急诊院前猝死事件的发生特点分析

了解院前猝死事件的发生规律,以便更好地对于院前猝死事件、特别是心源性猝死进行有效的求治,降低病死率。系统分析解放军总医院近20年来院前急诊救治病例1030例,其中院前发生猝死106例。结果显示,猝死高发年龄段有两个：一个为66－75岁年龄段（为27.3%),另一为46－55岁年龄（非退休 年龄,为22.6%)。既往有明确心血管病史的病例68例 （占64.2%),不明原因23例（占21.6%),其他原因15例（占14.2%) 。引发猝死的直接原因为;室速、室颤（构成比55.0%)、心源性休克（16.7%)。院前猝死事件,是目前需要院前急诊救治主要的急危重症之一,而其中以急性心血管事件所致猝死的救治原则更为重要。对于已有心血管病基础的患者应注意其发生猝死的高度危险性,同时应高度注意低年龄组人群也有相当比例的猝死的事件的发生。     

心脏猝死家庭急救的体会

北京总参军训和兵种部四管处门诊部冯芸庆来稿：心脏猝死家庭急救的体会。文章说，心脏猝死在人类疾病死亡中居首位，约占总死亡人数的1／4，且约有2／3的患者在发病1h内死于院外。对于心脏猝死的急救处理，主要是迅速施行心肺复苏，如能在疾病突发4～6min内得到有效急救，复苏率则能达到50％。因此，在院前非正规医疗条件下，尤其是在家庭中遇到需紧急复苏的心脏猝死患者时，应以“现场第一目击者即应是现场直接救护者”为原则，就地取材，争分夺秒，实施抢救。     

青海高原178例呼吸系统疾病猝死尸检的临床病理分析

目的：分析高原地区178例呼吸系统疾病猝死的病因、病理及临床特点,提高诊疗水平,尊多妻避免呼吸系统猝死的发生;方法：对本院1959年11月—2004年7月1158例尸检进行总譬分析;结果：青海高原呼吸系统疾病明显高于平原（x^2=28．6,P〈0．01）;结论：青海高原猝死的病因呼吸系统占首位且明显高于平原。     

院前猝死16例临床分析

70%以上的猝死事件发生于入院前,且多于症状发生后2h 内死亡。笔者对我部10年来遇到的16例院前猝死病例进行分析,报告如下。1 临床资料1.1 一般情况本组院前猝死患者中,男性13例,女性3例。年龄23～85岁,其中39以下3例(18.8%),40～59岁2例(12.5%),60～85岁11例(68.8%)。1.2 猝死诱因 16例院前猝死病例可查的诱因依次为:劳     

老年急腹症病人围手术期的处理

目的：总结老年急腹症病人（≥60岁）围手术期处理的经验，提高老年急腹症病人的治疗水平。方法：对1995。2008年的97例老年急腹症住院病人临床资料进行回顾性分析。结果：在97例手术中，93例（95．9％）治愈和好转。术前合并有不同疾病和功能异常者73例（73．2％），术后发生各种并发症18例（18．6％）。死亡4例（4．1％）。死亡原因与术前合并疾病有关。结论：加强围手术期处理，积极治疗并存疾病，把握的手术时机，老年急腹症病人治疗同样能达到满意效果。     

社区牙周指数评价老年牙周病患者全身疾病的相关性研究

目的利用社区牙周指数评价老年牙周病患者全身疾病与牙周炎的相关性。方法随机抽取口腔科接诊老年患者（60～70岁）共799例,进行牙周检查,全身病史记录;分析牙周病与老年患者全身情况的相关性。结果相关性分析显示老年患者,老年牙周病综合评分,冠心病159例（24．6％）,高血压368例（57．1％）,牙周病与全身疾病高血压、糖尿病、冠心病等均有明显的相关性（P〈0．05）。结论糖尿病、冠心病及高血压均与牙周炎的发生发展关系密切,老年牙周病除采取常规牙周治疗外,还需针对其全身慢性疾病和心理状态进行治疗。     

老年肝病患者52例并发败血症及感染性休克的临床分析

目的 了解老年肝病患者合并败血症及感染性休克的临床特点：方法 选择60岁以上血培养阳性的肝病患者52例的病例资料进行回顾性分析总结。结果 52例老年肝病患者发生败血症合并感染性休克者8例．占15．4％。发生败血症后肝、肾功能进一步恶化。52株病原菌中革兰阴性菌占71．2%．革兰阳性菌占16．9%、真菌占1.9%：全组病例死亡和病情恶化自动出院者共18例．占34．6％。结论 老年肝病患者并发败血症及感染性休克使病情恶化．严重影响预后．临床应高度重视．进行及早正确的综合治疗和及时抢救以降低病死率。     

惠州市188例院前猝死特点分析

目的:探讨惠州市院前猝死特点,提高惠州市院前抢救的成功率.方法:回顾惠州市2000-01～2003-12期间院前死亡病例,对资料完整且符合猝死诊断标准的188例院前猝死病例的临床特征及其流行病学特点进行分析.结果:188例猝死患者中,男性115例(61.17%),女性73(38.83%),男女比例1.58:1,随年龄增大,死亡数增多.以冬、春季多发,夜间(63%)多发.结论:对高危人群应加强预防指导及医学监护、普及急救医学知识,加强第一目击者抢救能力,完善急救医疗服务系统,争取抢救时间,提高复苏技术是最大限度抢救病人,减少死亡的有效方法.     

