75例猝死的临床病理分析

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75例猝死的临床病理资料。结果 75例猝死中,老年人47例,占62.7％,非老年人28例,占37.3 ％,男女之比约3:1。心原性猝死52例,其中冠心病猝死36例,占69.2％(36/52);非心原性猝死19例,其中以急性出血坏死型胰腺炎所占比例最高42.1％(8/19);4例尸检病理检查未见致死性疾病。冠心病猝死患者主要建立在冠状动脉多支严重病变基础上。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者猝死发生率高。防治冠心病、改善心肌缺血等综合治疗十分必要。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。猝死可发生在无器质性疾病的正常人,应加强心理素质训练。     

长沙地区12万人口1985,1986两年死亡调查报告

本文报告长沙地区12万人口中1985,1986两年30岁以上死亡者共1494人;其主要死因为心血管疾病,脑中风、肿瘤次之。心血管疾病中,以肺源性心脏病死亡率最高,冠状动脉性心脏病次之。猝死111人,60岁以上者猝死率明显增加。     

Cold snaps, snowfall and sudden death from ischemic heart disease.

The short-term effect of low temperature on the incidence of ischemic heart disease over a 15-year period was examined. To reduce confounding by other seasonal factors the analysis was restricted to the winter months and was based on the change in the daily rate of sudden death at the time of cold snaps (arbitrarily defined as days on which the mean temperature was at least 4.4 degrees C lower than the day before) and around the time of heavy snowfalls. A statistically significant increase in the daily rate of sudden death at the time of cold snaps occurred only in men under 65 years of age, and even in this group the effect was of relatively small magnitude (+16%) compared with the large change in rate following heavy snowfalls (+88%). Among persons aged 65 years or over cold snaps had virtually no effect, and only the men in this group showed an increased daily rate of sudden death following a snowfall. These results suggest that much of the increased frequency of death from ischemic heart disease in winter, particularly among the elderly, must be due to factors other than short-term cold stress.     

Sudden Death from Ischemic Heart Disease in Ontario

It is possible that there is a systematic geographical variation in the proportion of deaths from ischemic heart disease that occur suddenly, and that this variation may be causally related to water hardness or some other environmental factor. Three indices of sudden death have been examined; each showed a correlation with water hardness that was of similar sign and magnitude. A detailed examination of 1686 deaths occurring in residents of two cities which differ widely in the hardness of their water supply confirmed that in deaths ascribed to heart disease the proportion of sudden deaths was higher (by 20-30%) in the northern (soft-water) city than in the southern (hard-water) city.     

冠心病猝死的预防：附15例分析

对15例冠心病猝死病人临床资料进行分析,并对其发生机理、诱因、预防作了简要讨论。     

257例成年猝死患者临床分析

目的分析成年成年猝死患者的病因和猝死时间,为预防成年患者猝死提供临床依据。方法对2008年10月1日-2012年10月30日马鞍山市十七冶医院院257例成年猝死患者的临床资料进行回顾性分析。设定三餐就餐时间：早餐时间6：30—8：30,中餐时间11：00-13：00,晚餐时间18：30—20：30;根据猝死时间是否在就餐时间内分2组,并根据不同就餐时间分3组,组间进行比较;猝死年龄以60岁为界分2组,2组间率的比较采用x。检验,P〈0．05为差异有统计学意义。结果257例猝死患者60岁以上（大于60岁者）183例（71．21％）;小于等于40岁者15例（5．84％）;有冠心病者124例（48．24％）,有糖尿病者88例（34．24％）,有高血压者75例（29．18％）;有脑卒中者61例（23．74％）,不明原因者52例（20．23％）,有慢性阻塞性肺病者26例（10．12％）,有癫痫者10例（3．89％）;小于等于40岁者（总15例）以不明原因死亡者11例;60岁以上组猝死183例,其中猝死时间为就餐时间89例（48．08％）,60岁以下组猝死74例,猝死时间为就餐时间29例（39．19％）,2组间X。检验,x2=14．77,P〈0．01。结论成年猝死患者以印岁以上多见,有冠心病、高血压、糖尿病者多见;年青猝死者以不明原因死亡者多见;年老患者猝死时间以就餐时间多见,故就餐可能是猝死的诱发因素之一。     

