31例系统性红斑狼疮死亡原因分析

目的分析系统性红斑狼疮（SLE）患者的死亡原因及相关因素,探讨降低死亡率的方法。方法对31例住院死亡的SLE病例进行回顾性分析,并分析死亡原因与临床相关因素的关系。结果该组病例死亡率为9．7％,死于SLE引起的器官受累26例（83．9％）,死于感染的有5例（16．1％）。与该组病例死亡相关的临床因素有：部分病例长期误诊;部分患者未能根据病情及时调整免疫抑制治疗;患者的依从性差等因素。结论本组病例的死亡原因仍以SLE引起的器官损伤为主,原因为疫抑制治疗相对保守。早期诊断、及时合理免疫抑制治疗、积极的患者宣教以增强患者的治疗依从性,能提高SLE生存率。     

立体定向术治疗高血压脑出血致死因素分析及护理对策

目的探讨立体定向血肿清除术治疗高血压脑出血的死亡相关因素及护理对策.方法对我院行立体定向血肿清除术治疗的151例高血压脑出血患者的致死相关因素进行了回顾性分析.结果本组术后1个月内死亡14例,手术死亡率为9.27%.死亡的主要原因为年龄≥70岁、意识3～5分(Glasgow)、血肿体积>100ml、术后再出血、术后消化道出血、肺炎等并发症等.结论为降低手术死亡率,对高血压脑出血的致死相关因素如高龄、意识障碍明显、血肿量>100ml 、术后再出血及术后并发症等高危患者分别提出了相应的护理对策.     

糖尿病并发低血糖症75例原因分析及护理研究

目的 探讨糖尿病患者并发低血糖症的原因以及护理方法,为临床治疗糖尿病并发低血糖症提供参考.方法 选取2012年2月至2012年7月期间在我院治疗的75例糖尿病并发低血糖症患者作为研究对象,对75例患者的相关资料进行回顾性分析,并分析其发病原因,同时总结护理经验.结果 本组75例糖尿病并发低血糖症患者中,其中有71例患者在经过积极有效的治疗后在短时间内（数分钟至几个小时内）恢复正常,很快痊愈出院;有2例患者在3d后恢复正常;有1例患者成为植物人;有1例患者死亡.结论 在治疗过程中,不恰当的应用降血糖药物和胰岛素常会导致糖尿病患者低血糖的发生.医护工作者应密切关注糖尿病患者是否并发低血糖症,给予优质护理预防糖尿病患者低血糖症的发生,一旦发生低血糖症要及时采取有效措施.     

胰岛素强化治疗过程中发生低血糖的原因分析及护理对策

目的：探讨分析胰岛素强化治疗过程中发生低血糖的原因及应对措施,为临床预防和有效护理低血糖患者提供理论参考。方法回顾性分析我院2011年3月至2013年9月期间收治的46例胰岛素强化治疗过程中发生低血糖患者的临床资料,分析在胰岛素强化治疗过程中发生低血糖的原因,同时总结护理对策。结果本组46例患者经过及时有效的救治,有43例患者在数分钟至数小时内恢复正常,已痊愈出院;有2例患者在血糖正常后仍处于昏迷状态,经静脉滴注氢化可的松后逐渐恢复正常;有1例患者死亡。应用护理干预后,患者低血糖及相关并发症发生率较干预前明显降低,患者满意度较干预前显著升高,经比较差异均有统计学意义（ P＜0.05）。结论胰岛素强化治疗过程中发生低血糖症状与治疗方案、饮食控制、胰岛素给药剂量、护士操作技术等相关,应加强患者的血糖监测、健康宣教及护理干预,有效降低低血糖及相关并发症发生率。     

