主动脉夹层法医学伤病关系35例案例回顾分析

目的 通过案例分析不同原因导致的主动脉夹层(aortic dissection, AD)特征,为AD的法医学鉴定案例提供鉴定思路。方法 收集35例AD的法医学鉴定案例(包括32例死亡鉴定,3例法医临床鉴定),对被鉴定人的外伤史、年龄、性别、发病经过、医疗过程、尸体解剖、病理检验等进行分类分析。结果 35例AD案件中患者平均年龄为47岁,男性居多(32例);涉及外伤的案件13例,其中交通事故最多(8例);被鉴定人首发症状主要为胸痛或呼吸困难(18例),余依次为腹痛或呕吐(8例)、头晕或头痛(3例)、意识丧失(4例)、腰痛或下肢不适(2例);97%(31例)的被鉴定人在急性期死亡;27例合并高血压或心脏肥大,24例合并动脉粥样硬化症。结论 法医鉴定创伤性AD案件时应进行伤病关系分析,先检查被鉴定人的自身基础疾病,再评估外伤的作用力,最后考虑医疗等中介因素对死亡或损伤的影响。     

夹层动脉瘤破裂6例尸检报道并文献复习

目的 探讨急性主动脉夹层瘤的临床病理特征.方法 分析6例因主动脉夹层动脉瘤破裂导致死亡的尸检病例.结果 死者全部为男性、平均年龄53岁、所有病例均属突发.3例因急腹症入院后死亡,1例在排便过程中突发死亡,1例为饮酒后死亡,另有1例是因脑梗塞为首发症死亡.剖检结果 所有病例有不同程度的动脉粥样硬化,尤其是冠状动脉和脑动脉的粥样硬化.结论 夹层动脉瘤主要发生在主动脉,其发生与动脉粥样硬化有关,临床以急腹症为首发症状者多,主要死因是动脉瘤破裂出血.     

主动脉夹层动脉瘤临床-影像学研究

目的探讨主动脉夹层动脉瘤(AD)的临床特点及影像学特征.方法分析了20例AD的病因、临床特点、影像学表现、治疗和转归.结果 18例(90.0%)以突发疼痛为首发症状;2例(10.0%)呈无痛性.X线平片检出率70%(14/20),为非特异性改变,超声波检出率100%(20/20),表现为主动脉呈瘤样或梭形扩张,80%(16/20)可见主动脉夹层分离呈双腔改变;CT检出率100%(6/6),表现为主动脉内膜撕裂突入真腔形成“新月状”密度影.综合救治后13例(65.0%)好转出院,7例(35.0%)死亡.结论 AD主要表现为突发疼痛.X线平片特异性不强,但对诊断有重要提示意义;超声波、CT、MRI具有较高诊断价值.早期诊断、早期救治是控制病程进展、降低死亡率的关键.     

主动脉夹层猝死5例尸检病理分析

目的 探讨主动脉夹层(aortic dissection,AD)致猝死的临床特点、病理基础及致死因素,为进一步研究和防治提供参考依据.方法 对2003～2009年荆州地区5例AD猝死病例进行系统尸体解剖,并分析总结其临床病理特点及发病机制.结果 5例猝死者,年龄分布35～65岁,平均53.5岁;检出主动脉粥样硬化病变4例,有高血压病史者4例,最初大多表现非心血管病症状.结论 AD致病因素复杂,初始临床表现多样,易造成误诊漏诊,对患有粥样硬化病变、高血压及Marfan综合征的患者应保持警惕,并早期干预处理.     

主动脉夹层动脉瘤临床—影像学研究

目的 探讨主动脉夹层动脉瘤（AD）的临床特点及影像学特征。方法 分析了20例AD的病因、临床特点、影像学表现、治疗和转归。结果 18例（90.0%)以突发疼痛为首发症状;2例（10.0%)呈无痛性。X线平片检出率70%（14/20）,为非特异性改变,超声波检出率100%（20/20）,表现为主动脉呈瘤样或梭形扩张,80%（16/20）可见主动脉夹层分离呈双腔改变;CT检出率100%（6/6）,表现为主动脉内膜撕裂突人真腔形成“新月状”密度影,综合救治后13例（65.0%)好转出院,7例（35.0%)死亡。结论 AD主要表现为突发疼痛,X线平片特异性不强,但对诊断有重要提示意义;超声波、CT、MRI具有较高诊断价值。早期诊断、早期救治是控制病程进展、降低死亡率的关键。     

巨大升主动脉夹层动脉瘤手术麻醉1例

主动脉夹层动脉瘤是一种极为严重的血管疾病,外科手术是其有效的治疗手段,手术中对麻醉配合、体外循环方法及心肌保护有着特殊的要求[1]。现将我院收治的1例巨大升主动脉夹层动瘤病例的手术麻醉方法报告如下。     

以神经系统症状为首发表现的主动脉夹层1例并文献复习

主动脉夹层(AD)又称主动脉夹层动脉瘤,属于急性主动脉综合征的一种,具有起病急,病情重,死亡率高的特点.典型AD的临床表现为胸背部撕裂样疼痛,较易诊断,但不典型AD具有隐匿性,易造成误诊和漏诊.以神经系统症状为首发表现的AD较罕见,本文报告1例以双下肢无力和单侧下肢感觉障碍为首发表现的AD患者,同时结合相关文献进行分析...     

