住院精神病患者猝死的临床分析及预防

目的 了解精神科住院患者猝死特点,以降低住院精神科患者的猝死发生率,减少医疗纠纷.方法 对我院2002-01～2008-09猝死的住院患者共12例进行回顾性分析.结果 新入院1周内猝死率极高,占83.33%,大多数患者联合使用抗精神病药(APS),且多数合并躯体疾病.结论 入院初期进食差、联合用药、合并躯体疾病是精神科住院患者猝死的主要原因,护理人员应高度重视住院半月以内的患者,并加强特殊时段的护理.     

10年来我院精神科住院死亡病例临床分析

目的分析精神科住院死亡病例的死因,探讨精神科住院患者死亡的高危因素和降低精神科死亡率的措施。方法对我院10年来精神科住院患者11889例中死亡的30例进行回顾性调查。结果死亡率为0．25％,躯体疾病和猝死为死因前二位,占了全部死亡病例86．67％（分别为63．339／6、23．33％）。结论躯体疾病是住院患者最主要的死亡原因,提高对躯体疾病的诊治水平是降低精神科死亡率的重要措施。     

精神科住院患者猝死的相关因素分析：一项病例对照研究

目的识别精神科住院患者猝死的潜在危险因素，为探讨如何进一步预防住院精神病患者的猝死提供依据。方法选取1987年1月至2006年12月在广州市精神病医院精神科住院期间发生猝死的患者作为猝死组，选取与猝死组同性别相同或相近年龄、入院时间及在猝死者猝死当日仍住院的非死亡病例作为对照组，进行1：1匹配的病例对照研究。结果共有47例住院精神病患者发生猝死，猝死发生率1．68‰，（95％CI 1．20‰～2．16‰）。与对照组相比，猝死组合并心血管疾病、QTc间期延长及联用抗精神病药物的情况较多，差异有统计学意义（均P〈0．05）。结论对住院精神病患者的猝死危险评估和预防时要充分考虑其发生猝死的相关因素。     

精神科住院患者猝死的相关因素分析

为了探讨精神科临床猝死的规律，对本院住院患者发生的猝死病例进行回顾性研究。     

143例退伍军人精神病患者的死因分析

为了解住院退伍军人精神病患者死亡原因及其特点，作者对本院３６年间精神科住院死亡病例进行了分析。１资料１１死亡率１９６０年～１９９５年间我院精神科住院退伍军人患者共死亡１４３例，占同期住院患者的０９％。１２死因（１）躯体疾病１０２例：其中肺部疾病...     

某综合医院168例老年住院患者精神科会诊-联络资料分析

目的 了解综合医院老年患者精神(心理)服务需求的特点.方法 选取2010年1月～2012年12月某综合医院老年精神科会诊的168例患者,对其社会人口学资料、会诊科室、会诊原因、精神科诊断及治疗等进行分析.结果 在申请会诊的各科室中,前三位分别为神经内科(34.5％)、呼吸内科(19.1％)、高干病房(10.1％);常见会诊原因依次为以谵妄为主的意识障碍(20.8％)、躯体不适(19.6％)、焦虑抑郁(17.9％)、睡眠障碍(11.9％);会诊常见诊断主要为脑器质性精神障碍(34.5％);处理方式主要包括药物治疗及心理治疗等.结论 综合医院老年患者对精神(心理)服务需求大,精神科会诊联络服务有助于住院老年患者全面诊断和治疗.     

精神科住院病人猝死情况分析

目的了解精神科住院病人猝死特点,以便降低住院精神病人猝死发生率．方法回顾性调查住院期间猝死病人的病史,并进行均数及发生率统计分析．结果15年间猝死病人共有46例,猝死率为0．2％,男性和新入院者较多,秋冬季,4：00-8：00时间段为猝死高峰期,猝死者中93．25％伴有躯体疾病,服用氯氮平、氯丙嗪、奋乃静、氟哌啶醇者在猝死病人中占较高比例,且合用莱物者较多。结论精神科猝死病人中件有躯体疾病者较多,封此期患者使用精神药物时应格外小心。     