伍以活血化瘀法为主中药治疗脑挫裂伤

目的 探索在西医治疗基础上配合以活血化瘀法为主中药治疗急性期脑挫裂伤的临床效果.方法 将87例脑挫裂伤患者按随机原则分为中药治疗组(46例)和西药治疗对照组(41例).对照组给予常规西药治疗;中药组在西医治疗基础上辨证给予中药治疗.分别于治疗后5d和10d及3个月观察两组患者的治疗效果.结果 治疗5d后中药组清醒28例,昏迷13例,死亡5例,对照组分别为10、25、6例;治疗10d后中药组清醒31例,昏迷9例,死亡6例,对照组分别为17、17、7例;两组清醒和昏迷例数比较差异均有统计学意义(P<0.05或P<0.01).治疗3个月后,中药组恢复良好26例,轻残10例,重残4例,死亡6例,对照组分别为10、22、2、7例,两组恢复良好、轻残例数比较差异均有统计学意义(均P<0.01).结论 在西医治疗的基础上配合以活血化瘀法为主中药治疗急性期脑挫裂伤,对促进患者清醒、降低致残率有明显疗效.     

急性磷化铝中毒6例的临床救治

目的观察并探讨急性磷化铝中毒患者的临床表现、治疗方法、疗效及死亡原因。方法对启东市第六人民医院急诊内科2010年收治的6例口服磷化铝中毒患者的治疗情况进行分析,升压治疗的重要性。结果本研究存活3例,死亡3例,死亡患者均为重度中毒,死亡时间为入院后0.5～72 h,死亡原因为中毒性休克导致循环衰竭。存活者出院随访1个月均治愈。结论急性磷化铝中毒病死率高,早期内科综合治疗尤为重要,而早期治疗休克、改善微循环是降低病死率的重要方法。     

前列腺癌去势术42例的护理

目的探讨前列腺癌患者去势术后的护理。方法 42例患者进行心理护理,针对患者积极有效的术前准备、术后护理及并发症的观察、预防与处理,有效促进患者康复。结果本组1例切口感染延期愈合外,切口均正常愈合。1例术后发生心梗转入心内科继续治疗,术后回访与前列腺癌相关死亡4例,其他原因死亡5例。结论护理人员在整个治疗过程中通过有效的观察及护理为治疗的成功提供保障。     

急性心肌梗死急诊经皮冠状动脉介入治疗围术期死亡原因探讨

目的 分析急诊经皮冠状动脉介入治疗(PCI)急性心肌梗死(AMI)的死亡原因,以期进一步提高急诊PCI治疗AMI的效果.方法 回顾性分析经急诊PCI治疗的AMI死亡患者16例,对其临床特点、PCI策略、死亡原因等进行深入探讨.结果 急诊PCI围术期病死率为5.97％.急诊PCI术中死亡2例;术后＜24h死亡8例;术后24 ～72 h死亡2例;＞72 h死亡4例,最长死亡时间为术后第14天.多数患者在24h内死亡.术中死亡患者主要死于血管再通后无复流及顽固性恶性室性心律失常.术后72 h内死亡主要原因为顽固性心源性休克及室性心律失常等AMI并发症.超过72 h死因多为造影剂肾病致急性肾损伤、致命性内脏出血、急性肺栓塞、多器官功能衰竭等.结论 急诊PCI治疗AMI的主要死亡危险因素为老龄、心源性休克、基础疾病尤其糖尿病、再发AMI、冠状动脉多支病变、抗凝、抗血小板药物的致命性出血并发症等.为减少AMI病死率,应进一步提高PCI操作技术,重视合并症及综合治疗,合理应用抗凝、抗血小板药物等.     

颅内动脉瘤栓塞治疗中并发症的预防及处理

目的探讨颅内动脉瘤栓塞治疗中并发症的处理措施。方法回顾分析我科2007年1月到2009年10月采用血管内栓塞治疗颅内动脉瘤65例。结果65例患者中出现并发症10例,其中3例死亡。治疗中动脉瘤破裂2例：1例为宽颈动脉瘤,术中瘤颈破裂,栓塞失败,患者死亡;1例为前交通动脉瘤合并右眼动脉动脉瘤,术前分级为Ⅳ级,术中前交通动脉瘤成功栓塞,右眼动脉动脉瘤未能处理,术中破裂,患者死亡。合并不同程度脑血管痉挛8例,其中1例后交通动脉瘤患者,术前Ⅳ级,术中发生脑血管痉挛,术后并发肺部感染而死亡。3例后交通动脉瘤术后出现脑梗死,原因是弹簧圈部分脱出。4例前交通动脉瘤术后出现脑梗死,原因是载瘤动脉血栓形成。以上病例均表现为一侧肢体不全性瘫,经抗凝、扩血管等治疗后好转。结论颅内动脉瘤栓塞治疗中并发症的预防及处理是患者康复的关键。     

