心脏性猝死79例危险因素及病理分析  

Pathological and Relative Factors Analysis of Sudden Cardiac Death in 79 Patients

作　　者：雷普平[1] 李桢[1] 李利华[1] 瞿勇强[1] 陈燕祥 赵永和[1] 

机构地区：[1]昆明医学院法医学院,云南昆明650031 [2]云南省公安厅刑事侦查总队,云南昆明650228

出　　处：《昆明医学院学报》2010年第1期51-55,共5页Journal of Kunming Medical College

基　　金：国家重点基础研究发展计划973项目(2007CB512008)

摘　　要：目的探讨引起心脏性猝死(SCD)的相关因素及其心脏病理改变,为SCD的防治和法医病理鉴定提供线索.方法回顾性分析昆明医学院司法鉴定中心及云南省公安厅79例SCD的临床病理资料,包括SCD的病因、性别、年龄,SCD的诱因,各种导致SCD的疾病心脏病理改变.结果(1)79例SCD中,冠心病33例,风湿性心脏病(风心病)10例,心肌病7例,心肌炎7例,主动脉夹层动脉瘤破裂致心包填塞7例,高血压性心脏病(高心病)4例,心瓣膜病3例,心肌脂肪浸润2例,冠状动脉开口狭窄2例,冠状动脉栓塞1例,先天性心脏病(先心病)1例,心脏轻微病变2例;(2)冠心病是青、中年人SCD的最主要原因.心肌炎和风心病是34岁以下青年人SCD的主要原因;(3)79例SCD中25例具有明确诱因,且绝大数为男性.(4)33例冠心病性SCD中,21例冠状动脉粥样硬化血管管腔狭窄度达Ⅳ级,2例继发冠状动脉血栓形成,1例粥样硬化斑块破裂.发生急性心肌梗死(简称心梗)20例,其中4例合并陈旧性心梗,单纯陈旧性心梗8例,5例无心梗,仅有急性心肌缺血改变.结论SCD以冠心病为主,中老年男性多见,病程短而凶险,仅部分病例有明确诱因.尽早防治冠心病、风心病、心肌病等心脏病变,祛除诱因,是预防SCD的根本措施.SCD的法医病理学鉴定一般要有能引起急性心脏功能阻碍的形态学证据.Objective To investigate the associated factors and cardiac pathological changes of sudden cardiac death （SCD） , to provide the clues for preventing SCD and identification of SCD in forensic pathology. Methods We retrospectively analyzed the clinical and pathological materials of SCD in 79 cases in Judicial Identification Center of Kunming Medical College and Police Office of Yunnan province, including the cause, sex and age of death, the inducing cause of death, and the cardiac pathological changes of SCD. Results （1） The causes of SCD in ？9 cases were found coronary heart disease in 33 cases, rheumatic heart disease in 10 cases, myocardiosis in 7 cases, myocarditis in 7 cases, aortic dissecting aneurysm ruptured and leading to wad pericardial cavity in 7 cases, hypertensive heart disease in 4 cases, valvular vitium of the heart in 3 cases,myocardium fatty infiltration in 2 cases, stenosis of coronary ostia in 2 cases, thrombosis of coronary in 1 case, congenital heart disease in 1 case, mild cardiac changes in 2 cases. （2） Coronary heart disease was the predominant cause of SCD in young age group and middle age group. Myocarditis and myocardiosis were the major causes of SCD in younger group below 34 years old. （3） 25 cases of SCD had inducing factors, and most of them were male. （4） Among 33 cases died of coronary heart disease, the coronary artery atherosclerotic stenosis grade Ⅳ were found in 21 cases, of which 2 cases were combined with thrombosis and Ⅰ case was with the rupture of atheromatous plaque. Acute myocardial infarction were found in 20 cases, of which 4 cases were combined with old myocardial infarction, simple old myocardial infarction in 8 cases, simple myocardial ischemia in 5 cases. Conclusions The major cause of SCD was coronary atherosclerotic heart disease. Sudden and dangerous SCD frequently attacked the middle-aged and older patients, and only part of them had inducing factors. The foundation measure to prevent SCD is early preventing and treating coronary heart

关 键 词：心脏性猝死 法医病理鉴定 心脏病理 

分 类 号：R541.4[医药卫生—心血管疾病]