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。     

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。     

CORONARY RISK ANALYSIS - A STITCH IN TIME

Coronary heart disease (CHD) is the major cause of sudden death amongst adults throughout the globe. Though the prevalence of CHD is increasing steadily all over, CHD amongst Indians is peculiar in the sense that it is more prevalent, more severe and appears at younger age. Development of CHD depends upon the status of various coronary risk factors in one''s body. It has been observed that to measure the impact of risk factors for the cardiac health of a person, collective impact of all the known risk factors taken together should be calculated rather than individual risk factors. DEBEL (Defence Bio-Engineering and Electro-Medical Laboratory) is developing a cardiac risk analyser to calculate the absolute coronary risk of an individual in next 2,5 or 10 years and help in managing his coronary risk status.KEY WORDS: Absolute coronary risk, Coronary heart disease, Coronary risk factors     

反式脂肪酸对冠心病危险性的Meta分析

目的采用Meta分析法评价反式脂肪酸对冠心病危险性的影响。方法以"trans fatty acids""sudden cardiac death""myo-cardial infarction""coronary heart disease""反式脂肪酸""冠心病猝死""心肌梗塞"和"冠心病"等为关键词,通过Medline、EMBASE、Cochrane图书馆、中国期刊全文数据库、重庆维普数据库和万方数据库等工具进行文献检索,以多重校正后的相对危险度(RR)或比值比(OR)及其95%可信区间(CI)为效应值,经异质性检验后采用固定效应模型对纳入文献进行Meta分析。结果共纳入9篇文献,包括6项队列研究和3项病例对照研究。反式脂肪酸摄入量与冠心病和冠心病死亡的合并RR分别为1.234(95%CI 1.117~1.363,P=0.000)和1.307(95%CI 1.113~1.535,P=0.001);皮下脂肪中反式脂肪酸水平与首次心肌梗死的合并OR为1.560(95%CI 1.119~2.175,P=0.009)。敏感性分析显示本研究结果具有良好的稳定性。结论反式脂肪酸是冠心病的危险因素之一。     

老年住院病人死亡概况及心血管疾病分析

目的 探讨我院老年患者死亡原因及主要心血管疾病。方法 收集我院老年病区1976 年-2011 年死亡患者病例1 920例,对其进行致死原因分析。结果 1 920 例平均死亡年龄（81.48±7.64） 岁,＜60 岁占0.95%,60-70 岁占4.94%,70-80 岁占30.67%,＞ 80 岁占63.44%。其中男性占95.94%,女性占4.06%。肿瘤（705 例）、心血管疾病（328 例）、呼吸系统疾病（307例） 为死亡原因前三位。冠心病（45%）、心源性猝死（33%）、心衰（12%） 为心因死亡的主要原发疾病。结论 我院老年病区死亡患者多为高龄老年人;肿瘤、心血管疾病、呼吸系统疾病为老年人主要死亡原因;冠心病、心源性猝死、心衰为心血管主要原发疾病。     

Sudden death due to single coronary artery

Coronary artery anomalies that entail a risk of sudden death are frequently associated with complex cardiac malformations but may occasionally be solitary. A 31-year-old man became ill in the night and lost consciousness. He was taken to a hospital where he was treated. However, he died on the same day. The death was considered to be suspicious and an autopsy was mandated. On macroscopic examination, the heart weighed 410 g. A single coronary artery that originated from the right aortic sinus was found. The coronary artery ostium was 0.8 cm in diameter and had a hole-like shape. Demonstration of coronary artery pathologies in autopsies is vital for the elucidation of sudden death cases related to these lesions and for the development of new treatment approaches. The aims of this case report are to contribute to a better understanding of the coronary artery anomalies and emphasise their medicolegal importance.     

心内科老年患者院内心源性猝死的临床分析

目的：探讨心内科老年患者发生院内心源性猝死（SCD）的病因及临床危险因素。方法选择我院心内科收治的60例心源性猝死老年患者作为研究对象,回顾性分析导致猝死的病因及临床危险因素。结果导致老年患者发生院内心源性猝死的主要病因有冠心病、高血压心脏病等。导致老年患者发生心源性猝死的常见危险因素有饮酒、吸烟、情绪激动用力等。结论心内科老年患者发生院内心源性猝死的病因较复杂,因此应详细了解患者病史,规避导致患者发生心源性猝死的危险因素,降低心源性猝死的发生率。     

冠心病猝死及心脏复苏的临床分析

目的探讨冠心病发生猝死的临床特征,分析心脏复苏对冠心病猝死的临床效果。方法将2002年1008年我院收治的冠心病发生猝死的患者117例分为心脏复苏成功39例（对照组）和失败78例（猝死组）,分析其临床资料。结果先兆症状表现、诱因、猝死时间等因素统计结果显示,2组比较有显著性差异（P〈0．05）。结论猝死的诱因、猝死先兆的临床表现、前驱症状到猝死发生的时间等因素与猝死后心脏复苏的成功率有密切关系。     

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。     

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。     

冠心病患者的心率变异性分析

目的：心率变异性（ＨＲＶ）分析是反映支配心脏的自主神经活动的无创性指标。本研究目的是研究冠心病人ＨＲＶ的改变。方法：通过ＨＲＶ时域分析方法,研究了２５例正常人,４０例冠心病病人的心率变异特征。结果：冠心病患者ＨＲＶ的窦性心博间标准差（ＳＤＮＮ）和ＨＲＶ三角指数（ＨＲＶ指数）明显低于正常人,两组之ＨＲＶ均有明显的昼夜节律,结论：冠心病人的ＨＲＶ降低,提示支配心脏的自主神经功能不平衡。     

