血液透析患者心源性猝死的原因及预防

心源性猝死（Sudden cardiac death,SCD）是指各种心脏原因引起的不可预料的突然死亡,大部分由室性心律失常所致。根据2006年美国肾脏病数据系统（USRDS）的资料,美国透析患者的年死亡率约为230/1000,心源性猝死占29.7%,且透析持续时间越长,心源性猝死风险越高。研究血液透析患者心源性猝死的危险因素以及预防措施对于提高其存活率，改善生活质量有着重要意义。     

心源性猝死高危患者建立家庭自助急救标准化流程的需求调查

目的:了解心源性猝死(SCD)高危患者建立家庭自助急救标准化流程的现状及需求状况,探索建立心源性猝死高危患者家庭自助急救标准化模式的途径.方法:向SCD高危患者家属发放自行设计的调查问卷,调查SCD高危患者家属对SCD基本知识掌握状况、家庭自助急救知识及技能(CPR)培训方式需求状况;建立心源性猝死高危患者家庭自助急救标准化流程,对家属依据流程进行培训.结果:SCD高危患者家属对SCD相关知识知晓率低;家庭自助急救知识及急救技能(CPR)普遍不掌握.结论:亟需对患者家属开展规范的家庭自救知识及技能培训,建立患者家庭自助急救标准化流程,可以促进培训效果,提高SCD患者抢救成功率.     

心源性猝死的诸因素及防治探讨

回顾性分析我院2004年1月-2012年1月收治入院抢救的30例SCD患者资料。分析SCD患者的危险因素。SCD患者中在各发病年龄段、性别、发作时间、发作季节、心电图特征、基础疾病等方面,P〈0.05和（或）P〈0.01。心源性猝死是最常见的死亡模式,重视预防危险因素有助于预防猝死。     

心脏性猝死临床相关因素与病理探析

目的:探讨分析心脏性猝死(SCD)的相关因素与病理基础,为SCD的防治提供线索与对策。方法:抽取广东省东莞市厚街医院经尸体解剖、生前无明确病史的SCD病例12例,对其临床及病理资料展开回顾性分析。结果:12例SCD病例中男性与女性的比例是3∶1;12例患者中存在明确诱因者7例,SCD的诱因以运动或劳累过度、情绪波动多见,两者所占比例最高(P0.05);心脏标本病理检查镜下可发现不同程度的冠脉血管狭窄、心肌细胞变性或纤维化、心肌间质细胞浸润等现象。结论:SCD以冠心病为主,中老年男性多见,大部分病例有明确诱因。SCD病因复杂,对心脏标本进行病理检查对解释SCD原因起重要作用。积极开展冠心病的一、二级预防,祛除诱因是防治SCD的有效措施。     

心源性猝死高危患者建立家庭自助急救标准化流程的需求调查

目的：了解心源性猝死（SCD）高危患者建立家庭自助急救标准化流程的现状及需求状况,探索建立心源性猝死高危患者家庭自助急救标准化模式的途径。方法：向SCD高危患者家属发放自行设计的调查问卷,调查SCD高危患者家属对SCD基本知识掌握状况、家庭自助急救知识及技能（CPR）培训方式需求状况;建立心源性猝死高危患者家庭自助急救标准化流程,对家属依据流程进行培训。结果：SCD高危患者家属对SCD相关知识知晓率低;家庭自助急救知识及急救技能（CPR）普遍不掌握。结论：亟需对患者家属开展规范的家庭自救知识及技能培训,建立患者家庭自助急救标准化流程,可以促进培训效果,提高SCD患者抢救成功率。     

58例心源性猝死的病理学分析

探讨心源性碎死（SCD）的病理特点与鉴别要点。对近几年司法实践中58例SCD死亡案例进行回顾性分析其病因、年龄、诱因及病理改变，结果本组资料显示冠心病、心传导系统病变、心肌炎、心肌病等在SCD中占有较大比例。冠心病碎死是中老年人SCD的最主要原因，青壮年人SCD的病因以非冠心病为主。如传导系统病变、心肌炎、心肌病。在儿童的SCD中先天性心脏病、传导系统病变及心肌炎占主导地位。结论不同的病因，其病理特点不同，其病理变化是法医学鉴定的主要依据。     

