摘要
目的总结事件的流行病学特点、临床表现、实验室结果及病理学特征,为云南不明原因猝死病因探讨和防控提供依据。方法对事件现场进行流行病学调查;对死者家属及村民包括心电图在内的健康体检;采集死者家属及村民血清,标本采集后及时送大理州人民医院,作电解质、肝肾功能、血糖、血脂、心肌酶、肌钙蛋白、肌红蛋白、C反应蛋白等指标检测;对符合尸体解剖取材条件的病例进行尸体解剖取材;收集同发病例的流行病学资料和住院治疗期间的所有资料并对所有资料进行认真、客观、系统的分析。结果本次事件发生在云南不明原因猝死流行的高发季节(8月),20 h之内7口之家猝死4人,有家庭聚集现象,猝死者均为青壮年农民,女性多于男性(3/1),死前均无特殊临床表现和不适,从发病到死亡仅几分钟时间,死前1个月内死者家庭无特殊饮食史;对家属及村民的健康检查中,42例自诉有头昏、胸闷、乏力,均给予了治疗;对村民做了4次心电图检查,4次结果变化比较明显,第2天改变率为最高(77.27%),其次是第1天(69.57%),第3天(58.82%),最低是第15天(35.71%);改变项目较多的是ST-T异常、QT间期延长、频发室性早搏等;血清结果,死者家属中1例心肌酶5项均轻度升高,1例心肌酶3项和碱性磷酸酶轻度升高;病理结果,3例均有淋巴细胞性心肌炎,2例出现急性肺水肿,房室结动脉内膜偏心性纤维性增厚致管腔狭窄、卵圆孔未闭各占1例。同发病例于8月5日下午18时在死者家帮忙时突然晕厥倒地,21时40分送往县医院住院治疗,生命体征平稳,8月13日出院。结论本次事件符合云南不明原因猝死病例定义的诊断标准,按云南不明原因猝死卫生应急处置及时上报。
Objective to sum up epidemiological features ,clinical manifestations ,experimental results and pathological characteristics of the accident to provide basis for discussing etiology of the sudden unex-plained death in Yunnan and preventing such death .Methods A field epidemiological survey was conduc-ted and four physical examinations （4 th ,5 th ,6 th and 18 th August ） were arranged for the family and vil-lagers of the departed ,including electrocardiography .Serum was collected from 28 family members and resi-dents ,which was sent to a provincial people＇s hospital within 12 hours after collection for testing electrolyte , liver＆amp;kidney functions ,glucose ,blood lipid ,myocardial enzyme ,troponin ,myoglobin and C-reactive pro-tein ,etc .Materials were collected from cases meeting the corresponding conditions by corpse dissection .Epi-demiological materials of cases suffering from the same disease and all materials produced during hospitaliza-tion were gathered for meticulous ,objective and systematic analysis .Results this accident happened in a season （August ） with a high incidence of sudden unexplained death in Yunnan . Four out of seven family members suddenly died within 20 hours and there presented a phenomenon of familial aggregation .All sudden deaths were young peasants ,among whom there were more females than males （3/1） .They neither had spe-cial clinical manifestations nor felt sick before death ,who died merely several minutes after the onset of ill-ness and whose families had no special dietary histories within 1 month before death .After examining the health of family members and villagers ,42 cases felt faint ,suffered from chest tightness and fatigue ,all of whom were treated .There exhibited significant changes in four electrocardiogram results .The change rate was the highest on the 2nd day （77 .27% ） ,followed by the 1st day （69 .75% ） ,3rd day （58 .82% ） and the 15th day （35 .71% ） .The greatest changes occurred to ST-T （abnormality） ,Q-T interval （p
出处
《国外医学（医学地理分册）》
CAS
2014年第2期117-121,共5页
Foreign Medical Sciences：Section of Medgeography
基金
科技部卫生行业科研专项资助项目(No.200802002)
关键词
云南不明原因猝死
猝死病例
同发病例
资料分析
sudden unexplained death in yunnan
cases of sudden death
cases suffering from the same diseases
data analysis