30例主动脉夹层动脉瘤围术期护理体会

主动脉夹层动脉瘤围术期护理对病顺利康复,痊愈出院起着至关重要的作用,因此,病人入院后首先要做好心理护理,疼痛发作时,尽快止疼,消除病人紧张情绪.嘱病人卧床休息,减少活动,以免引起血管破裂.术后回到监护室,密切观察病情变化,同麻醉师和手术医生了解术中出血及手术情况,以及特殊用药等.给予心电监护、检测动脉血气、呼吸机辅助呼吸、积极补充血容量、维护循环稳定,使患者逐渐康复.     

覆膜支架介入治疗主动脉夹层动脉瘤的麻醉处理

目的探讨覆膜支架介入治疗主动脉夹层动脉瘤的麻醉处理及注意事项。方法16例DeBakeyⅢ型主动脉夹层动脉瘤在全身麻醉和控制性降压下施行经股动脉覆膜支架介入治疗术。麻醉采用丙泊酚和瑞芬太尼为主的全凭静脉麻醉,持续监测心电图,连续桡动脉测压,脉搏血氧饱和度,中心静脉压,呼气末二氧化碳分压和尿量,计算心率收缩压乘积(RPP),以硝普钠控制术中收缩压在90~120mm Hg,在释放支架时将收缩压控制在70~90mm Hg。术毕及时建立术后镇痛。结果手术时间为(148.16±23.25)min,麻醉效果满意,血流动力学稳定,术中收缩压90~120mm Hg,心率70~80次/min,RPP<12000,释放支架时收缩压为(78.2±6.3)mm Hg。术毕病人清醒快,无躁动,顺利拔管。随访无麻醉相关并发症。结论全身麻醉及控制性降压用于覆膜支架介入治疗主动脉夹层动脉瘤效果良好。     

覆膜支架介入治疗外伤性主动脉夹层动脉瘤术后的护理

目的 讨论覆膜支架植入治疗外伤性主动脉夹层动脉瘤术后的护理.方法 2006年12月～2010年10月,采用先健AnkuraTM大动脉覆膜支架系统施行EVGA术的病人有5例,男4例,女1例,年龄31～55岁.护理积极配合医生治疗,严密观察病人的生命体征,做好健康教育.结果 5例患者支架全部成功植入.术前血压控制平稳,5例术中无并发症及死亡发生.术后2月～4年随访,所有患者复查CT示假腔径缩小并见腔内血栓形成,真腔径增大,未发生瘤体破裂及支架移位等并发症.结论严密、认真的护理措施对外伤性主动脉夹层覆膜支架植入术的成功和病人的康复有重要意义.     

系统性红斑狼疮合并肺部感染猝死一例并文献复习

目的：分析系统性红斑狼疮（SLE）的临床特征、治疗及预后,提高医生对SLE合并脏器损伤导致猝死的认识。方法：回顾性分析1例确诊为SLE合并肺部感染猝死的临床特征及治疗过程并结合文献进行复习。以“系统性红斑狼疮猝死”及“Sudden death of systemic lupus erythematosus”为关键词检索1984年1月至2017年2月万方数据库、中国知网及PubMed数据库的相关文献,共获得文献9篇,其中中文2篇,英文7篇。结果：患者女性,26岁,主要临床表现为面部蝶形红斑、发热、胸闷。肾穿刺活检：局灶增生性狼疮性肾炎基底膜增厚,胸部CT示双肺炎症,治疗过程中突然出现室颤而导致死亡。经文献检索共检索到11例SLE猝死患者,5例女性,3例男性,3例性别不详,其中4例资料不全,年龄22~64岁。结论：SLE常合并多系统损伤,当出现心血管症状时,由于常合并其他脏器受累容易被忽视,所以应及时进行心电图、心肌酶、肌钙蛋白等检查,并加强对患者的监护,防止猝死的发生。     

Sudden death of a young woman due to aortic dissection caused by Turner's syndrome

A 24-year-old woman was found dead in her bed. There had been an episode of fainting with cervicodynia 1 day before death but no significant past medical history, except for menstrual irregularities. Post-mortem examination revealed that death was due to hemopericardium caused by rupture of the ascending aorta by thoracic aortic dissection (Stanford type A). Microscopically, weakness of the aorta was due to cystic medial necrosis. On external examination, short stature, a short neck and multiple pigmented nevi were observed, while internal examination revealed coarctation of the aorta and funicular ovaries. Examination of the X chromatin showed a decrease in numbers of Barr bodies in the tissues, and a 45,X/46,XX mosaicism was suspected. It is concluded that the cause of death was aortic dissection due to Turner's syndrome.     