老年人猝死的生化学机制

众所周知，猝死是事先预想不到的突然死亡，因此要了解猝死前的病情变化极为困难，尤其生化学改变更不易掌握。据日本杉下报道，在226例因运动而猝死的病人中，只有15．5％被了解到生前的病情。目前对此问题的研究主要是通过尸体解剖和对复苏成功的幸存者检查进行的。在老年人猝死中，心源性猝死所占比例较大，故本文以此为基础介绍几种生化学改变导致老年人猝死的发病机制。一、神经内分泌系统的异常反应临床资料证实，老年人摔死多在一定诱因作用下促使基础疾病发作或恶化而发生。常见的诱因有精神刺激，剧烈运动或过劳，外伤、手术或疾病…     

老年人猝死42例分析

临床资料本组老年人猝死42例，男36例，女6例；年龄60～84岁（平均67．5岁）；猝死原因：心血管系统疾病25例，中枢神经系统疾病10例，呼吸系统疾病6例，消化系统疾病1例；除3倒在院外猝死外，39例均在住院期间发生猝死；42例中仅2例住院期间猝死抢救存活。猝死存活时间最短为心跳骤停，4倒立即死亡，存活时间最长为脑梗死，平均1185min（附表）。附表不同病因猝死时间比较讨论猝死是突然发生的、意想不到的死亡，故也称为突然意外死亡。老年人猝死包括老年心源性猝死和老年非心源性猝死。据报道[1]，日本每年死亡75万人中，猝死约7～8万人…     

Medicolegal study of Egyptian suspicious childhood deaths during 2020–2021

BackgroundPediatric autopsy is an effective tool for identifying the cause and the manner of death in suspicious childhood deaths.Aim of the studyTo explore the pattern of suspicious childhood deaths during the recent years (2020–2021) in the Egyptian community and to identify the risk factors to avoid them during the childhood period.Subjects and methodsOne hundred and fifty Egyptian suspicious child death cadavers (less than 18 years old) were autopsied in Zeinhom Morgue during one-year period (2020–2021). Demographic data, circumstances of death, causes and manner of death were defined and statistically analyzed.ResultsIdentity was known in 77.3% of the studied cases, and male to female ratio was 2.2:1. Most of cases were recruited from Cairo and Giza governorates. Adolescents contributed to about one third of the cases. Deaths at home or in hospital were more than outdoor deaths. Seasonal variation was observed as more cases were autopsied during spring and summer. Homicidal deaths (32%) were more in toddlers and adolescents mostly by blunt trauma (58.3%) with signs of violence and resistance or child abuse, mainly in males. The perpetrator was known to be a family member in more than half of the studied cases (56.25%). Accidental deaths (17.3%) were mainly by firearm injuries or poisoning. Suicidal deaths (13.3%) were represented more in adolescents by hanging or by aluminum phosphide poisoning. Natural deaths (13.3%) by bronchopneumonia or leukemia were found in neonates and adolescents. Sudden infant death syndrome (SIDS) (6.7%) was diagnosed by exclusion among neonates and infants only during spring, with equal gender distribution (1:1). Malpractice (6%) leads to death by sepsis or hemorrhage.ConclusionsAll manners of death contribute to suspicious death during childhood period, especially during summer and spring. Family members are the perpetrator for most of accidental, homicidal or suicidal deaths.RecommendationsTraining courses are recommended to parents for proper care and protection of their children to avoid violence, abuse and accidents at home or outdoor.     