心源性猝死及ICD治疗

1 心源性猝死 1.1 定义心源性猝死(sudden cardiac death, SCD)是指由心脏原因引起的突然死亡,从先兆症状发生 1 h 内,产生意识丧失.猝死发生前可以有或无心脏病表现,其发生的时间是无法预测的.心源性猝死定义中最重要的内容是"突然的""快速的"和"不可预测的".关于心源性猝死的定义一直是有争议的,因为临床医生,流行病学家,病理学家以及科学家看问题的角度以及理解病理生理的机制不同.     

植入型心律转复除颤器病人的常见问题及对策

心源性猝死（SCD）是心血管疾病的主要死亡原因之一,大多由恶性室性心律失常引起。植入型心律转复除颤器（implantable cardioverter defibrillator,ICD）能有效终止恶性室性心律失常,降低SCD高危人群心脏事件发生率,显著提高病人的生存率。然而,ICD病人往往受诸多因素影响,治疗效果及术后生活质量不理想。     

超声心动图对右室心肌病的诊断价值

右室心肌病 (rightventricularcardiomyopathy ,RVC) ,亦称致心律失常型右室心肌病 (arrhythmogenicrightventricularcar diomyopathy ,ARVC) ,是冠心病前年龄组 ( <3 5岁 )发生心源性猝死 (suddencardiacdeath ,SCD)的主要原因之一 ,在年轻运动员死亡事件中约占 2 5 %,日益受到医学界的重视。超声心动图的普及 ,使右室心肌病诊断率、准确性有了明显提高 ,本文对 2 8例右室心肌病进行了回顾性分析 ,旨在评估超声心动图对右室心肌病诊断的应用价值。1　临床资料本院 2 8例右室心肌病均为住院治疗者 ,男性 19例 ,女性 9例 ,临床症状和心电…     

老年心源性猝死68例救治体会

老年心源性猝死(SCD)是老年人猝死的主要原因之一,及时抢救复苏至关重要.现总结本院2004年1月至2008年12月急诊抢救68例老年SCD患者的经验报告如下. 1 临床资料 1.1 一般资料:68例老年SCD患者的诊断符合文献[1-2]标准.其中男58例,女10例;年龄61~89岁,平均(71.6±1.5)岁.21例在夜间睡眠中发生猝死;47例在白天发生猝死,其中19例在休息状态下猝死,28例在日常生活时猝死.     

Risk markers of sudden cardiac death in standard 12-lead electrocardiograms

Abstract The annual incidence of sudden cardiac death (SCD) is estimated at 1 per 1,000 for adults over the age of 35 years, and 1 per 100,000 for adolescents and young adults. Although the overall incidence of unexpected SCD among previously healthy persons is small, the emotional impact of these events is devastating. The 12-lead electrocardiogram (ECG) has been used as a risk assessment tool from healthy occupational applicants and athletes to patients with cardiovascular disorders. The ECG is also routinely recorded in the majority of patients hospitalized for non-cardiovascular causes. Thus, it is a widely used tool intended for identification of unsuspected heart disease generally, as well as for diagnosing specific disorders predisposing to fatal arrhythmias in subjects who have not experienced such events but who are at increased risk. Recognition of specific ECG features is of importance for prevention of SCD in asymptomatic persons. The purpose of this review is to catalog the disorders associated with SCD that may be reflected in 12-lead ECGs seen in office or hospital practices and to discuss their prevalence and the magnitude of risks. The focus is on ECG findings suggesting increased SCD risk among the asymptomatic subjects without previously diagnosed cardiac disease.     