Sudden cardiac death in Air Force recruits. A 20-year review

We reviewed the clinical and autopsy records of the 19 sudden cardiac deaths that occurred among the 1,606,167 US Air Force healthy, medically screened recruits (90% male; 17 to 28 years old) during a 42-day basic training period between 1965 and 1985. Sixteen (all male) died suddenly of underlying structural heart disease, whereas no anatomic cause of death was identified in the remaining three. Thirty-two nonsudden, noncardiac deaths occurred during the same period, and only two had structural heart disease. Strenuous physical exertion was associated with sudden death in 17 of 19 cases (0.017 deaths per 50,000 exercise-hours), and the most frequent underlying etiology was myocarditis. Sudden cardiac death, a rare event in healthy young adults, is usually associated with exertion.     

慢性心力衰竭住院死亡病例临床分析

目的分析慢性心力衰竭（CHF）住院死亡病例的临床特点,为心力衰竭的防治提供依据。方法对2002年1月-2009年12月期间于大连市中心医院心内科住院死亡的239例CHF患者临床资料进行回顾性分析。结果死亡病例的病因以冠心病和高血压心脏病为主,分别为46.4%、21.3%;心力衰竭后总的生存期为5年（2-10年）,男性生存期4年（1-10年）,女性生存期5年（2-15年）;死亡方式依次为：泵衰竭144例（60.3%）,其他并发症死亡44例（18.4%）,猝死36例（15.9%）,脑梗死8例（3.3%）,死因未明3例（1.3%）,脑出血2例（0.8%）。结论冠心病和高血压心脏病是心力衰竭住院死亡的主要病因;心力衰竭主要死亡方式为泵衰竭和猝死。     

猝死42例临床分析

目的探讨猝死的病因、诱因及流行病学特征，为临床防治猝死提供依据。方法回顾性分析42例猝死病例的临床资料。结果猝死的病例中心血管病33例，占78％；糖尿病7例，占17．3％；过度肥胖2例，占4．7％．心肺复苏成功4例，成功率9．5％，结论应重视心率变异性研究，预防猝死高危因素，以提高抢救成功率。     

29例云南不明原因聚集性猝死的尸检病理学研究

目的：分析云南不明原因聚集性猝死的病理特点,为其病因探索和实施干预提供依据。方法：收集云南省进行这类猝死监测以来临床与病理资料较完整的尸检材料29例,占同期死亡病例的10．2％。年龄8至69岁（平均32岁）,男16例、女13例。核查心脏标本,观察了主要脏器的组织病理改变,对其中5例还做了心脏传导系统检查。心肌炎的病理诊断参照Dallas标准和世界心脏联合会的共识,标准克山病的病理诊断依据国家相关卫生行业标准。结果：心脏主要病理改变有：淋巴细胞性心肌炎11例、中性粒细胞性心肌炎3例、致心律失常性右室心肌病4例、左室肥厚合并流出道异常肌束2例、缺血性心脏病2例、过敏性支气管炎和慢性支气管炎合并肺气肿2例、主要脏器未找到明显致死性病理形态改变5例。29例中均未见克山病和扩张型心肌病的病理形态改变。心肌炎均为局灶性,5例心脏传导组织检查见2例有希氏束或左束支起始段急性出血,1例炎症波及房室结。4对家庭聚集性病例的病理改变不同,4例首发猝死中3例为心肌炎、1例慢性感染,续发猝死中3例与急性心肌缺血有关,1例为致心律失常性右室心肌病。多数病例伴肺水肿,少数伴呼吸道和肺部感染。部分出现淤血性或缺血性肝细胞坏死。结论：云南不明原因聚集性猝死的基本病理改变不同,多数为心肌炎症、心脏发育异常和其他致死性心肺疾患,未见克山病的病理学证据,致心律失常性右室心肌病等基础性心脏病应引起重视,猝死的聚集性可能是多种因素的综合表现。     

