院前猝死事件的发病特点分析

目的：系统分析院前猝死事件的发生特点及其规律。方法：回顾性分析1992～2002年院前急诊救治病例1030例的临床资料。结果：院前发生猝死病例106例。猝死的高发年龄段有2个：66～75岁(27．3％)和46～55岁(22．6％)。发生猝死病例中，既往有明确心血管病史者69例(65．1％)，不明原因者22例(20．7％)，其它原因者15例(14．2％)。引发猝死的直接原因为：室速、室颤(55．0％)，心源性休克(16．7％)。结论：院前猝死事件中，以急性心血管事件所致比例最大，救治更为重要；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，同时应注意低年龄组人群也有较高比例的猝死事件发生的趋势。     

心脏骤停患者心肺复苏的疗效观察

目的探讨院前心肺复苏（CPR）的有效措施，提高CPR成功率。方法对我院2003年1月～2006年12月院前急诊救治的247例患者的临床资料进行回顾性分析。结果院前猝死病例247例，约72％有明确的心血管病史，猝死的高发年龄段有2个：66—75岁（27．3％）和46—55岁（22．6％）。发生猝死病例中，既往有明显心血管病史者177例（71．66％），不明原因者20例（8．10％），其它原因者50例（20．24％）。引发猝死的直接原因为：室速、室颤（77．0％）。结论院前猝死事件中，以急性心血管事件所致比例最大，及时救治更为重要；对于已有心血管病病史的患者应注意其发生猝死的高度危险性，同时应注意低年龄组人群也有较高比例的猝死事件发生。心脏骤停患者尽早实施电除颤可明显提高CPR成功率。     

心脏骤停患者心肺复苏的疗效观察

目的 探讨院前心肺复苏(CPR)的有效措施,提高CPR成功率.方法 对我院2003年1月～2006年12月院前急诊救治的247例患者的临床资料进行回顾性分析.结果 院前猝死病例247例,约72%有明确的心血管病史,猝死的高发年龄段有2个:66～75岁(27.3%)和46～55岁(22.6%).发生猝死病例中,既往有明显心血管病史者177例(71.66%),不明原因者20例(8.10%),其它原因者50例(20.24%).引发猝死的直接原因为:室速、室颤(77.0%).结论 院前猝死事件中,以急性心血管事件所致比例最大,及时救治更为重要;对于已有心血管病病史的患者应注意其发生猝死的高度危险性,同时应注意低年龄组人群也有较高比例的猝死事件发生.心脏骤停患者尽早实施电除颤可明显提高CPR成功率.     

院前猝死62例临床分析

目的：分析院前猝死的临床特点及危险因素，探讨防治措施，提高院前急救的成功率。方法：回顾性分析2001年1月至2004年6月院前猝死62例的临床资料。结果：猝死发病率较高的年龄段是66-75岁(36％)和45—55岁(19％)；既往有明确心血管病史者41例(66％)；有前驱症状者22例(36％)，院前抢救仅1例获得Ⅰ期复苏成功。结论：院前猝死以心源性猝死为主，应加强对心血管疾病的治疗，注意识别高危患者及前驱危险信号．可减少猝死的发生；合理调配院前急救资源，缩短医务人员到达现场时间，可提高院前猝死急救的成功率。     

院前急症心血管突发事件发生特点的分析

目的：了解院前心脏突发事件的发病特点,以便更好地进行院前急救,降低病死率。方法：分析我院１９７３～１９９７年１０３０例院前急症事件患者资料。结果：发病构成比最高的前３位病种是：冠心病（４８．６％）,心律失常（２８．９％）,高血压病（６．５％）;在不同年龄段心脏事件发病中,冠心病（包括急性心肌梗死、心胶痛）的发病高峰年龄段为５６～６６岁（占３６．３％）;心律失常的发病高峰年龄段在５６～７０岁（占５０．４％）;急诊高血压高发年龄段在６６～７０岁（占２５．０％）。猝死的高发年龄段有两个,其中第１个为５１～５５岁年龄段（占２１．０％）,第２个为６１～７６年龄段（占１５．０％）。,前者明显高于后者。冠心病各类型发生比例中,不稳定型心胶痛占４３．４％,急性心肌梗死占３０．６％。在１０３０例院前救治的总病例数中,发生猝死事件     

