药源性肺闭锁综合征21例病因及临床分析

支气管哮喘是常见呼吸道疾患 ,病因和发生机制非常复杂 ,闭锁肺综合征 (ＬｏｃｋｅｄＬｕｎｇＳｙｎｄｒｏｎｅ ,ＬＬＳ)便是其危重临床类型。多年来尽管投入巨大人力和财力 ,但哮喘的全球发病率和病死率仍在上升。而在诱因明确的哮喘死亡中 ,药源性因素已占首位[1] 。本文拟对 2 1例药源性ＬＬＳ进行分析 ,并就预防措施做初步讨论。1　临床资料1.1　一般资料　 1987年至 1998年 6月间住院及急诊ＩＣＵ确诊为支气管哮喘 ( 14例 )或慢支并哮喘 ( 7例 )急性发作患者共2 1例 ,诱因明确 ,均符合重度哮喘急性发作标准 ,并排除心源性哮喘 ,气胸及…     

药源性低钾血症58例临床分析

目的探讨药源性低钾血症的疾病特点,为临床早期诊断和治疗提供依据。方法回顾分析2009年1月1日至2011年1月1日期间收治的58例药源性低钾血症住院患者的临床资料。结果本组药源性低钾血症患者中,男性25例,女性23例;年龄35～83岁,平均年龄56.8岁;胰岛素类(39.7%)导致的药源性低血钾反应居首位,其次为利尿药(20.7%)、泻药(17.2%)、抗生素(13.8%)。本组患者通过及时补钾治疗均痊愈。结论药源性低钾血症的诊断,必须具备相关药物的用药史,再结合症状、体征、血钾及心电图检查等进行综合分析判断。     

药源性低血糖症22例临床分析

低血糖症(简称低血糖)是内科中常见的急症之一，及时处理预后良好，但因其临床症状比较复杂，容易误诊、漏诊，如稍有疏忽则可遗留有不同程度的脑损害甚至危及生命，而60％～80％以上的低血糖为药源性低血糖，本文对22例药源性低血糖症临床资料进行回顾分析，讨论如下。     

猝死23例临床分析

随着生活节奏的加快及生活压力的增加,猝死在临床上亦随之增多,本文收集了近二年在我院急诊收治的猝死病例,探讨其猝死的病因,以提高预防水平及抢救成功率。 1 临床资料 1.1 一般资料:23例均为青壮年男性,年龄为28～43岁。发病时问:18例发生在夜间,且以睡眠时多见;发生在上午者2例,下午3例。 1.2 发病时情况及诱因:突发昏迷15例,头痛4例,尖叫3例。死前有明确病史者、高血压病者2人,心肌炎者1例,自觉胸闷者3例,“上感”者5例。猝死前可查诱因:有饮酒史者1例,情绪激动者2例,疲劳者2例。 1.3 就诊时情况:23例患者送至我院急诊时,均     

院内猝死32例临床分析

目的：探讨猝死的病因、诱因及流行病学特征,为临床防治猝死提供依据。方法：回顾性分析32例猝死病例的临床资料。结果：32例中男性多见,无明显职业分布;基础疾病38％为心血管系统,其次为呼吸系统;仅28％有明确诱因,发作以夏冬季常见,24h中以凌晨和夜间多见。全部经心肺复苏,仅1人存活。结论：应针对猝死的特征进行一系列的干预．以积极防治猝死。     

院前猝死255例临床分析

目的:通过对院前猝死病例的分析,探讨影响心肺复苏术(CPR)成功的关键因素,以提高院前猝死的抢救成功率.方法:回顾性分析我科2007年3月-2009年9月诊治的院前猝死255例的临床资料.结果:心肺复苏有效7例,占2.75%,康复出院5例,占1.96%.结论:尽早发现猝死病人和尽快进行CPR是复苏成功的关键;医务人员尽快达到现场和有效干预是重要因素;对人民群众普及CPR技术对复苏成功至关重要.     

