vol. 14, pp. S104-S107, September 2003, Suppl.)     

The Conduction System Findings in Sudden Cardiac Death

Conduction System in Sudden Death. This is a brief review of the findings in the conduction system in cases of sudden death victims who were living "normal" active lives. Twenty–two representative samples from more than 100 cases of sudden cardiac death, especially in young and asymptomatic individuals, revealed a plethora of findings that varied from normal to congenital and acquired changes, in most cases either at the gross or microscopic level, especially in the conduction system to a varying degree. Despite these changes, the individuals were living normal, symptom–free lives and were not clinically diagnosed to have lethal cardiac problems. This suggests that these individuals might have experienced lethal arrhythmias in the past, which might have been "silent" in nature. Innovative new methodologies must be developed to detect the silent lethal arrhythmic focus that may lead to sudden cardiac death.