126例院前死亡病例临床分析

目的：通过分析院前死亡的病因构成，院前救护的时机和复苏成败的原因，合理配置医疗资源，提高现场救护的成功率。方法：回顾性分析126例院前死亡病例从发病到呼救时间，救护车反应时间，临床特点，年龄段分布特点，发病时间段分布特点以及现场复苏效果。结果：猝死组发病有2个高峰年龄段（60－79岁、40－49岁）；有明显既往病史者49例。有前驱症状者24例。该组发病高峰时间段在6－12am。非猝死组高峰年龄段在20－39岁，以车祸为主要致伤原因；无高峰时间段分布特点，126例经院前救护有3例获Ⅰ期复苏成功，结论：识别高危人群及前驱危险信号，对其进行实时监控，对事故发生高峰时间段的资料进行合理配置，才能有效缩短事故发生至呼救时间，呼救至救护车反应时间，提高院前复苏成功率。     

急性中毒的临床救治探讨(附急性中毒778例临床分析)

目的 了解急性中毒临床特点，探讨急性中毒的临床救治原则。方法 利用急性中毒调查表调查1998年5月－2000年4月急性病例的一般资料、毒物接触史、临床表现、病情分级、治疗经过、结果等。结果 急性中毒778例，患者男433例（55．7％），女345例（44．3％），以20－29岁年龄组占比例最高（47．0％）。死亡5例，病死率0．6％。结论 急性中毒的临床救治关键在于临床医师要熟悉常见急性中毒的临床特点，及时对症采取有效措施诊治病人。     

致命性冠心病的死亡原因──100例临床病理分析

从冠心病为死亡主要或重要原因100例的尸解所见，冠状动脉粥样硬化在冠脉主支有≥Ⅲ级者占98％，多个主支有≥Ⅲ级者70％，主支有完全或几乎完全阻塞性病变者35％。单纯AMI者18％，兼有AMI与OMI51％，急性缺血性心肌病变6％；多处心梗病变者85％。25例发生心室壁瘤，14例发生心脏破裂。经统计学处理死亡原因居首位为急性左心衰竭（含泵衰竭）占85％；第二位为严重心律失常40％（含猝死为55％）、心源性休克42％（含泵衰竭38％）、呼吸衰竭31％；第三位为心脏破裂14％与多脏衰16％，三者间有很显著差异（P＜0．01）。严重心律失常及猝死在院前及发病早期占死亡原因的首位。针对以上分析，提出相应的防治意见。     

基层医师规范化院前救治在急性中毒抢救中作用的临床研究

目的：研究通过加强对基层医师进行急性中毒流程的培训，是否能提高急性中毒救治成功率。方法：将435例各种急性中毒患者分为二组：将经过培训后的乡村医师在现场进行正规院前救治者为甲组，共214例。而未进行任何院前救治者为乙组共221例。结果：院前组住院天数明显低于非院前组，两者差异有统计学意义（P〈0．01）：院前组病死率亦明显低于非院前组，院前组病死率为9．81%，非院前急救组病死率达13．83％，两者差异有统计学意义（P〈0．01）。结论：加强基层医师培训，使基层医师掌握急性中毒程度，救治流程及方法，实施规范化院前救治。以提高急性中毒抢救成功率，减少死亡率。     