精神科住院病人10年猝死情况分析

目的了解精神科住院病人猝死特点，以便降低住院精神病人猝死发生率。方法回顾性调查住院期间猝死病人的病史，并进行均数及发生率统计分析。结果10年间猝死病人共有52例，猝死率为0．7％，男性和新入院者较多，秋冬季、4：00～8：00时间段为猝死高峰期，猝死者中96．15％伴有躯体疾病，服用氯氮平、氯丙嗪、奋乃静者在猝死病人中占较高比例，且合用药物者较多。结论精神科猝死病人中伴有躯体疾病者较多，对此类患者使用精神药物时应格外小心。     

不同年代住院精神病患者死亡原因的比较

为探讨不同年代精神病患者死亡原因的特点 ,我们对本中心住院死亡的 987例患者进行分析。资料和方法　为本中心 195 8年 7月至 1997年 12月的死亡病历 ,共 987例 (占同期住院总病例的 0 9% )。按死亡时间分为 6 0年代 (含 195 8年和 195 9年 )、70年代、80年代、90年代 4组。采用回顾性查阅死亡病历的方法进行研究。数据统计采用Ｇ检验。结果　 (1)死亡原因 :并发感染 2 6 0例 (2 6 3% ) ,躯体疾病 2 2 9例 (2 3 2 % ) ,慢性衰竭 16 8例 (17 0 % ) ,自杀 (包括院外发生自杀被送本中心抢救者及假出期自杀死亡者 ) 16 1例(16 3% ) ,猝死 10…     

住院精神病人猝死的原因分析及护理

住院精神病人猝死的原因分析及护理苏州市广济医院（２１５００８）袁梅英，闵奇萍本文对我院１９８１～１９９３年住院精神病患者中发生７例猝死者的临床资料进行回顾性分析，并对护理措施进行简要探讨，现报告如下。１临床资料１．１一般资料男６例，女１例；年龄３５～...     

Deaths in psychiatric care

The significance of deaths among psychiatric inpatients has been reviewed in brief and a glimpse of the future suggested by a study of the characteristics of 100 patients dying in a general hospital psychiatric unit. Though suicide was a common cause of death among the few young patients dying, it did not occur among the elderly, who usually died of natural causes. Dementia and depression were more frequent diagnoses than schizophrenia and “other diagnoses” which still dominate mental hospital deaths and very long terminal admissions were unusual. Most patients had been admitted on more than one occasion and had received a great deal of extramural care and treatment—they represent a very disabled group. Multiple physical pathology was identified in many at the time of admission and new pathology arose during admission. Almost half of male deaths were sudden, but women often endured prolonged and distressed deaths and these require enlightened management.     

Dying in the psychiatric ward

General hospital staff is experienced in dealing with the death of a patient. However, aside from cases of sudden death among psychiatric inpatients, psychiatric medical staff faces such situations considerably less frequently. Many chronic psychiatric patients do not have a family or home, a situation which may become even more painful if the patient is dying of a physical illness. Coping with a terminally-ill oncology patient is a difficult task for the multidisciplinary staff and for fellow patients in chronic care psychiatric departments. The authors describe the slow deterioration of two psychiatric inpatients who were also diagnosed with advanced cancer, and present the dilemmas involved with continued treatment of terminal oncology patients in a psychiatric ward when the psychiatric status no longer warranted inpatient psychiatric care.     

Causes of Death in Institutionalized Epileptics

To assess the causes of death in institutionalized epileptics, the patient records, death certificates, and other data from the only hospital for epileptics in Finland (Vaajasalo Hospital) were reexamined. During the years 1900--1976, 179 inpatients in Vaajasalo Hospital died; this was 12% of all inpatients. The most common causes of death were as follows: pneumonia in 40 cases, seizures in 34 cases (single seizure in 18 and status epileptics in 16), drowning in 29 cases, stroke in 10 cases, and heart infarct in 9 cases. Chronic intoxication caused by phenytoin and/or phenobarbitol was a common supplementary factor leading to death in patients who died of pneumonia or seizures. Thirteen deaths were recorded as suicides or suspected suicides (11 by drowning and 2 by strangulation). The results reflect the severe epilepsy and the poor conditions of the patients, as well as the poor condition of the local facilities in the past. The information obtained should be useful in the effort to improve medical care for these patients.     

