老年及老年前期肺源性猝死64例病因分析

肺源性猝死并非少见,尤以老年人为多。笔者对我院8年间64例老年及老年前期发生肺源性猝死患者的病因进行了分析,现报告如下。 1 临床资料 1984年1月～1991年12月住院的老年及老年期前病人死亡者1135例,其中猝死188例(16.6％)。相据临床与尸解的资料属肺源性猝死64例(34％),其中男35例,女28例。年龄45～59岁34例,60～76岁30例。老年人多同时患几种疾病,我们根据临床资料确定与猝死直接有关或关系最大者称“基础病”,在此基础上成为猝死的直接原因者称“直接猝死”,并从以上两方面进行分析。 本组中直接猝死于肺栓塞37例(57.8％),其中     

猝死型胰腺炎胰管的病理形态学研究

目的本文旨在探讨猝死型胰腺炎发生猝死的病理学基础．方法应用光镜检查３０例猝死型胰腺炎胰管的病理学改变，另用３０例非胰腺疾患死亡病例的胰腺作对照观察．结果在３０例猝死型胰腺炎中，非炎症性猝死型胰腺炎２９例（９６７％），其中出血坏死型２３例，脂肪坏死型４例，水肿型２例，炎症性猝死型胰腺炎仅见１例．上述类型均出现胰管壁内有胰管存在．对照组３０例，无１例胰管上皮细胞脱落或增生，管腔内未积任何物质，仅见３例胰管壁内有胰管存在．结论胰管结构上的畸异改变，是引起胰腺管道系统遭到破坏，使被激化的蛋白水解酶进入胰腺组织，继之使胰腺组织发生水肿、缺血、出血、坏死的重要原因，也是引起急性胰腺炎猝死的重要原因之一．     

一例年青成人的急性心肌梗塞：病例报告及文献复习

年青患者与运动有关的心脏性猝死有许多原因；肥厚性心肌病、先天性冠状动脉异常以及心肌炎构成运动后心脏性猝死大约一半的原因，因此筛检所有的运动员以预防其发生是重要的。每年的检查包括：临床检查，负荷超声心动图，和实验室检查，另外，可卡因和服麻醉品也可导致运动后的心脏问题和猝死，也应检测。本文报道一例17岁男孩在进行冰球（曲棍球）比赛后由于急性心肌梗塞发生心室纤颤。本文复习了有关年青运动员心脏性猝死的主要原因及其主要研究资料。     

对不明原因猝死者的回顾性分子筛选

在所有的心脏性猝死(SCD)中，不明原因猝死的患者占到5％。这些人通常比较年轻，50％以上以猝死作为首发且唯一的临床表现。他们往往死于原发性的电生理紊乱，而心脏结构完全正常。该研究调查了不明原因心脏性猝死者中心律失常相关候选基因缺陷的发生情况。     

心脏性猝死（1）

心脏性猝死（１）１心脏性猝死的定义和发生机制１．１心脏性猝死的定义心脏性猝死严重地威胁人民生命。当今世界上很多地区对猝死已予以广泛的重视。有关心脏性猝死的标准尚不统一。有的规定指出，从发生症状至未预料到的心脏原因所致死亡在半小时内者为猝死；有的则认为...     

心内科老年患者院内心源性猝死的临床探讨

目的分析心内科老年患者院内心源性猝死的临床原因。方法选取2014年6月~2015年6月我院收治的心脏病猝死患者60例作为研究对象,回顾性分析心内科老年患者院内心源性猝死的临床原因和过程。对在住院期间患者的主要病因予以记录分析。结果冠心病、高血压、心脏病等是导致老年患者发生院内心源性猝死的主要病因;饮酒、抽烟和情绪激动用力等是导致老年患者发生院内心源性猝死的常见危险因素。结论心内科老年患者院内心源性猝死的原因比较复杂,因此应详细的了解患者的相关病史,预防导致患者发生心源性猝死的相关危险因素,减少心源性猝死的发生率。     

非心脏手术围术期猝死6例临床和病理分析

目的　探讨非心脏手术围术期猝死原因及处理对策。方法　本文对绵阳市 1998年 7月至 2 0 0 2年 2月部分医院非心脏手术围术期猝死 6例病人 ,进行临床和病理检查分析。结果　 6例外科手术围术期猝死原因均为心源性猝死。结论　心源性猝死是外科手术围手术期猝死的主要原因。在手术前进行围术期心脏危险性评价 ,并根据危险程度进行危险因素干预处理 ,可以预防或减少围手术期猝死的发生     