Sudden infant death syndrome associated with rotavirus infection

Rotavirus was detected in the stools of five children stricken with sudden infant death syndrome (SIDS) over a three-week period. While none of the children had acute gastroenteritis, four of the five had acute upper respiratory infections. Rotavirus was also identified in tracheal aspirates from two of the infants. Extensive investigations failed to reveal the presence of any other viruses or toxins in specimens obtained from the five children with SIDS. Rotavirus was not found in the stool specimens obtained from a control group of 36 infants including six who died of causes other than SIDS. Future attempts at the prevention of rotavirus infections should be directed at populations susceptible to sudden infant death syndrome.     

Sudden unexpected death as a consequence of indinavir-induced nephropathy. A case report

A 60-year-old male had tested in 1986, at age 46, positive for human immunodeficiency virus (HIV). In mid-1996 he was started on a protease inhibitor regimen, which included indinavir, lamivudine and stavudine, and remained on this therapy until his death. In April 1999 he was hospitalized after a fainting episode. Although examination focusing on cardiac disease did not disclose any remarkable findings, he died suddenly one week after being discharged from hospital. At autopsy the kidneys were enlarged, with a total weight of 500 g, patchy pale gray and pinkish. Microscopy showed leukocytic cell casts in many of the tubules and collecting ducts. In many of these casts there were clefts left by crystals. In the interstitium, both in the cortex and the medulla, there was focal inflammation and fibrosis. Death was attributed to sudden cardiac dysfunction, probably ventricular fibrillation as a consequence of severe nephropathy with electrolyte disturbances. It is likely that kidney damage developed secondary to the indinavir treatment as indinavir can cause not only nephrolithiasis but also crystal-induced acute renal failure.     

Thymic adenocarcinoma associated with thymic cyst: a case report and review of literature

Thymic adenocarcinoma of the mediastinum is extremely rare. Only 12 cases adenocarcinoma associated with a thymic cyst have been reported in the literature. In this report, we describe a case of a thymic adenocarcinoma associated with thymic cyst. A 70-year-old man, presented with two months of chest tightness, breath shortness and chest pain. The contrast enhanced CT scan of chest revealed a round, cystic mass in right anterior mediastinum. Microscopic examination revealed that the lining consisted of flat to cuboidal and columnar epithelium and adenocarcinoma infiltrated into the thymic tissue and the soft tissue around the wall of cyst. Based on clinical history, imaging studies, pathological findings and absence of extramediastinal tumor, a diagnosis of thymic adenocarcinoma associated with thymic cyst was established. The patient was alive without any sign of recurrence 7 months after the operation.     

Dissecting aneurysm of the pulmonary artery

Summary Dissecting aneurysm of the aorta is often seen; similar changes in the pulmonary artery are rare. In the German literature they are unknown. 11 previously described cases have been compiled with their clinical and pathological records, and a new added. The patient, a 45 year old woman, suffered from pulmonary hypertension which resulted in medionecrosis and a large aneurysm of the trunk of the pulmonary artery. She died of haemopericardium after rupture of the artery in two stages, with a tear of 8 cm in the trunk which reached to the bifurcation of the vessel.     

湖南地区106例猝死的临床病理分析

目的 通过对湖南地区猝死事件的临床病理研究与分析,探讨猝死的发生规律和特点,为猝死的进一步研究和预防提供一定的依据.方法 对湖南省湘雅司法鉴定中心(2004年~2008年)106例猝死的法医病理尸体解剖进行临床病理学的研究和分析.结果 106例猝死事件中男性有86例,平均年龄42.73岁.发生的年龄与季节无明显相关性,有诱因的占61.3%,心源性猝死占68%.结论 湖南省2004年~2008年的106例猝死事件以男性中壮年发生为多,且心源性猝死为主要死因,因此对心血管疾病的预防是干预防治猝死的关键.     

猝死37例死因分析

目的 分析不明原因死亡患者的疾病分布及尸检病理学特点。方法 收集不明原因死亡尸体107例，解剖结果显示37例为猝死，占35％，对其进行组织病理学检查。结果 37例猝死的疾病分布以心血管最常见，共16例，占43．2％，其次为呼吸系统、神经系统、消化系统疾病。结论 通过尸体解剖和病理学检查，为解决医疗纠纷和明确猝死死因提供科学的鉴定依据，对提高医疗质量起到积极的作用。