153例脑梗塞病人死亡原因分析

本文对153例脑梗塞病人的死亡原因进行分析,结果114例死于多脏器(MOF),14例死于脑水肿、脑疝,21例死于猝死,1例为其他原因。认为引致(MOF)的主要感染,猝死是病人血浆儿茶酚胺增高,心肌细胞溶解。提出应重视脑血管病临床二三级预防综合性治疗,降低死亡率。     

住院精神病人猝死对照研究

目的：探讨影响住院精神病患者猝死的因素及特征。方法：采用回顾性查阅病历的方法登记近十年20例猝死患者，并与同期住院的非死亡患者（20例）作对照，定量观察猝死前一个月抗精神病药的平均日剂量及不良用药方式，躯体营养状况恶化率，心电图异常率。结果：猝死患者的躯体营养状况恶化率及心电图异常率均显著高于对照组（P＜0．01或P＜0．05），抗精神病平均日剂量比较无显著性差异（P＞0．05），但不良用药方式成为诱发猝死的重要因素。结论；正确使用抗精神病药，减少对心肌的不良影响，加强躯体状况的改善，对减少猝死发生率有一定的积极意义。     

精神疾病患者猝死前心电图分析

目的：探讨精神疾病患者猝死前心电图特征及其相关影响因素。方法：将临床诊断为心脏性猝死的49例患者作为猝死组；随机抽出同期住院的60例患者作为对照组。比较两组患者心电图特征，人口学资料以及临床特征。结果：猝死组心电图异常发生率显著高于对照组（P〈0．05），主要表现为窦性心动过速、室性期前收缩、QT间期延长、T波改变、ST段低平、U波或TU融合波、左束支传导阻滞（LBBB）。猝死组氯氮平使用率显著高于对照组（P〈0．05）。两组使用氯氮平者心电图异常率明显高于未使用氯氮平者（P〈0．05或P〈0．01）。猝死组高龄，兴奋状态，低血钾，肌酸激酶升高，心脑血管疾病的发生率均显著高于对照组（P均〈0．05）。结论：精神疾病患者猝死前大多心电图异常，多呈非特异性改变。高龄、使用氯氮平以及某些临床征象可能成为患者猝死的危险因素。     

SUDEP classification: Discordances between forensic investigators and epileptologists

We compared sudden unexpected death in epilepsy (SUDEP) diagnosis rates between North American SUDEP Registry (NASR) epileptologists and original death investigators, to determine degree and causes of discordance. In 220 SUDEP cases with post-mortem examination, we recorded the epileptologist adjudications and medical examiner- and coroner- (ME/C) listed causes of death (CODs). COD diagnosis concordance decreased with NASR’s uncertainty in the SUDEP diagnosis: highest for Definite SUDEP (84%, n = 158), lower in Definite Plus (50%, n = 36), and lowest in Possible (0%, n = 18). Rates of psychiatric comorbidity, substance abuse, and toxicology findings for drugs of abuse were all higher in discordant cases than concordant cases. Possible SUDEP cases, an understudied group, were significantly older, and had higher rates of cardiac, drug, or toxicology findings than more certain SUDEP cases. With a potentially contributing or competing COD, ME/Cs favored non–epilepsy-related diagnoses, suggesting a bias toward listing CODs with structural or toxicological findings; SUDEP has no pathognomonic features. A history of epilepsy should always be listed on death certificates and autopsy reports. Even without an alternate COD, ME/Cs infrequently classified COD as “SUDEP.” Improved collaboration and communication between epilepsy and ME/C communities improve diagnostic accuracy, as well as bereavement and research opportunities.     

垂体腺瘤经颅手术死亡因素探讨

目的:探讨垂体腺瘤经颅手术后死亡原因,以降低手术死亡率。方法:对537例经颅垂体腺瘤手术中的12例术后死亡病例进行回顾性分析。结果:6例死于术后颅内出血,5例死于下丘脑损伤,1例死于突发呼吸停止。死亡率为0.2%。结论:术后颅内出血和下丘脑损伤足垂体腺瘤经颅手术后死亡的主要原因,应采用相应措施,降低死亡率。