心源性猝死的临床分析及预见性护理

<正>心脏性猝死(sudden cardiac death,SCD)系指由于心脏原因所致的突然死亡,常在急症出现后1h内死亡。由于猝死事件发生急骤,猝死前病情大多较稳定又缺少预兆,难以预测,故一旦发生幸存机会极低患者突然死亡,处理不好家属不易接受,极易引发医疗纠纷。因此,正确认识猝死,熟练掌握猝死的判断急救与护理,提高抢救成功率等,在临床上至关重要本文通过对2002年6月至2008年6月本院住院的33例心源性猝死发作临床病例资料回顾性分析,从     

云南省祥云县不明原因心源性猝死回顾性调查

目的 了解云南省祥云县不明原因心源性猝死的流行特征。方法 对祥云县2004年以前上报的云南不明原因心源性猝死病例和同发病例开展回顾性调查，疑似病例搜索调查，将资料核实整理、讨论归类后，进行统计学分析。结果 共调查到14例云南不明原因心源性猝死病例，3例同发病例，4例野生菌中毒死亡病例和4例未定论病例。不明原因猝死病例村庄、家庭聚集性明显（P〈0．01），时间分布在7、8月份，发病年龄为10—50岁，性别及民族间发病率差异无统计学意义（P〉0．05）。调查中野生菌中毒死亡的流行特征与不明原因心源性猝死极为相似。结论 祥云县不明原因心源性猝死呈现出明显的地区性、季节性、人群选择性、村庄聚集和家庭聚集的流行特点，提示危险因素在特定条件下存在，猝死病例间具有同源暴露史。     

心内科老年患者治疗期间心源性猝死的临床病因探讨

目的探讨心内科老年患者在治疗期间发生心源性猝死的临床病因。方法选取我院2015年1月~2016年5月收治的在治疗期间发生心源性猝死的心内科老年患者23例,对患者的临床资料进行回顾性分析,总结患者发生心源性猝死的原因。结果引起心内科老年患者在治疗期间发生心源性猝死的临床病因主要包括肥厚性心肌病、急性冠脉综合征以及肺源性心脏病等,同时患者的运动方式、心理状态以及吸烟饮酒等生活方式也是导致其出现心源性猝死的重要临床原因。结论基础性心脏病、心力衰竭以及高血压等临床症状都是引起心内科老年患者在治疗期间发生心源性猝死的主要原因,必须要重视合并肥厚性心肌病与急性冠脉综合征等疾病的心内科老年患者,加强对老年患者病情的针对性分析,给予老年患者全面的监护管理,让患者的生命安全得到最大程度的保证。     

心率变异性对慢性肺源性心脏病猝死的预测价值

目的探讨心率变异性(HRV)对慢性肺源性心脏病(肺心病)猝死的预测价值。方法选取2007—2010年我院收治的慢性肺心病猝死患者26例作为猝死组,另选取同期我院收治的慢性肺心病患者272例作为非猝死组,回顾性分析所有患者临床资料,记录其HRV时域指标和频域指标。结果猝死组患者HRV时域指标和频域指标均低于非猝死组(P0.05)。结论 HRV对预测慢性肺心病猝死的发生有指导意义。     

Torsades de Pointes as a Cause of Sudden Death in a Patient with Aortic Stenosis and Atrial Fibrillation

The occurrence of sudden cardiac death during Holter monitoring in patients with aortic stenosis has been reported previously. In the majority of the reported cases, the cause of death was a malignant ventricular tachyarrhythmia. The presence of a strong association between frequency and complexity of ventricular arrhythmias and sudden death in patients with aortic stenosis has been proposed. We report the case of a 77‐year‐old woman with aortic stenosis and atrial fibrillation who had an episode of torsades de pointes that degenerated into ventricular fibrillation during Holter monitoring. A short–long–short sequence, but not increased ventricular ectopics, precipitated torsades de pointes and sudden death in this case which is strongly indicative of triggered activity as the underlying mechanism of the lethal arrhythmia.     