胸部外伤合并休克的临床救治

目的：探讨胸部外伤发生的原因，总结胸部外伤合并体克的临床特点。材料与方法：对我院1990年9月－2006年10月期间救治的48胸部外伤合并休克病例的资料进行回顾性总结。结果：胸部外伤发生休克的主要原因以失血性休克为主者33例占68．8％，以心包填塞为主者6例占12．5％，以纵隔摆动为主者5例占10．4％，以心肌挫伤为主者4例占8．3％。结论：胸部外伤发生休克的原因错综复杂，失血性休克是最常见的原因，而心包填塞、纵隔摆动及心肌挫伤亦是不可忽视的重要原因。在救治过程中强调综合性治疗，合理补液，妥善处理心包填塞、心肌挫伤、肺挫伤及颅脑损伤。早期就应特别注重对肺功能的保护，预防ARDS。     

Elderly deaths associated with balneotherapy in denizli, Turkey province: three autopsy cases

Abstract Background: Turkey is one of the richest countries in the world in terms of balneotherapy resources. Thermomineral water baths are preferred by the elderly because of their positive beneficial effects over regulation of musculoskeletal system functions. However, existing cardiovascular and respiratory system diseases may constitute a risk and trigger ischemic changes in the heart. Methods: In this study, 2 cases are presented who suffered sudden cardiac death while having a thermal bath and 1 drowning case that was precipitated by chronic myocardial infarction. While 1 case was 63 years old, 2 cases were above 65 years of age. Two (2) cases had atherosclerotic coronary artery disease, whereas 1 case had heart failure. Results: The success of spa treatment, which is based on stimulation/harmonization therapy, restores bodily harmony and depends on the health of organs and functions playing a role in this process. Conclusions: In the elderly, some conditions, particularly limited pulmonary and cardiovascular functionality, should be taken into consideration while applying those treatments.     

探讨心内科老年患者治疗期间心源性猝死的临床危险因素江西省安福县人民医院内一科 曾林飞

目的 分析心内科老年心血管疾病患者发生心源性猝死的高危因素。方法 搜集自2016年2月- 2019年8月在本院心内科住院期间发生心源性猝死的患者共68例,作为研究组;搜集同期未发生心源性猝死的心血管疾病患者共145例,作为对照组。收集并比较两组患者的饮酒史、吸烟史、合并症、BMI、年龄、疾病类型等临床资料,展开回顾性分析,采用Logistic分析影响患者发生心源性猝死的高危因素。结果 研究组患者中心率失常、伴高血压、伴高血脂、伴心肌梗塞病史、伴外伤、便秘、瓣膜心脏病和慢性肺病比例、BMI值明显高于对照组,差异具有统计学的意义(P<0.05);经Logistic分析显示,瓣膜心脏病、高血脂、心肌梗塞病史、慢性肺病、便秘、心率失常、BMI≥28kg/m²均为患者发生心源性猝死的高危因素(P<0.05)。结论 高血脂、心肌梗塞病史、慢性肺病、便秘以及肥胖均会增加老年心血管疾病患者发生心源性猝死的风险性,在治疗时需早期评估心内科老年患者的心源性猝死风险,指导患者调整生活习惯,控制合并症,预防猝死的发生。     

The old but reliable digitalis: persistent concerns and expanded indications

Digitalis has been an old but reliable drug for 240 years. Concerns regarding its clinical indications and benefits still exist in the absence of a reduction in all-cause mortality. While intravenous digitalis is used without question in cases of atrial fibrillation, it is still controversial in sinus rhythm, despite the Digitalis Investigation Group (DIG) study showing a significant reduction in death and the need for hospitalisation for congestive heart failure in both diastolic and systolic dysfunction. The influence of digitalis in acute myocardial infarction, coronary artery disease and sudden cardiac death remains speculative. In cases of uncomplicated hypertension, it appears to prevent the onset of left ventricular dysfunction and myocardial infarction. Thus, digitalis can be a cost-effective agent with added benefits.     

Adverse cardiovascular events temporally associated with ma huang, an herbal source of ephedrine.