Risk markers of sudden cardiac death in standard 12-lead electrocardiograms

Abstract

The annual incidence of sudden cardiac death (SCD) is estimated at 1 per 1,000 for adults over the age of 35 years, and 1 per 100,000 for adolescents and young adults. Although the overall incidence of unexpected SCD among previously healthy persons is small, the emotional impact of these events is devastating. The 12-lead electrocardiogram (ECG) has been used as a risk assessment tool from healthy occupational applicants and athletes to patients with cardiovascular disorders. The ECG is also routinely recorded in the majority of patients hospitalized for non-cardiovascular causes. Thus, it is a widely used tool intended for identification of unsuspected heart disease generally, as well as for diagnosing specific disorders predisposing to fatal arrhythmias in subjects who have not experienced such events but who are at increased risk. Recognition of specific ECG features is of importance for prevention of SCD in asymptomatic persons. The purpose of this review is to catalog the disorders associated with SCD that may be reflected in 12-lead ECGs seen in office or hospital practices and to discuss their prevalence and the magnitude of risks. The focus is on ECG findings suggesting increased SCD risk among the asymptomatic subjects without previously diagnosed cardiac disease.     

临床护士健康心理表现值与社会属性的相关性分析

目的:探讨临床护士健康心理表现值与社会属性的相关性.方法:采用无记名自愿的形式对枣庄市三级医院在编临床(病房)护士(310名)进行随机抽样问卷调查,内容包括症状自评量表(SCL-90)、生活事件量表(LES)、社会支持评定量表(SSRS).结果:临床护理人员心理健康表现值偏低,不同职称护士心理健康表现值与常模比较差异有统计学意义(P＜0.05,P＜0.01);家庭生活事件严重影响临床护理人员的心理健康,负性生活事件是影响护师、主管护师、副主任护师的主要因素,家庭生活事件的发生是其主要方面;工作学习方面是影响护士的主要事件.社会支持对心理健康起到良好的缓冲作用,护士的支持利用率高.社会支持、生活事件与SCL-90各因子表现值相关性有统计学意义(P＜0.05,P＜0.01).结论:临床护理人员的心理健康表现与负性生活事件、工作学习、家庭生活具有相关性,社会支持在临床护理人员的心理健康表现中占重要作用.     

心内科住院病人心脏性猝死原因分析及对策

目的 探讨心脏性猝死病人死亡的相关因素,以预防猝死的发生.方法 分析我院心血管病房2000年1月～2006年1月猝死的52例心脏病人临床资料,探讨猝死的相关因素.结果 52例猝死病人75%为冠心病,很多合并其它疾病,如呼吸道感染、高血压、糖尿病等,有明显诱发因素,有一定的季节和时间分布特点.结论 在治疗原发病的同时,注意预防和治疗合并症,避免诱发因素是预防心脏性猝死的关键.     

The role of heart rate variability in prognosis for different modes of death in chronic heart failure

Classic risk factors for mortality due to chronic heart failure (CHF), such as low left ventricular ejection fraction, NYHA functional stage, and increased heart rate perform well in the prediction of death from pump failure. The prediction of sudden cardiac death (SCD) remains somewhat problematic. Numerous studies have analyzed the potential contribution heart rate variability (HRV) can make to risk assessment in CHF. The aim of this review was to summarize the literature and identify the role HRV might play in identifying mode of death, as well as overall mortality risk. In studies where all-cause mortality or cardiac events were the clinical end point(s), global and slow oscillatory measures of HRV were the strongest risk predictors. In the fewer studies that used SCD as an end point, the strongest risk factors were HRV measures of short-term oscillations and sympathovagal interaction. We concluded from these findings that different HRV measurements predict different modes of death in CHF.Additionally, further studies using short-term analysis of HRV and non-linear analyses are warranted. Furthermore, studies with multiple end points, which clearly delineate pump failure from SCD, may be useful to identify more clearly the role HRV measures can play in the prediction of SCD.     