复发缺血事件与心肌梗死后心源性猝死相关性质疑

心肌梗死是严重威胁人类健康的心血管疾病。心肌梗死存活者有很高的心源性猝死风险。2008年11月,《美国医学会杂志》（JAMA）发表的题为“心肌梗死后心源性猝死”的文章,探讨了人群中心肌梗死后心源性猝死的发生率及其与复发缺血事件以及心力衰竭的相关性。我们对该项研究的几处试验设计细节提出了质疑,认为心肌梗死后心源性猝死与复发缺血事件无关的结论值得商榷。     

心性猝死—4例主动脉瘤破裂的法医病理学鉴定

目的:探讨主动脉瘤破裂猝死的发病特点和病理学基础,为临床医师提供帮助。方法:对本系2002年12月至2006年l2月期间,所作450例法医病理检案的4例主动脉瘤破裂猝死案例进行分析研究。结果:4例主动脉瘤破裂致死占尸体解剖总数的0.89%,占SCD的4.1%,其中,DAA3例;2例DAA与AS有关。结论:主动脉瘤破裂病程短骤、凶险,是心性猝死的病因之一,早期症状与冠心病酷似,且病死率极高,因此应引起临床医师的高度重视,提高诊治水平。     

心率减速能力检测对心肌梗死后猝死的预警

心肌梗死后由于迷走神经功能受到抑制,心脏负性频率调节能力下降而容易诱发心脏性猝死。通过自主神经功能检测可预测心肌梗死后心脏性猝死的发生。通过检测心率减速力和连续心率减速力,定量评价迷走神经张力的大小,可对猝死风险进行分层。国内外大量研究都高度肯定心率减速能力检测对心肌梗死后心脏性猝死的预警价值,该文就心率减速能力检测的方法、优越性及其对心肌梗死后猝死的预警价值予以简单综述。     

国产药物洗脱支架在冠心病弥漫性长病变中的临床应用

目的研究国产雷帕霉素药物洗脱支架(Firebird)在冠心病弥漫性长病变中的疗效及安全性。方法 2008年1月1日至2008年12月22日单纯置入Firebird支架的冠心病弥漫性长病变患者72例。随访患者住院期间和出院后主要不良心脏事件(包括心肌梗死、心源性猝死及靶血管再次血运重建术)、心绞痛发作情况等。结果 72例患者术后随访10~24(16.54±6.68)个月,57例心绞痛症状消失(79.17%,57/72),14例心绞痛复发(19.44%,14/72),1例猝死(1.39%,1/72)。再狭窄2例(2.78%,2/72),随访期间发生猝死1例,无急性心肌梗死发生病例。结论国产Firebird药物涂层支架应用于冠心病弥漫性长病变患者中介入治疗是安全有效的。     

南充市475例院前猝死病例分析

目的分析院前猝死的各种影响因素,以利提高院前急救成功率。方法对南充市1999年1月至2005年12月期间475例院前猝死患者的性别、年龄,发生时段及诱发病因进行统计学分析。结果年龄大于60岁的人占院前猝死的60.00%。且在冬春季多发;明确有冠心病、心律失常病史的人占院前猝死的56.42%。结论在冬春季节对有冠心病、心律失常病史的老年人,进行积极的预防保健,可减少院前猝死的发生。     

Tobacco smoking and hypertension

Coronary artery diseases is rapidly increasing in our part of the world. The South Asian ethnic groups are especially vulnerable to coronary artery disease. The two most striking features of coronary artery disease in the South Asian population are extreme prematurity and severity of the disease, both resulting from the malignant atherosclerosis that begins at an earlier age than in other population. Triple vessel disease and complicated lesions are not common even in young people and follow a malignant course. The most important aspect of prevention is to identify individuals with high risk of coronary artery disease at an early age and aggressive modification of risk factors. Tobacco smoking and hypertension are the two most important risk factors for coronary heart disease and stroke. Both of these risk factors have very high prevalence in India, Nepal and other countries of this region. There is a synergistic interaction of tobacco smoking with hypertension and high blood cholesterol which greatly increase coronary heart disease risk as well as sudden death and stroke.     

New diagnostic modalities for the evaluation of the patient with syncope

Syncope is a common clinical problem. Patients with cardiac syncope have a poor prognosis and a high incidence of sudden death during follow-up. The most common diagnosis in these patients is ventricular tachycardia in the setting of coronary artery disease. Patients with syncope and structural heart disease should undergo EP testing to exclude ventricular tachycardia. The use of SAE may be helpful in selecting patients who are likely to have ventricular tachycardia at EP testing. Patients with syncope and a normal heart have an excellent survival, but about 30 percent have recurrent spells. Those patients with a normal heart and syncope in the upright position often have neurally mediated syncope, and the diagnosis can be confirmed by tilt testing. Patients defying diagnosis should undergo loop monitoring to document the cardiac rhythm during syncope.     

Marriage is associated with a lower risk of ischaemic heart disease in men

Comparison between subjects who were identified from a register of cases of myocardial infarction and a random sample of the same community showed that in the Lower Hunter region of New South Wales men who currently are not married are at higher risk of acute myocardial infarction or of sudden coronary death than are married men of the same age. While there are indications that unmarried men have a life-style that is different from that of currently married men, their increased risk of ischaemic heart disease is greater than can be accounted for by differences in factors such as age, the previous history of heart disease, their alcohol and tobacco consumption and various socioeconomic factors.     

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.