云南省鹤庆县一起不明原因猝死事件资料分析
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 unexplained death in Yunnan and preventing such death.Methods A field epidemiological survey was conducted and four physical examinations(4 th,5 th,6 th and 18 th August) were arranged for the family and villagers of the departed,including electrocardiography.Serum was collected from 28 family members and residents,which was sent to a provincial people's hospital within 12 hours after collection for testing electrolyte,liver & kidney functions,glucose,blood lipid,myocardial enzyme,troponin,myoglobin and C-reactive protein,etc.Materials were collected from cases meeting the corresponding conditions by corpse dissection.Epidemiological materials of cases suffering from the same disease and all materials produced during hospitalization 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 special clinical manifestations nor felt sick before death,who died merely several minutes after the onset of illness 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 the15 th day(35.71%).The greatest changes occurred to ST-T(abnormality),Q-T interval(prolonged) and frequent premature ventricular contractions,etc.Regarding the results of serum,the myocardial enzyme five of one of the bereaved slightly increased,and the myocardial enzyme three and alkaline phosphatase of another member of the bereaved both slightly increased.In terms of pathological diseases,3 cases suffered from lymphocytic myocarditis and 2 cases were diagnosed with acute pulmonary edema.Meanwhile,1 case's lumens were narrow due to fibrous centric wall thickening of intima of atrioventricular node.Besides,focal infiltration was discovered on one case's lymphatic cells of liver and kidney,while one case's foramen oval was unclosed,with congestion in liver,kidney and lung.Toxicants were tested negative.Cases suffering from the same diseases accidentally fainted on the ground in providing help in the family of the departed on the afternoon of 5th August,who were sent into the county hospital for treatment at 21 ! 40.Their vital signs were stable and they were discharged from hospital on 13 th August.Conclusion there were no apparent clinical manifestations for these cases of sudden deaths before their death,so known intoxication and specific causes may be excluded.As indicated by survey results,this event conforms to the diagnostic criterion for sudden unexplained deaths in Yunnan and shall be handled and reported as sudden unexplained death in this area.
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 unexplained death in Yunnan and preventing such death.Methods A field epidemiological survey was conducted and four physical examinations(4 th,5 th,6 th and 18 th August) were arranged for the family and villagers of the departed,including electrocardiography.Serum was collected from 28 family members and residents,which was sent to a provincial people's hospital within 12 hours after collection for testing electrolyte,liver & kidney functions,glucose,blood lipid,myocardial enzyme,troponin,myoglobin and C-reactive protein,etc.Materials were collected from cases meeting the corresponding conditions by corpse dissection.Epidemiological materials of cases suffering from the same disease and all materials produced during hospitalization 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 special clinical manifestations nor felt sick before death,who died merely several minutes after the onset of illness 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 the15 th day(35.71%).The greatest changes occurred to ST-T(abnormality),Q-T interval(prolonged) and frequent premature ventricular contractions,etc.Regarding the results of serum,the myocardial enzyme five of one of the bereaved slightly increased,and the myocardial enzyme three and alkaline phosphatase of another member of the bereaved both slightly increased.In terms of pathological diseases,3 cases suffered from lymphocytic myocarditis and 2 cases were diagnosed with acute pulmonary edema.Meanwhile,1 case's lumens were narrow due to fibrous centric wall thickening of intima of atrioventricular node.Besides,focal infiltration was discovered on one case's lymphatic cells of liver and kidney,while one case's foramen oval was unclosed,with congestion in liver,kidney and lung.Toxicants were tested negative.Cases suffering from the same diseases accidentally fainted on the ground in providing help in the family of the departed on the afternoon of 5th August,who were sent into the county hospital for treatment at 21 ! 40.Their vital signs were stable and they were discharged from hospital on 13 th August.Conclusion there were no apparent clinical manifestations for these cases of sudden deaths before their death,so known intoxication and specific causes may be excluded.As indicated by survey results,this event conforms to the diagnostic criterion for sudden unexplained deaths in Yunnan and shall be handled and reported as sudden unexplained death in this area.
引文
[1]牛存龙,左文昌,侯龙才,等.云南暴发性病毒性心肌炎流行概况[J].中国地方病学杂志,2000,19(4):164-166.
[2]杨林,陈白云,奚凌云,等.2005年鹤庆县“云南不明原因心源性猝死”病情资料分析[J].中国自然医学杂志,2007,9(2):139-141.
[3]杨林,陈白云,杨金钰,等.鹤庆县急性病毒性心肌炎发病概况[J].云南预防医学,2001,6(4);36-37.
[4]杨林,黄文丽,李兆祥,等.云南地方性暴发性心肌炎临床特点分析[J].地方病通报杂志,2006.21(5):4-6.
[5]杨林,黄文丽,李兆祥,等.1975-2004年云南不明原因心源性猝死回顾性调查[J].预防医学情报杂志,2008,24(2):110-113.
[6]左文昌,杨崇福,沙丽萍.1991-2002楚雄州暴发性心肌炎病情分析[J].地方病通报,2004,19(1):52-53.
[7]王红月,赵红,宋来风,等.29例云南不明原因聚集性猝死尸检病理学研究[J].中华医学杂志,2007,87(31):2209-2214.
[8]刘孝柏,宋先毅,刘继海,等.7例致心律失常性右室心肌病猝死病例流行病学调查报告[R].中华医学第一届全国公共卫生会议,2009.
[9]夏德义,冯红旗,王铜,等.云南省地方性猝死的临床分析[J].中国地方病杂志,2004,23(5):482-485.
[10]陈良,孙承业,沈壮,等.云南不明原因猝死事件中毒线索调查[C].2006年第四届环境与医学国际学术研讨会论文集,2006,320-323.
[11]杨林,叶枫,王安伟,等.2008-2011年云南省地方病健康教育项目效果评价[J].国外医学医学地理分册,2013,34(2):102-105.
[2]杨林,陈白云,奚凌云,等.2005年鹤庆县“云南不明原因心源性猝死”病情资料分析[J].中国自然医学杂志,2007,9(2):139-141.
[3]杨林,陈白云,杨金钰,等.鹤庆县急性病毒性心肌炎发病概况[J].云南预防医学,2001,6(4);36-37.
[4]杨林,黄文丽,李兆祥,等.云南地方性暴发性心肌炎临床特点分析[J].地方病通报杂志,2006.21(5):4-6.
[5]杨林,黄文丽,李兆祥,等.1975-2004年云南不明原因心源性猝死回顾性调查[J].预防医学情报杂志,2008,24(2):110-113.
[6]左文昌,杨崇福,沙丽萍.1991-2002楚雄州暴发性心肌炎病情分析[J].地方病通报,2004,19(1):52-53.
[7]王红月,赵红,宋来风,等.29例云南不明原因聚集性猝死尸检病理学研究[J].中华医学杂志,2007,87(31):2209-2214.
[8]刘孝柏,宋先毅,刘继海,等.7例致心律失常性右室心肌病猝死病例流行病学调查报告[R].中华医学第一届全国公共卫生会议,2009.
[9]夏德义,冯红旗,王铜,等.云南省地方性猝死的临床分析[J].中国地方病杂志,2004,23(5):482-485.
[10]陈良,孙承业,沈壮,等.云南不明原因猝死事件中毒线索调查[C].2006年第四届环境与医学国际学术研讨会论文集,2006,320-323.
[11]杨林,叶枫,王安伟,等.2008-2011年云南省地方病健康教育项目效果评价[J].国外医学医学地理分册,2013,34(2):102-105.
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