军校护生心理健康状况及其相关因素研究

目的 :了解军校护生的心理健康状况及相关因素。方法 :采用症状自评量表(SCL -90 )、青少年生活事件量表和简易应对方式问卷 ,对 2 42名军校护生进行测评。结果 :SCL -90结果显示 :护生的主要心理问题是躯体化、强迫症状、抑郁、焦虑、敌对、偏执和精神病性。相关和回归分析表明 :生活事件、积极应对和消极应对对护生心理健康水平有预测性 ,其中生活事件应激值的作用最大。结论 :军校护生有较多的心理问题 ,在帮助护生克服心理问题时 ,应重视并注意区分生活事件、应对方式所起的作用。     

Changes in sense of coherence in old age – a 5‐year follow‐up of the Umeå 85+ study

Scand J Caring Sci; 2013; 27; 13–19 Changes in sense of coherence in old age – a 5‐year follow‐up of the Umeå 85+ study Objective: This study aims to describe the changes in sense of coherence (SOC) over time and relate these changes to negative life events among very old people. Design: Prospective and longitudinal study. Subjects: 190 old women and men participated, of whom 56 could be included in the 5‐year follow‐up. Methods: The mean SOC score from the first and second data collection were compared using a paired sample t‐test. The relationship between the index of negative life events and the changes on SOC score between the two data collections was investigate using linear regression. Main outcome measures: Antonovsky’s SOC scale and an index of negative life events including severe physical and mental diseases, various losses as losses of spouses, cognitive and functional ability. Result: For the whole group of subjects (n = 56), the SOC scores was higher (70.1 vs. 73.7, p = 0.029) at the second point measure. The most common negative life events at follow‐up were loss of independence in activities in daily living and decrease in cognitive function. A significant correlation between the index of negative life events and changes in SOC over 5 years was found (p = 0.025). The more negative life events, the more decrease in SOC. Conclusion: We concluded that there is a risk of decreased SOC and thereby quality of life when negative life events accumulate among very old people. Nursing interventions might play an important role for maintaining and perhaps strengthening SOC among old people exposed to negative life events.     

我院34例不良事件发生原因分析与对策

目的探讨不良事件发生的原因与对策。方法分析我院2007年12月至2009年12月34例不良事件发生的原因。结果跌倒/坠床、烫伤、意外拔管发生率最高,占不良事件发生率总数的67.65%。不良事件的发生与患者的年龄、疾病因素、身体机能状况以及护理人员防范意识欠缺、护理措施不到位等有关。结论采取创建安全文化、建立相关制度和防范措施、改善医院环境设施等干预措施,防范不良事件的发生。     

Molecular and genetic basis of sudden cardiac death

The abrupt cessation of effective cardiac function due to an aberrant heart rhythm can cause sudden and unexpected death at any age, a syndrome called sudden cardiac death (SCD). Annually, more than 300,000 cases of SCD occur in the United States alone, making this a major public health concern. Our current understanding of the mechanisms responsible for SCD has emerged from decades of basic science investigation into the normal electrophysiology of the heart, the molecular physiology of cardiac ion channels, fundamental cellular and tissue events associated with cardiac arrhythmias, and the molecular genetics of monogenic disorders of heart rhythm. This knowledge has helped shape the current diagnosis and treatment of inherited arrhythmia susceptibility syndromes associated with SCD and has provided a pathophysiological framework for understanding more complex conditions predisposing to this tragic event. This Review presents an overview of the molecular basis of SCD, with a focus on monogenic arrhythmia syndromes.     

颅脑损伤后神经症患者生活质量影响因素分析

目的:分析颅脑损伤后神经症患者生活质量影响因素及干预效应,以期为颅脑损伤的康复治疗提供帮助。方法:通过对276例颅脑损伤康复期患者生活质量因素进行总结分析,所得资料均进行单因素分析和多元逐步回归分析。结果:单因素分析显示,年龄、性别、伤情、文化程度、社会、心理因素等影响患者生活质量。多因素分析,则显示伤情(P=0.0121)、社会因素(P=0.0326)、心理因素(P=0.0063),均有显著意义(P<0.05)。结论:伤情、社会因素、心理因素是影响生活质量的重要因素,其中社会、心理因素为促发因素。充分认识这些因素,并进行干预措施,可提高其生活质量。