动态心电图对冠状动脉粥样硬化性心脏病猝死的预测价值

冠状动脉粥样硬化性心脏病(简称冠心病)是心脏性猝死的最常见的基础疾病,对患者风险评价的不足仍然是目前限制临床预防战略的最主要原因。近年来,动态心电图分析仪的一些功能被认为对预测急性心肌梗死后发生猝死有预测价值,且部分动态心电图参数对冠心病患者猝死有预测价值。这在国外通过多项研究已得到证实,我国尚缺乏相关数据,积极开展心脏性猝死的预防研究具有非常重要的社会价值和经济意义。     

Sudden death in young Aboriginal adults with rheumatic heart disease

A retrospective review for the period 1983 to 1988 was made of all sudden deaths in young Aboriginal adults from the Darwin and East Arnhem regions who had known rheumatic heart disease. A total of five cases was identified from autopsy reports. The age range was between 16 and 35 years. All were being treated for asymptomatic heart disease (grade I). The sudden, unexpected death in each of these patients resulted in their deaths all being reported to the coroner. In all cases there was no evidence at autopsy of significant coronary artery disease or bacterial endocarditis. All had evidence of rheumatic valvular heart disease affecting either one or both mitral and aortic valves to varying degrees. No other cause of death was found. This report serves to illustrate the fact that rheumatic heart disease is still a significant contributor to morbidity and mortality in Aborigines, and that while the usual picture of progressive deterioration in exercise tolerance may be the norm, sudden death without any apparent preceding symptomatology can occur.     

热休克蛋白在冠心病猝死病例心肌和血管中的表达及意义

目的:探讨冠心病猝死心肌组织和血管组织HSP70染色改变。为法医学鉴定冠心病猝死提供客观依据。方法:选择8例患冠心病但非冠心病猝死案例(A组)、10例冠心病猝死案例(B组)以及7例非冠心病死亡案例(C组).用免疫组化方法对比检测热休克蛋白70(heat shock protein70 HSP70)的表达。结果:HSP70在患冠心病但非冠心病猝死案例和冠心病猝死案例中呈阳性表达,在心肌组织中冠心病猝死组表达水平明显高于患冠心病但非冠心病猝死组(P0.05),非冠心病猝死组均呈阴性表达。结论:HSP70的阳性表达是心肌和血管缺血缺氧的重要指标,对推断冠心病猝死具有一定的实际应用价值。     

神经系统疾病60例猝死临床与病理

本文报告神经系统疾病314例中猝死者60例(占19％),其中以脑血管病最常见。死因除和病变部位、病灶大小及病情进展速度有关外,尚有心、肺等脑外因素,应引起注意。     

猝死50例临床病理探讨

<正> 突然死亡者称猝死。猝死判定标准尚不统一。有的认为在出现致死症状后“立即”死亡者也有的认为在“一小时内”或“24小时之内”甚至“6天内”死亡者均属猝死。多数认为“猝死是指出现症状或体征后立即或在24小时内死亡者”。本文收集了我校28年院外突然死亡的50例临床和尸解资料加以探讨,拟从中总结经验教训,进一步降低病死率。     

Holter监测冠心病无痛性心肌缺血发作规律的研究

目的:探讨冠心病性无痛性心肌缺血(SMI)发作规律。方法:对确诊的冠心病人486例,进行24hHolter监测,观察SMI发作,分析发作次数、时间与预后的关系。结果:监测中记录到SMI335人698次,累计时间为3526min,其中619次(88.7％)与活动有关。6:00～12:00am为SMI发作高峰,此期间发作次数为389次,累计时间为2100min。具有SMI的冠心病患者的死亡率明显高于有症状冠心病患者。结论:SMI存在并且有一定的发作规律,对于指导临床治疗、降低心脏猝死及缺血性心肌病的发生有一定参考价值。     