Acute fatal pulmonary embolism: its prevention, diagnosis and treatment

Acute fatal pulmonary embolism is one cause of sudden death which should be guarded against. It is the most often missed diagnosis in sudden death cases within the hospital. Clinical pictures of 10 patients with acute fatal pulmonary embolism proved by autopsy were examined to elucidate the problems of diagnosis, and to look for an effective treatment, and a method of prevention. Common risk factors were old age and immobility due to stroke or postoperative state. Common past histories were hypertension, diabetes mellitus, obesity, atrial fibrillation and hyperlipidemia. Electrocardiogram and echocardiogram showed that in these patients there was definite evidence of acute right ventricular overload. High doses of intravenous urokinase should be given whenever acute cardiovascular collapse develops in such high risk patients. Emergent pulmonary angiogram and pulmonary embolectomy could be life-saving in patients with acute massive pulmonary embolism. Prevention is, however, the best treatment. In addition to anticoagulation medication, frequent change of body position and early mobilization are important precautions to prevent fatal pulmonary embolism developing in such patients.     

Sudden death after radiofrequency ablation of the atrioventricular node in patients with atrial fibrillation

OBJECTIVES: We evaluated the incidence and predictors of sudden death after atrioventricular (AV) node ablation and pacemaker implantation. BACKGROUND: Sudden death may occur after radiofrequency catheter ablation of the AV node and pacemaker implantation in patients with atrial fibrillation (AF). Whether it is related to the procedure or to pre-existing heart disease remains unclear. METHODS: All patients who had radiofrequency catheter ablation of the AV node and pacemaker implantation for rate control of medically refractory AF were identified retrospectively and observed prospectively. All patients with sudden death after ablation were identified. The relationship between the procedure and sudden death was defined on the basis of the time between the two as "likely," "possibly" or "unlikely." RESULTS: Of 334 consecutive patients with AF who underwent AV node ablation, nine had sudden death after the ablation. Four patients (1.2%) had sudden death likely related to the procedure: in 3 patients, arrest occurred within 48 h after the procedure; in one patient, arrest occurred four days after the procedure. In three other patients (0.9%), sudden death was possibly related to the procedure because the event occurred within three months afterward. The remaining two deaths were unrelated to the procedure. Diabetes, New York Heart Association functional class (>or=II), preprocedure ventricular arrhythmia, mitral or aortic stenosis, aortic regurgitation and chronic obstructive pulmonary disease were independent predictors for sudden death. CONCLUSIONS: Sudden death likely or possibly related to catheter ablation occurred in 7 of 334 patients (2.1%). Risk of sudden death is highest within two days after the procedure.     

肺栓塞尸检五例临床病理分析

目的总结肺动脉栓塞猝死病例临床、病理特点.方法对5例来自不同科室的肺动脉栓塞死亡的患者进行临床资料及解剖进行分析.结果5例均为肺动脉干及左右分支的大块血栓栓塞,临床均漏诊肺栓塞.右心室腔均可见轻度扩大,肺动脉干扩大明显.镜下血栓体部均为混合性.结论巨大肺动脉栓塞是导致猝死常见原因之一,常继发于长期卧床或手术后,生前临床常不能明确诊断,对这类患者应想到本病的可能,采取特异性检查以明确诊断,及时诊治.     

A population-based prospective evaluation of risk of sudden cardiac death after operation for common congenital heart defects

Objectives. This study sought to define 1) the risk of sudden death after operation for common congenital heart defects; and 2) factors associated with an increased risk of sudden death.Background. Although the prognosis for patients with congenital heart defects is improved by surgical treatment, they remain at a well recognized but poorly defined risk of late sudden death.Methods. This population-based study evaluated all patients <19 years old undergoing surgical treatment of common forms of congenital heart disease in the state of Oregon between 1958 and 1996. Patients were identified retrospectively through 1958, with prospective biannual follow-up beginning in 1982. The incidence and cause of late sudden death were evaluated for 3,589 patients surviving operation for the following defects: atrial, ventricular and atrioventricular septal defects; patent ductus arteriosus; pulmonary stenosis; aortic stenosis; coarctation of the aorta; tetralogy of Fallot; and d-transposition of the great arteries.Results. There were 41 unexpected late sudden deaths during 45,857 patient-years of follow-up, an overall event rate of 1/1,118 patient-years. Thirty-seven of the 41 late sudden deaths occurred in patients with aortic stenosis, coarctation, transposition of the great arteries or tetralogy of Fallot, an event rate of 1/454 patients-years. In contrast, only four sudden deaths occurred among the other defects, an event rate of 1/7,154 patient-years (p < 0.01). The risk of late sudden death increased incrementally 20 years after operation for tetralogy of Fallot, aortic stenosis and coarctation. However, risk was not dependent on patient age at operation or surgical era. The causes of sudden death were arrhythmia in 30 patients, circulatory (embolic or aneurysm rupture) in 7 and acute heart failure in 4.Conclusions. The risk of late sudden death for patients surviving operation for common congenital heart defects is 25 to 100 times greater than an age-matched control population. This increased risk is primarily represented by patients with cyanotic or left heart obstructive lesions. The risk of sudden death appears to be time dependent, increasing primarily after the second postoperative decade.     