院前死亡患者病因及危险因素分析探讨

目的:对院前死亡患者的病因及危险因素进行临床分析探讨与预防。方法:对2000年6月—2005年10月间院前死亡374例患者进行了病因及危险因素与预防的回顾性临床分析与探讨。结果:心源性猝死148例占39.5%,位列第一,脑座中131例占35%,位列第二。结论:心源性猝死及脑卒中是院前死亡的主要疾病病因。高龄、高心病、高血压、高脂血症、糖尿病、动脉粥样硬化是心源性猝死及脑卒中的主要危险因素。     

GRACE评分对急性心肌梗死患者主要心脑血管不良事件与出血事件预测价值

目的研究GRACE评分对急性心肌梗死(AMI)患者1年内主要心脑血管不良事件(MACCE)与出血事件的预测价值。方法回顾性分析2009-2013年收治的6 787例AMI患者的临床资料,应用GRACE评分将患者分为低危组(评分≤88分)、中危组(89~118分)及高危组(评分>118分)。随访患者1年,记录1年内MACCE[包括全因死亡、心肌梗死、缺血性卒中及靶血管血运重建(TVR)]与出血事件发生情况,应用生存曲线计算累积发生风险,评价GRACE评分对AMI患者MACCE与出血事件的预测价值。结果 1年内发生MACCE 361例(5.32%),其中,全因死亡167例(2.46%)、心肌梗死65例(0.96%)、TVR 105例(1.55%)及缺血性卒中24例(0.35%);发生出血事件91例(1.34%)。单支与三支病变、全因死亡与心肌梗死的发生概率随着GRACE评分的增加而显著增加,差异有统计学意义(P<0.05)。MACCE与出血事件的累积发生风险随着GRACE评分的增加而显著增加,差异有统计学意义(P<0.05)。结论 GRACE评分对AMI患者出院后1年内MACCE具有较高的预测价值,对出血事件也具有一定的预测价值。     

Death during recreational exercise in the State of Rhode Island

From January 1, 1975 to May 1, 1982, 81 individuals died during or immediately after recreational exercise in the State of Rhode Island. Deaths occurred during a variety of activities, but the majority of deaths occurred during golf (23%), jogging (20%), and swimming (11%). Atherosclerotic coronary heart disease (ASHD) was the presumed cause of 88% of the deaths, primarily in subjects over age 29 with known cardiac abnormalities. Only 7% of ASHD victims had no relevant medical history or ASHD risk factors and were considered healthy by their families and physicians. In contrast, deaths in young subjects were rarely associated with ASHD or prior knowledge of cardiovascular disease. Only six deaths in individuals aged 29 or younger occurred during the study period. These deaths were associated with congenital cardiovascular disease (N = 2), valvular heart disease (N = 1), hemorrhagic gastritis (N = 1), idiopathic myocardial hypertrophy (N = 1), and hypertrophic cardiomyopathy with ASHD (N = 1). A diagnosis was made before death only in the individual with valvular disease. We conclude that death during recreational exercise is predominantly due to ASHD and occurs in men with recognized ASHD risk factors, relevant medical histories, or known disease. Death during exercise in asymptomatic subjects is rare and relatively more frequent in younger age groups.     

Pulmonary embolism and sudden–unexpected death: Prospective study on 2477 forensic autopsies performed at the Institute of Legal Medicine in Seville

Pulmonary embolism (PE) and deep venous thrombosis (DVT) are clinical manifestations of the same entity, venous thromboembolic disease (VTD). In approximately 25% of patients, the first manifestation of PE is sudden–unexpected death.We carried out a prospective study at the forensic pathology service of the Institute of Legal Medicine in Seville with the aim to know the incidence of PE as well as to describe the epidemiological, pathological and clinical characteristics of these deaths and associated risk factors.In the study period (32 months) 32 cases of PE were registered from a total of 2447 completed autopsies. Three cases were considered accidental deaths and the remaining 29 cases were sudden natural deaths, which represents 1.3% of the total autopsies, 2.6% of natural deaths and 4.3% of sudden deaths. Nineteen cases (59%) were men (mean age 50.3 ± 13.8, range 22–74 years) and 13 cases (41%) were women (mean age 50.3 ± 13.8, range 18–87 years). In 78% of cases death occurred at home or during transfer to a health care centre, mainly during the fall or winter (69%) and between 8 a.m. and 4 p.m. (47%). Pulmonary infarction was associated only in two cases (6%). Nine cases (28%) had been immobilized but only three (9%) received anticoagulant therapy. Surgical interventions had occurred in seven cases (22%). A history of psychiatric pathology was found in 31%. Overweight or obesity was found in 75%. The most frequent symptoms prior to death were dyspnea (31%) and chest pain (19%), and 19% of patients were examined in an Emergencies Department for symptoms compatible with deep vein thrombosis and/or PE, but this diagnosis was not suspected in any case.PE frequently makes its first appearance as sudden death. In addition to the classic risk factors, this study highlights that 75% of the cases were overweight/obese as well as 31% having had a history of psychiatric disorders and treatment as to support that this association should be considered as a risk factor. PE continues to be under diagnosed in Emergencies Department patients, which hinders the application of adequate therapeutic measures to prevent these deaths.     