OBJECTIVE: To evaluate possible cardiovascular toxic effects associated with use of dietary supplements containing ma huang, an herbal source of ephedrine. METHODS: We reviewed the comprehensive database Adverse Reaction Monitoring System of the Food and Drug Administration, which included clinical records, investigative reports, and autopsy reports related to ma huang use. The main outcome measurements were stroke, myocardial infarction, and sudden death. RESULTS: From 1995 to 1997, 926 cases of possible ma huang toxicity were reported to the Food and Drug Administration. In 37 patients (23 women and 14 men with a mean +/- SD age of 43 +/- 13 years), use of ma huang was temporally related to stroke (in 16), myocardial infarction (in 10), or sudden death (in 11). Autopsies performed in 7 of the 11 patients who experienced sudden death showed a normal heart in 1, coronary atherosclerosis in 3, and cardiomyopathies in 3. In 36 of the 37 patients, use of ma huang was reported to be within the manufacturers' dosing guidelines. CONCLUSIONS: Analysis of the 37 patients indicates the following findings: (1) ma huang use is temporally related to stroke, myocardial infarction, and sudden death; (2) underlying heart or vascular disease is not a prerequisite for ma huang-related adverse events; and (3) the cardiovascular toxic effects associated with ma huang were not limited to massive doses. Although the pathogenesis of the cardiac toxic effects of ma huang remains incompletely defined, available observational and circumstantial evidence indicates that use of the substance may be associated with serious medical complications.     

Psychosocial nursing therapy following sudden cardiac arrest: impact on two-year survival

BACKGROUND: Although psychosocial therapy has been shown to reduce mortality after myocardial infarction, it is unknown whether the benefits of psychosocial therapy on mortality reduction extend to out-of-hospital sudden cardiac arrest, a main cause of cardiovascular mortality. OBJECTIVE: Describe efficacy of psychosocial therapy on two-year cardiovascular mortality in sudden cardiac arrest survivors. METHOD: Survivors of out-of-hospital ventricular fibrillation or asystole (N = 129), documented by electrocardiograms from registries of a citywide Medic One unit and two countywide emergency units, were randomized into a two group, experimental, longitudinal design. The intervention consisted of 11 individual sessions, implementing three components: physiologic relaxation with biofeedback training focused on altering autonomic tone; cognitive behavioral therapy aimed at self-management and coping strategies for depression, anxiety, and anger; and cardiovascular health education. The primary outcome measure was cardiovascular mortality. RESULTS: Risk of cardiovascular death was significantly reduced 86% by psychosocial therapy, p = .03. Six of the seven cardiovascular deaths in the control group were caused by ventricular arrhythmias. The cardiovascular death in the therapy group was due to stroke. Controlling for depression, previous myocardial infarction, low ejection fraction, decreased heart rate variability, and ventricular ectopic beats had little impact on estimated treatment effect. The risk of all-cause mortality was reduced by 62% in the therapy group, p = .13. There were a total of three deaths in the therapy group and eight deaths in the control group. CONCLUSIONS: Psychosocial therapy significantly reduced the risk of cardiovascular death in sudden cardiac arrest survivors.     

急性冠状动脉综合征患者经皮冠状动脉介入治疗围术期死亡原因分析

目的：探讨急性冠状动脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）围术期死亡原因。方法：2002年1月—2006年3月在复旦大学附属中山医院接受PCI的3 806例冠心病患者中36例ACS患者发生围术期死亡。其中男性23例,女性13例;年龄24~85岁（平均年龄69±23岁）,包括急性心肌梗死（AMI）29例、不稳定心绞痛7例,其中既往有陈旧性心肌梗死史者7例、PCI治疗史者4例、冠状动脉旁路移植术（CABG）史者1例、脑卒中史者4例,合并有高血压病者20例、脂代谢紊乱者11例、糖尿病者6例、慢性阻塞性肺病者4例。结果：36例ACS患者中,因AMI行急诊PCI者24例,ACS行择期PCI者12例（包括AMI5例、不稳定心绞痛7例）。冠状动脉造影显示,26例有2支及以上多支血管病变,10例为单支血管病变。36例ACS患者PCI围术期死亡原因为心力衰竭或（和）心源性休克16例（44.4%）,室颤和（或）心脏骤停8例（22.2%）,多脏器功能衰竭4例（11.1%）,心脏破裂4例（11.1%）,急性或亚急性支架内血栓形成3例（8.3%）,消化道大出血1例（2.8%）。急诊PCI因泵衰竭死亡的12例患者中,广泛前壁AMI7例、下壁＋后壁AMI3例,下壁＋右室AMI2例。结论：ACS患者PCI围术期死亡的主要原因为泵衰竭、室颤和（或）心脏骤停、多脏器功能衰竭、心脏破裂及支架内血栓形成。     