Prognostic value of programmed electrical stimulation in patients with a recent episode of unstable angina

Patients with a recent episode of unstable angina have a 10% 1-year risk of sudden cardiac death. To determine prospectively whether electrophysiologic testing might be useful in predicting sudden death, 20 patients admitted to our hospital underwent programmed electrical stimulation as part of their evaluation. None had persistent angina, severe congestive heart failure, or sustained arrhythmias at the time of testing. Because of their long-term benefits, beta-blocking agents were continued whenever possible (18 of 20 patients). Ten of 20 patients (50%) had inducible ventricular tachycardia. In 19.5 months' mean follow-up, three patients (15%) either died suddenly or survived an episode of ventricular fibrillation. Programmed electrical stimulation was an insensitive (33%) and nonspecific (47%) predictor of sudden death in these patients. Programmed ventricular stimulation soon after admission for unstable angina is not a useful prognostic indicator for sudden death. Such patients do have a frequent induction of ventricular arrhythmias which appears to be a nonspecific marker of underlying coronary disease.     

Electrophysiologic testing and follow-up of patients with aborted sudden death

Clinical, electrophysiologic and follow-up data were analyzed for 108 patients with aborted sudden death. The mean follow-up interval was 2 years. All patients underwent baseline drug-free invasive electrophysiologic studies. Seventy-five patients (group I) had inducible ventricular arrhythmias (including nonsustained and sustained ventricular tachycardia and ventricular fibrillation) and 33 patients (group II) had no inducible arrhythmias. Noninducibility was not predictive of a favorable outcome, because the incidence of both sudden death and recurrent ventricular tachycardia was similar in the two groups. Treatment guided by electrophysiologic testing was used in 17 patients; in 13 (17%) in group I arrhythmias became noninducible, and in 4 (5%) sustained ventricular arrhythmias became nonsustained after administration of conventional drugs. There was a significantly higher incidence of sudden death and recurrent ventricular tachycardia in the 4 patients with inducible arrhythmias (n = 3, 75%) compared with the 13 patients whose arrhythmias were noninducible (n = 2, 15%) (p less than 0.05). For the group as a whole, 11% died suddenly and 15% had recurrence of ventricular tachycardia. Sixty-four patients were treated with amiodarone and, of these, four (6%) died suddenly during the follow-up period and nine (14%) had recurrent ventricular tachycardia. Ventricular arrhythmias could be induced in 69% of patients with aborted sudden death but inducibility could be suppressed in only 20% of them. The role of therapy guided by electrophysiologic testing could therefore not be fully assessed. The findings reveal a significant recurrence rate of symptomatic, potentially life-threatening ventricular arrhythmias in medically treated patients with aborted sudden death.(ABSTRACT TRUNCATED AT 250 WORDS)     

Outcome of patients with Eisenmenger syndrome. Apropos of 62 cases followed-up for an average of 16 years]

In an era when heart-lung transplantation offers a therapeutic option for patients with Eisenmenger's syndrome, it is important to assess the natural history of this condition. With this objective the authors studied 62 patients followed-up by the same cardiologist. The average follow-up period was 16 years, but 22 patients were followed up for over 20 years. The average age at death was 29 years. It differed significantly for genetically normal patients (31 years for 21 fatalities) compared with a population of trisomics (21 years for 6 fatalities). Half the patient population lived for over 30 years. Fourteen of the 27 deaths occurred during the third decade and only 4 before the age of 20. The probability of surviving 10 more years for a 20 years old genetically normal patient was 56%. The causes of death in the 19 cases in which it could be established were: 5 sudden deaths, 4 right heart failures, 3 massive haemoptyses, 3 pulmonary emboli, 2 pneumonias and 2 peroperative deaths. The functional disability was nearly always minimal or mild, enabling the patient to work: 24 of the 45 non-trisomic patients had full-time jobs. Pregnancy was a poor prognosis factor and could be lethal (2 deaths due to pulmonary embolism in the post-partum period). A heart-lung transplantation would only seem to be justified in patients with severe symptoms, polycythaemia, irreversible right heart failure and/or haemoptysis.