我国5516例尸解猝死病例流行特征分析  

Analysis of epidemic characteristics of 5516 sudden death autopsy cases in China

作　　者：赵智梅 陈晓松 杨仪君[3] 杜鹏举 周攀豪 Zhao Zhi-mei;Chen Xiao-song;Yang Yi-jun;Du Peng-ju;Zhou Pan-hao(Emergency&Trauma College of Hainan Medical University,Haikou 571100,China)

机构地区：[1]海南医学院急诊创伤学院,海南海口571100 [2]海南医学院第一附属医院,海南海口570102 [3]重庆医科大学附属第一医院,重庆400016

出　　处：《中国急救医学》2020年第2期158-163,共6页Chinese Journal of Critical Care Medicine

基　　金：海南省研究生创新科研课题(Hys20l9313)。

摘　　要：目的归纳分析尸解猝死(SD)病例,探讨其不同亚群(性别、年龄、危险因素、病谱等)的流行特征.方法搜索CBM、万方、知网、维普、百度文库等国内的常见数据库,分别检索到我国28个省级行政区,首篇自1964年以来至2018年8月长达约55年期间的相关文献428篇.纳入明确病例为猝死并进行尸体解剖且数据资料较完整的文献231篇.进一步统计分析5516例猝死者的人群分布、疾病特点、发生时间及地点分布等.结果①人群分布:5516例尸解猝死病例中,男:女=2.63:1.年龄最小为出生后21 h,最大97岁,平均年龄41.60岁.②发作特点及病谱分布:情绪激动(25.66%)、劳累(24.53%)等.临床表现呈多样性,常见为:突发(20.10%)、休息睡眠中(16.71%)等.有既往病史者中,最多见高血压(37.95%)、心脏病(30.02%)、糖尿病(23.79%).5516例尸解中,猝死首要原因是心源性猝死,为3186例,占57.76%(95%CI44.8%~70.8%),这其中又以冠心病猝死占最高55.24%(95%CI53.51%~56.97%);肺源性猝死占猝死总病谱的第二位(21.63%),第三是脑源性猝死(9.21%).不同年龄组总体病谱构成不同,Pearson值为1145.321,P<0.001.其中0~3周岁多见肺源性猝死,3~15周岁多见脑源性猝死,青年人多心源性猝死.31~63周岁为心源性猝死高峰,高于其他年龄段,包括63岁以上.并且,年龄不影响冠心病猝死的发生.③时间分布:极端气温的冬夏季猝死发生率高于平均气温的春秋季(P<0.001).猝死尸解时间中,3天内解剖者94.17%.④空间分布:2447例有地点记录者中院内猝死(62.73%)高于院外(37.27%,P<0.001).结论预防猝死的关键在于识别高密度低风险人群.猝死的预防需避免劳累、情绪激动,要戒烟限酒,注意极端气温,适当运动,控制“三高”及冠状动脉痉挛.Objective To explore the epidemiological characteristics of sudden death cases in different subgroups(sex,age,risk factors,disease spectrum,etc.)by analyzing in autopsy cases.Methods It obtained 428 related literatures from 1964 to August 2018 about 55 years covering 28 provincial administrative regions by searching common databases,such as CBM,Wanfang data,CNKI,VIP and so on.And we finally screened for 231 articles with autopsy cases and complete data.We then further analyzed the data of 5516 patients'the population distribution,disease characteristics,time and location distribution.Results①The population:male:female was 2.63:1 in 5516 sudden death cases.Among them,the minimum age was 21 h after birth and the maximum age was 97 years old,the average age was 41.60.②Seizure characteristics:The common triggers were emotional excitement(25.66%),fatigue(24.53%)and so on.The symptoms were diverse such as sudden onset(20.10%),rest and sleep(16.71%),ect.In the past history,the most common disease was hypertension(37.95%),heart disease(30.02%),and diabetes(23.79%).Among the 5516 sudden death autopsy cases,the leading cause was sudden cardiac death,accounting for 3186 cases(57.76%)(95%Cl 44.8%-70.8%),of which the main cause was sudden coronary death,accounting for 55.24%(95%C/53.51%-56.97%).And the rest were pulmonary(21.63%)and brain-derived(9.21%).The overall disease spectrum of different age groups was different and Pearson was 1145.321,P<0.001.Among them,pulmonary sudden death was common in the 0~3 years old;brain-induced sudden death occurred mostly 3-15 years old.Young people were more likely to sudden cardiac death.And the peak of sudden cardiac death was 31 to 63 years old.③Time:Incidence rates with extreme temperature(winter and summer)were higher than those in average temperature(spring and autumn),P<0.001.The autopsy time of cases was within 3 days accounting for 94.17%.④Location:Sudden death was higher in hospital(62.73%)than outside hospital(37.27%),P<0.001.Conclusion The key to preventing sudden deat

关 键 词：尸体解剖 猝死(SD) 流行特征 

分 类 号：R181.3[医药卫生—流行病学] R541.78[医药卫生—公共卫生与预防医学]