The role of focal myocardial inflammation in sudden unexpected cardiac and noncardiac deaths—A clinicopathological study

The significance of focal myocardial inflammation in sudden death is poorly understood, because there are few studies addressing its frequency in noncardiac and cardiac arrhythmic deaths. We prospectively assessed inflammation in 384 consecutive hearts seen in consultation from a single medical examiners' office. Hearts were received intact and sectioned uniformly in five areas and reviewed histologically by a single pathologist. Intrinsic inflammatory diseases of the myocardium were excluded. Infiltrates were classified as lymphocytic without necrosis, lymphocytic with myocyte necrosis, and eosinophilic. Histologic findings were retrospectively correlated with other cardiac findings, history of drug and medication use, postmortem toxicology, and cause of death. In the 384 hearts, any infiltrate was found in 18%. There were multifocal infiltrates in 9%, inflammation with necrosis in 2%, and eosinophilic myocarditis in 4%. Infiltrates were most frequent in natural noncardiac deaths (31%), and least frequent in traumatic deaths (12%). Infiltrates with myocyte necrosis occurred in 4% of arrhythmic deaths with no other cause, 3% of cardiac deaths with cardiomegaly, 3% of traumatic deaths, 2% of natural noncardiac deaths, 2% of other cardiac deaths, and 1% of coronary deaths. Infiltrates were common in patients on antibiotics (54%) or neuroleptic drugs (27%). Eosinophilic infiltrates were especially common in patients on antibiotics (18%). We conclude that incidental cardiac inflammatory infiltrates without necrosis are not uncommon, but focal myocarditis, defined as inflammation with necrosis, occurs in about 5% of hearts, and may be considered a possible contributory factor. Incidental infiltrates are common in patients on medications, especially antibiotics.     

31例心脏锐器伤的救治

目的总结心脏锐器伤的救治经验,探讨影响死亡的因素方法 对１９８３～１９９８年以来收治的３１例心脏锐器伤患者,根据到达急诊室的临床生理状况,按Ｉｖａｔｕｒｙ分类法组,全部进行了开胸手术治疗,其中急诊室开胸手术１１例,手术室开胸手术２０例。结果全组死亡８例,死亡率２６％。１组死亡２例（２／２）,２组死亡５例（５／１３）,３组死亡１例（１／１３）,４组无死亡８例,死亡率２６％,１组死亡２例（２／２）,     

Prevalence of HCM and long QT syndrome mutations in young sudden cardiac death-related cases

Cardiomyopathies and channelopathies are major causes of sudden cardiac death. The genetic study of these diseases is difficult because of their heterogenic nature not only in their genetic traits but also in their phenotypic expression. The purpose of the present study is the analysis of a wide spectrum of previously known genetic mutations in key genes related to hypertrophic cardiomyopathy (HCM), long QT syndrome (LQTS), and Brugada syndrome (BrS) development. The samples studied include cases of sudden cardiac death (SCD) in young adults and their relatives in order to identify the real impact of genetic screening of SCD in forensic cases. Genetic screening of described variation in 16 genes implicated in the development of HCM and three more genes implicated in LQTS and BrS was performed by using MassARRAY technology. In addition, direct sequencing of the two most prevalent genes implicated in the development of SQTL type 1 and 2 was also carried out. Genetic screening allowed us to unmask four possibly pathogenic mutation carriers in the 49 SCD cases considered; carriers of mutation represent 9% (2/23) of the probands with structural anomalies found after autopsy and 7% (1/14) of the probands with structurally normal hearts after in depth autopsy protocol. One mutation was found among 12 of the recovered SCD cases considered. In people with direct family history of sudden cardiac death, but not themselves, 11 additional mutation carriers were found. Three different mutations were found in six of the 19 LQTS patients, representing three families and two different mutations were found among six patients with previous syncope. Genetic analysis in sudden cardiac death cases could help to elucidate the cause of death, but it also can help in the prevention of future deaths in families at risk. The study presented here shows the importance and relevance of genetic screening in patients with signs of cardiac hypertrophy and in family cases with more than one relative affected.     

Impact of magnetic resonance imaging on cardiac mortality in thalassemia major

Purpose:

To evaluate whether the introduction of magnetic resonance imaging (MRI) in the management of thalassemia major (TM) patients has affected the risk of cardiac death.

Materials and Methods:

In all, 804 TM patients from two large reference units were included and the risk of dying of cardiac causes, before and after their first MRI, was assessed by a Cox proportional hazards model with time‐dependent covariates.

Results:

Adding information from MRI reduced the risk of cardiac death from 6.0 deaths/1000 patient‐years to 3.9 deaths/1000 patient‐years (P = 0.22). The risk of cardiac death before having an MRI study was 82% higher compared to the risk observed after the first MRI.

Conclusion:

MRI has become a vital component of ongoing management and seems to have a beneficial effect on cardiac mortality in TM. J. Magn. Reson. Imaging 2011;. © 2011 Wiley‐Liss, Inc.