Sudden Cardiac Death From the Perspective of Coronary Artery Disease

Sudden cardiac death accounts for approximately 50% of all deaths attributed to cardiovascular disease in the United States. It is most commonly associated with coronary artery disease and can be its initial manifestation or may occur in the period after an acute myocardial infarction. Decreasing the rate of sudden cardiac death requires the identification and treatment of at-risk patients through evidence-based pharmacotherapy and interventional strategies aimed at primary and secondary prevention. For this review, we searched PubMed for potentially relevant articles published from January 1, 1970, through March 1, 2014, using the following key search terms: sudden cardiac death, ischemic heart disease, coronary artery disease, myocardial infarction, and cardiac arrest. Searches were enhanced by scanning bibliographies of identified articles, and those deemed relevant were selected for full-text review. This review outlines various mechanisms for sudden cardiac death in the setting of coronary artery disease, describes risk factors for sudden cardiac death, explores the management of cardiac arrest, and outlines optimal practice for the monitoring and treatment of patients after an acute ST-segment elevation myocardial infarction to decrease the risk of sudden death.     

抑郁症对冠心病患者预后的影响

目的分析抑郁症对冠心病患者预后的影响。方法将246例冠心病患者分为抑郁症组和非抑郁症组,比较两组患者近期心血管事件发生率,分析抑郁症与心血管事件的关系。结果冠心病合并抑郁症患者心绞痛、急性ST段抬高型心梗、急性非ST段抬高型心梗、心力衰竭、短阵室性心动过速、心室颤动、心脏性死亡的发生率分别为75.6%、11.1%、17.8%、26.7%、12.2%、8.9%和7.8%,抑郁症为心血管事件发生的独立预测因素。结论冠心病合并抑郁症患者心血管事件发生率升高,且抑郁症为心血管事件发生的独立预测因素。     

The epidemiology of non-traumatic prehospital sudden death in Macau

OBJECTIVE: To understand the epidemiology of non-traumatic prehospital sudden death (NPSD) in Macau, and to discuss potential diseases related to NPSD. METHODS: We analysed the epidemiological characteristics of 605 NPSD cases occurred between January 1, 2003 and December 31, 2005 in Macau. Four hundred NPSD victims' medical records were reviewed to collect information regarding associated diseases. RESULTS: NPSD was more common in males than females (56.5% versus 43.5%). Male patients were 7.9 years younger than female patients (68.8+/-17.7 versus 76.7+/-16.7, p=0.000). NPSD had a higher incidence in the months December to March. There were 21.8 NPSD cases per month on an average during this period. NPSD occurred more frequently during daylight hours. The following diagnoses were frequently found in the patients' medical records: hypertension (39.5%), cerebral vascular accident (18.5%), type 2 diabetes mellitus (17.8%), congestive heart failure (13.3%), chronic renal failure (11.3%), and chronic obstructive pulmonary disease (11%). Coronary artery disease was diagnosed in only 9.2% in all NPSD cases. CONCLUSIONS: NPSD has similar epidemiological characters with sudden cardiac death. Most NPSD should be presumed to be of cardiac aetiology. Chronic diseases that affect cardiovascular system have close relations with NPSD. Coronary artery disease in these patients should be recognised early.