猝死100例死因分析

对猝死病例进行尸检和法医学检验，以确定死亡原因，在医学、法医学等方面均有重要意义。本文报告经尸检及其它检验的猝死病例１００例。９３例（９３％）能找到猝死原因，包括心脏疾病４７例（４７％）；消化系统疾病２１例（２１％）；中枢神经系统疾病１６例（１６％）；呼吸系统疾病６例（６％）；所谓胸腺淋巴体质３例（３％）。未找到死因７例（７％）。由于心脏疾病是猝死的主要原因，应引起临床医师、病理医师及法医特别注意。     

急性心肌缺血时锌铜含量的变化及影响

目的　探讨急性心肌缺血时锌铜含量的变化及影响。方法　分别测定急性心肌缺血家兔局部心肌、心血、外周血及 15 0例急性心肌缺血病人血清中锌铜含量 ,并与对照组比较。腹腔给予急性心肌缺血家兔补充锌铜溶液 ,观察给予前后ECG变化。结果　家兔随心肌缺血时间延长 ,锌铜含量在局部心肌中逐渐减少 ,心血及外周血中逐渐增加 ,与对照组比差异显著 (P <0 .0 5 ) ;急性心肌缺血病人血清锌铜含量明显降低 (P <0 .0 1) ;家兔腹腔给予锌铜溶液心肌缺血及心律失常明显好转。结论　急性心肌缺血早期锌铜含量变化能引起心电活动的改变 ,可能是猝死的原因之一。补充锌铜对纠正心律失常及心肌缺血有一定作用。     

肺栓塞症382例尸检材料分析

本文报告382例肺栓塞症的尸检材料。男性194人,女性188人;年龄在14岁至94岁之间,平均年龄为62岁。肺栓塞最多继发于恶性肿瘤(39.8％)、肺动脉粥样硬化症(14.1％)、深部静脉血栓形成(11.5％)、心肌梗死(11.0％)和慢性肺源性心脏病(9.9％)等疾患。血栓栓塞是肺栓塞最常见的发病原因,肺栓塞见于心、肺和血管疾患者占全部病例数的54.1％。本组382例中,临床表现为猝死32例(占8.4％),合并肺梗死237例(占62.1％),患者死亡前临床诊断为肺栓塞者114例(占29.8％)。文中对肺栓塞症的病因学和发病机理、病理改变和临床表现进行了讨论。     

Primary prevention of sudden cardiac death by implantable cardioverter-defibrillator therapy in Chinese patients with heart failure: a single-center experience

Background An implantable cardioverter-defibrillator （ICD） has been suggested for heart failure patients for primary prevention of sudden cardiac death. However, few data have been reported on the application of ICD as primary prevention of sudden cardiac death in China. We evaluated the value of primary prevention ICD therapy in Chinese patients with heart failure.Methods Thirty-four patients at an average age of （60.2±13.7） years seen in Peking Union Medical College Hospital were treated with ICD implantation for primary prevention of sudden cardiac death from November 2005 to July 2009. Single-chamber ICDs were implanted in 16 （47.0%） cases, and dual-chamber or cardiac resynchronization therapy defibrillators in 18 （53.0%） cases. The patients had an average left ventricular ejection fraction of （26.9±5.5）% （11% to 35%）, of which 18 （53.0%） patients had ischemic cardiomyopathy and 16 （47.0%） patients had non-ischemic cardiomyopathy. All patients were followed up at three months after the implantation and every six months thereafter or when prompted by an ICD event.Results There were five （14.7%） deaths, including two of heart failure and three with a non-cardiac course, during an average follow-up of （15.0±11.9） months. Forty-one ICD therapy events were recorded, including 19 （46.3%） appropriate ICD therapies in six patients and 22 （53.7%） inappropriate ICD therapies in four patients with single chamber leads. Inappropriate ICD therapies were mainly due to supraventricular tachyarrhythmias, especially atrial fibrillation. Patients with ischemic cardiomyopathy and non-ischemic cardiomyopathy did not differ in the incidence of either appropriate or inappropriate therapy.Conclusions ICD for primary prevention of sudden cardiac death in China prevents patients from arrhythmia death. Relatively high incidence of inappropriate therapies highlights the importance of an atrial lead.