慢性肺源性心脏病伴呼吸衰竭104例临床观察

目的:探讨肺心病伴呼吸衰竭的治疗方法、治疗难点和治疗失误。方法:对华西医院呼吸科1995年09月～1997年09月收治的104例确诊肺心病伴呼吸衰竭患者的治疗措施及预后转归和死亡原因进行回顾性分析。结果:104例患者男61例,女43例,平均年龄为(62.8±18.5)岁,其中45—70岁的占67.9%。好转55例,占52.9%,45例死亡,死亡率43.3%。伴发糖尿病及肺部真菌感染与预后不良显著相关。伴肺性脑病、呼吸机相关肺炎是肺心病死亡的高危因素。结论:肺心病伴肺部严重感染、其他系统性疾病、肺性脑病、DIC、上消化道出血、感染中毒性休克、水电解质失衡及酸碱平衡紊乱、心律失常以及呼吸机相关肺炎的重症患者预后不良,死亡率高。机械通气能提高抢救成功率,降低病死率。     

Mortality in Crohn's disease--a clinical analysis

We have examined the causes of death and the changing pattern of mortality over time among 769 patients with Crohn's disease under long-term review between 1944 and 1984. One hundred and fifty-six patients have died. The cause of death could not be classified in five. The deaths were divided into those related directly to Crohn's disease and unrelated deaths from incidental causes. The cause and age at death among 59 unrelated deaths was similar to that expected in the general population. The common causes of related deaths were sepsis, digestive tract cancer, pulmonary embolus and metabolic disorders. There were 30 deaths after surgery, usually from sepsis after emergency surgical treatment. There have been fewer deaths in recent years and the cause of death has altered. Sepsis and electrolyte imbalance have declined in importance and cancer of the digestive tract is now the most common cause of related death. Occasional death from sepsis occurs in elderly patients. Elective rather than emergency surgical treatment and the routine use of antimicrobial prophylaxis before surgery has probably reduced mortality. With the exception of cancer of the digestive tract the appropriate medical and surgical treatment of patients with Crohn's disease can eliminate excess mortality previously associated with the disorder.     

Application of transcranial Doppler ultrasonography for the diagnosis of brain death

Objective: To determine the clinical validity of transcranial Doppler ultrasonographic (TCD) signs of total cerebral circulatory arrest for confirmation of brain death and to define the test protocol. Design: Study of a diagnostic test. Setting: General and neurosurgery intensive care units. Patients: 137 patients in a coma (Glasgow Coma Score 3–5), caused by various pathological conditions, observed from January 1992 to July 1998. 84 patients met the clinical criteria of brain death; 43 patients out of 137 received sedative drug therapy and 31 of these developed brain death. Results: Total cerebral circulatory arrest was demonstrated by TCD in 81 patients. All of them proved to be brain dead according to subsequent clinical examination In 29 of 31 patients who had received sedative drug therapy TCD examination showed total cerebral circulatory arrest 12–48 h before the formal confirmation of the diagnosis. In 1 out of 84 clinically brain dead patients a false negative result was obtained. In 2 of 84 cases, no clear signals from intracranial vessels were obtainable. Fifty-three patients who did not meet the clinical criteria for brain death showed no TCD signs of total cerebral circulatory arrest. The specificity of the TCD test for confirmation of brain death was 100 % and the sensitivity 96.5 %. Conclusions: In agreement with previously published data, we conclude that TCD ultrasonography is a highly specific and sensitive confirmatory test and should be included as an additional test in the protocol for the assessment of brain death. Received: 16 November 1998 Final revision received: 16 March 1999 Accepted: 17 May 1999     