猝死患者７７例临床分析

猝死是指原发先正常人的突发的,非预料性的死亡,世界卫生组织规定发病２４小时内死亡为猝死,据文献报告^[1],猝死约占所有非外伤性院前死亡的１／３左右,心源性猝死的定义是在发病６小时内死亡,约占猝死的９０％,目前更多的心脏病学者主张把时限在６小时内,本文旨在通过对１９９７－１９９８年于本民人急诊科诊治的猝死病例的分析,试图了解其高发年龄、危险因素、并发对病的预防,救治水平的提高,病死率的降低进行探讨。     

猝死22例临床分析

本文通过对２２例猝死患者的临床资料进行回顾性分析。结果表明，在病房里的猝死发生率，占内科死亡患者数的２１．２％，其中以心性猝死居首位，占猝死患者的８６％，而冠心病是心性猝死最常见的原因。作者根据本文资料特征，提出对猝死病人的防治：１．争取早期发现最可能导致猝死的病人；２．密切观察有心电不稳定证据的患者；３．要重视猝死因的预防；４．对心律失常而药物不能控制者临床上要引起高度重视。     

31例药源性帕金森综合征临床分析

目的:探讨药源性帕金森综合征患者的预防策略.方法:采用微机查阅病历,对31例帕金森综合征病例进行回顾性分析.结果:31例患者的原发疾病包括消化系统疾病12例,梅尼埃病6例,抑郁征5例,心律失常4例,高血压4例.对症给予胃复安、西比灵、氯丙嗪、胺碘酮、降压药及中药治疗,发现患者在治疗过程中出现药源性帕金森综合征.结论:药源性帕金森综合征发病率逐年上升,在服用相关药物时应严格控制剂量并加强监测.通过临床对该病诱因及治疗过程的分析,可以采取有效的预防策略降低其发病率.     

Emotional Stress and Sudden Death

Acute emotional stress appears to play an important role in the development of sudden cardiac death. An interplay of autonomic neural imbalances, metabolic effects of stress and stress-induced myocardial injury is believed responsible although precise mechanisms remain unknown.     

精神科住院病人5年猝死情况分析

目的通过了解精神科住院病人猝死情况变化，分析猝死现象及相关因素，以便更好地降低住院病人猝死发生率。方法回顾性调查住院期间猝死病人的病史，进行均数及百分率统计分析。结果5年间猝死病人共有31例，猝死率为0.5％，猝死患者平均年龄为67.29岁，70～79岁为猝死人数最多的年龄组，猝死者中96．77％伴有躯体疾病或实验室检查结果异常，使用抗精神病药物者26人，其中单用22人，2药联用4人，服用氯氮平及典型抗精神病药物者在猝死病人中占69．23％，抗精神病药物的平均目剂量为258．08mg。结论精神科住院猝死病人中伴有躯体疾病者居多，尤以老年患者更多，对此类患者使用抗精神病药物应格外谨慎。     

腹泻致心脏病患者猝死的原因分析

分析１７例心脏病患者猝死的原因，其中６例由腹泻所致。发生原因与腹泻时电解质紊乱引起严重的心律失常、限制摄入量致心肌缺血缺氧而致心搏骤停及药物的副反应有关。护理上应加强心电监护及电解质监测，注意药物的副反应，合理进食。     

Heart Rate Variability and Sudden Infant Death Syndrome

PERTICONE, F., ET AL.: Heart Rate Variability and Sudden Infant Death Syndrome. The sudden infant death syndrome (SIDS) is the most common cause of death in infancy. The pathophysiological mechanism leading to SIDS is still obscure. In the QT hypothesis, the mechanism must be an arrhythmogenic sympathetic imbalance: the infants die suddenly of cardiac arrhythmia. Recently, it has been suggested that analysis of heart rate variability (HRV), expressed as standard deviation or variance analysis, can provide adequate information on sympathovagal interaction. We studied 150 newborns enrolled in a previous prospective electrocardiographic study to evaluate the predictive value of QT interval for SIDS. We analyzed the ECGs recorded with infants alert on the fourth day of life and after 2 months. For each ECG, the HRV was calculated using the first standard deviation of of RR intervals (ms) measured for 1 minute. The average RR interval was 441 ± 71 ms at the fourth day and 420 ± 39 ms at the second month. The QT_c and HRV mean values were 396 ± 23 and 23 ± 12 ms at the fourth day, 412 ± 19 and 15 ± 7 msec at the second month. Therefore, the SD values of heart rate were correlated with QT_cin order to assess a possible relationship between the two variables. The correlation coefficient and regression equation were: -0.639 and y = 423.67 - 2.18*× (P < 0.002) at the fourth day, -0.146 and y = 418.09 - 0.37*× (NS) at the second month. In conclusion, our data seems to confirm a delayed maturation or impaired fuctioning of the autonomic nervous system in the first weeks of life, reflecting a direct correlation with QT prolongation.     