心脏手术相关医疗纠纷的法医学分析

目的分析心脏手术相关医疗纠纷的临床及法医学特点,并就发生原因进行剖析及提出相应防范措施。方法对2002年1月-2011年12月四川华西法医学鉴定中心受理的四川省各级医疗机构发生的17例与心脏手术相关的医疗纠纷法医学鉴定资料进行回顾性分析。结果17例心脏手术相关医疗纠纷中,12例进行了尸体解剖死因鉴定,死亡原因有心脏传导系统出血,术后感染,低心排量综合症、肺动脉高压、失血性休克致死等。其余5例加上尸体解剖2例在内共7例进行了医疗过错鉴定,存在的医疗过错包括术前检查不完善,告知不充分,手术操作不细致,术后观察、处理不足,医疗记录不完整等。结论心脏手术相关医疗纠纷与术后并发症关系密切,医护人员应重视对心脏术后并发症的防治。尸体解剖对解决心脏术后死亡引起的医疗纠纷具有重要意义。     

Transcranial Doppler ultrasonography to confirm brain death: a meta-analysis

Objective Barbiturate therapy or hypothermia precludes proper diagnosis of brain death either clinically or by EEG. Specific intracranial flow patterns indicating cerebral circulatory arrest (CCA) can be visualized by transcranial Doppler ultrasonography (TCD). The aim of this study was to assess the validity of TCD in confirming brain death.Design Meta-analysis of studies assessing the validity of TCD in confirming brain death.Methods A systematic review of articles in English on the diagnosis brain death by TCD, published between 1980 and 2004, was performed. An oscillating or reverberating flow and systolic spikes were considered to be compatible with CCA. The quality of each study was assessed using standardized methodological criteria. The literature was searched for any article reporting a false-positive result.Results Two high-quality and eight low-quality studies were included. Meta-analysis of the two high-quality studies showed a sensitivity of 95% (95% CI 92–97%) and a specificity of 99% (95% CI 97–100%) to detect brain death. Meta-analysis of all ten studies showed a sensitivity of 89% and a specificity of 99%. In the literature we found two false-positive results; however, in both patients brain-stem function did show brain death shortly thereafter.Conclusions CCA by TCD in the anterior and posterior circulation predicted fatal brain damage in all patients; therefore, TCD can be used to determine the appropriate moment for angiography. Further research is needed to demonstrate that CCA by TCD on repeated examination can also predict brain death in all patients.     

Cause of death in systemic lupus erythematosus: a pattern based on age at onset

We reviewed the causes of death in 50 patients treated for systemic lupus erythematosus at the University of Mississippi Medical Center between 1973 and 1985. Two groups of patients could be distinguished based on the age at onset but not on the duration of disease. Younger patients more often died of active renal disease an infectious complications, while older patients died of other organ involvement, inactive renal disease, and miscellaneous causes. Common causes of infection were gram-positive cocci and gram-negative bacilli. Atherosclerotic cardiovascular disease was an infrequent cause of death, and no patients died of malignancy. Patients who died had more multisystemic involvement, with serositis and renal, central nervous system, and hematologic manifestations than patients who were alive at last follow-up.     

梗阻性黄疸术后死亡原因探讨：（附140例分析）

本文回顾分析140例梗阻性黄疸术后死亡原因,结果发现,感染、中毒性休克、肾衰、肝衰和消化道出血等是梗阻性黄疸术后最常见的并发症和主要死亡原因。其中,肾、肝功能掼害程度远较以往临床所想象的严重。因此,对梗阻性黄疸病人肝、肾功能障碍的防治值得十分重视。内毒素血症是引起休克、肾衰以及消化道出血的重要原因,采取中西医结合的方法防治内毒素血症,可望改善预后,很值得进一步探索。     

Fate of Explanted ICD Patients

Of 56 consecutive patients who underwent an initial AICD implantation at our center, we analyzed eight patients who subsequently had their units explanted and not replaced by other antitachycardia devices. The mean age was 57.8 years, mean ejection fraction was 28.4%; six patients had coronary disease and two had cardiomyopathy. The presenting arrhythmia was sudden death in four patients and sustained ventricular tachycardia in four others. Mean follow-up from implant to explant was 25 ± 22 months, and 22 ± 10 months from explant to end of follow-up. Reasons for explantation were: infection in five patients, lead fracture in one patient, battery depletion in one patient, and one patient underwent cardiac transplantation. Devices were not reimplanted because of: patient refusal in three patients, physician discretion in two patients (one recurrent infection, one received no shocks over 24 months), cardiac transplantation in one patient, ablation of VT focus in one patient, and one patient died while being treated for infection. Three patients died 2, 21, and 26 months after device explantation of nonsudden cardiac, sudden cardiac and noncardiac causes, respectively. Conclusions: Preoperative clinical parameters were not indicative of a lower risk of arrhythmic events in these patients as compared to the general population of AICD implantees. Of eight patients, two received alternate nonmedical therapy, one died while receiving treatment for a device-related infection; of the five remaining patients none died of cardiac causes. Termination of AICD therapy for malignant ventricular arrhythmias does not imply imminent sudden cardiac death for most patients treated by alternate modes of therapy.     