Classification of Sudden and Arrhythmic Death

Since all death is (eventually) sudden and associated with cardiac arrhythmias, the concept of sudden death is only meaningful if it is unexpected, while arrhythmic death is only meaningful if life could have continued had the arrhythmia been prevented or treated. Current classifications of death as being arrhythmic or sudden are all biased by the difficulty of having to decide on the degree of unexpectedness or the likelihood that life could continue without the arrhythmia. The uncertainties are enlarged by the fact that critical data (such as knowledge of arrhythmias at the time of death or autopsy) are available in only a few percent of cases. A main problem in using classifications is the lack of validation data. This situation has, with the MADIT trial, changed in the case of the Thaler and Hinkle classification of arrhythmic death. The MADIT trial demonstrated that arrhythmic death was nearly abolished by the implantable defibrillator, indicating that arrhythmic death by this classification is meaningful, at least in the population studied. For future investigations, a call is made for committees to present data in a way that allows the reader to examine the quality of the data used for evaluation.     

Sudden Cardiac Death, Implanted Defibrillation, and Clinical Electrophysiology

A mere 25 years ago, the technique of external defibrillation became the starting point for the development of clinical electrophysiology by permitting routine use of endocavitary programmed electrical stimulation of the heart without undue risk. Major advances in knowledge of clinical arrhythmias and the understanding of their mechanisms were, thus, permitted. Mirowski's implanted defibrillator also constituted a major breakthrough therapeutically; unfortunately, however, some 10 years later, it has not yet induced similarly hoped for consequences in terms of progressing knowledge concerning lethal arrhythmias, largely due to the absence of Holter functions in the implanted devices. As a result of this, in our opinion, better established therapeutic indications are still needed. The reasons for the present situation, we believe, may be partly technical but are conceptual as well. The key point is that even the clear demonstration of the great practical efficacy of a therapeutic tool does not exempt us from the obligation of determining the mechanisms of this effect.     

Influence of Age on the Potential Risk of Sudden Death in Asymptomatic Wolff-Parkinson-White Syndrome

Sudden death might be the first event in patients with asymptomatic WPW. The purpose of the study was to know if the age of the patient modifies the electrophysiological characteristics of asymptomatic WPW. Transesophageal stimulation was performed on 92 asymptomatic WPW patients from the following age groups: 10-69 years (n = 14), 20-29 years (n = 33), 30-39 years (n = 15), 40-49 years (n = 17), and 50-69 years (n = 13). The procedure consisted of atrial pacing up to the second AV block, programmed atrial stimulation using one and two extrastimuli delivered on two driven rhythms in the control state, and after infusion of isoproterenol. In thefive age groups, paroxysmal junctional tachycardia occurred, respectively, in 1 (7%), 1 (3%), 2 (13%), 2 (12%) patients, and not at all in the oldest group. AF > 1 minute occurred, respectively, in 3 (21%), 9 (27%), 5 (33%), 3 (18%), and 4 (31%) patients. The dangerous form of WPW (rapid conduction in the Kent bundle > 240/min in the control state or > 300/min after isoproterenol + AF induction) occurred, respectively, in 3 (21%), 9 (27%), 4 (27%), 1 (6%), and 3 (23%) patients. In conclusion, electrophysiological data of asymptomatic WPW are not modified by age of the patient. Elderly patients remain at risk of a dangerous form of WPW; systematic evaluation of WPWis recommended in patients with an active life independent of age.     

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。