经颅多普勒超声对脑死亡的诊断意义

目的:探讨经颅多普勒超声(TCD)对脑死亡的诊断意义。方法:选择临床拟诊断脑死亡患者32例,行TCD检查双侧大脑中动脉、基底动脉,每12 h观察1次,至少重复2次,终点事件为患者心跳不可逆停止,记录每种血流频谱出现的时间及持续时间。结果:所有患者均在发现振荡波后1-7 d内出现心跳不可逆停止,出现钉子波频谱后患者于0-48 h内出现心跳不可逆停止,出现血流信号消失的患者于0-12 h内出现心跳不可逆停止,每种频谱持续的时间长短不同。结论:在脑电图及诱发电位基础上行TCD检查可提高脑死亡诊断准确性达100%;脑死亡各种TCD频谱呈规律性改变,依次出现振荡波、钉子波及血流信号消失。     

颈椎曲度异常与青少年头痛等相关症状的临床研究

目的:探讨不明原因青少年头痛、头晕的病因,颈椎曲度异常对头痛的影响和探索有效的治疗方法。方法:根据X光片颈椎曲度异常的程度,将120例12～35岁头痛头晕并有颈椎曲度异常的患者分为轻度（41例）、中度（40例）、重度（39例）三组,对各组病程、临床症状（头痛程度、头晕、晕厥、记忆力减退等）;体征（血压、Hoffmann征、闭目难立征）;脑电图、经颅血管彩色超声进行分析比较;并对其中100例接受了牵引、手法按摩治疗患者的疗效进行了比较。结果:随颈椎曲度异常程度加重,头痛症状、阳性体征、实验室检查异常增加,轻中重各组有显著差异（P<0.05～0.01）;颈椎曲度异常与头痛的程度和病程密切相关（P<0.01）;在90例完成治疗的患者中,痊愈53例（58.9％）,显效24例（26.6％）,好转8例（8.9％）,无效加重5例,总有效率94.4％。结论:颈椎曲度异常与青少年头痛的发生密切相关,可能是一个不可忽视的潜在病因;牵引、按摩的物理治疗对减轻此类头痛有效,部份得到治愈。     

维持性血液透析患者死亡原因分析

目的 总结维持性血液透析患者死亡原因,分析其相关影响因素.方法 回顾性分析36例维持性血液透析患者死亡原因及其相关影响因素.结果 36例死亡的血液透析患者中,主要死亡病因为心血管事件15例(41.7％),脑血管意外7例(19.4％),感染7例(19.4％),上消化道出血3例(8.3％),恶性肿瘤2例(5.6％),原因不明2例(5.6％).与非心脑血管疾病死亡患者相比,死于心脑血管疾病的患者中合并糖尿病45.5％(10/22) vs 7.1％(1/14)(P＜0.05)、充血性心力衰竭54.6％(12/22) vs 14.3％(2/14)(P＜0.05)、左心室肥厚50.0％(11/22) vs14.3％(2/14)(P＜0.05)的比例较高,而血白蛋白的水平较低(31.9 g/L vs 36.3 g/L,P＜0.05).进一步进行logistic回归分析提示糖尿病、透析前充血性心力衰竭史、左心室肥厚可能是维持性血液透析患者死亡的危险因素.结论 持性血液透析患者的死亡原因主要为心血管疾病、脑血管疾病和感染.积极改善患者的营养状况,有效预防和干预糖尿病、充血性心力衰竭、左心室肥厚等并发症,可能有助于提高患者的早期和长期生存率.