主动脉内球囊反搏术在急性心肌梗死患者中的临床应用

目的:探讨主动脉内球囊反搏术(IABP)在急性心肌梗死(AMI)患者中的临床应用.方法:收集从2008年1月至2008年12月因急性心肌梗死急诊入住我院CCU并行IABP及经皮冠状动脉介入治疗(PCI)病例32例,回顾性分析患者的临床特征、冠脉造影及介入治疗情况,观察使用IABP前后患者心率血压变化,IABP相关并发症,住院期间死亡率.结果:急性心肌梗死患者入院后及时在IABP支持下成功完成急诊PCI手术,患者应用IABP治疗后心率血压均得到明显改善.IABP相关并发症发生率仅9例,严重并发症0例,无术中死亡,住院期间死亡3例,其中合并心源性休克死亡2例.结论:主动脉内球囊反搏术在急性心肌梗死患者中的应用安全、有效,显著降低了急性心肌梗死患者的住院期间死亡率.     

肠功能障碍评分对于急性胰腺炎预后判断的价值

目的:目前判断急性胰腺炎预后的预测方法的准确度尚不能满足临床需要.本研究通过将5级肠功能衰竭(GIF)评分系统与SOFA评分系统结合,探讨GIF评分系统在急性胰腺炎预后中的价值.方法:回顾性分析2008年9月～2012年4月在西京消化病医院重症监护室住院的241例急性胰腺炎病例资料.计算患者入院后前3天的SOFA及GIF评分.应用受试者工作曲线下面积(AUC)比较GIF评分、SOFA评分及SOFA联合GIF评分(联合评分)对急性胰腺炎预后的判断价值.结果:235例患者纳入最终分析.死亡率随着入院后前3天GIF评分均值的升高而增加.联合评分有最大的AUC(0.849),显著高于单独使用SOFA评分(0.793,P=0.002),GIF评分的AUC是0.812.入院后前3天内发生肠功能衰竭和未发生肠功能衰竭的患者入院后30天内的的死亡率分别是45.5％和5.2％ (log-rank test=60.306;P=0.000).结论:GIF评分可用于对急性胰腺炎预后的评估,GIF评分与SOFA评分联合应用对预后判断的准确度高于单独运用其中任一个.     

330例2型糖尿病患者死因分析

目的:通过对80年代、90年代及近6年(2000-2006)我院2型糖尿病患者死因的比较,探讨分析糖尿病患者的死亡原因及其变迁,为提高糖尿病防治水平,减少糖尿病死亡率提供科学依据。方法:采用回顾性调查方法对我院1983-2006年住院2型糖尿病患者死因进行分析,并分三阶段进行比较。共调查2型糖尿病死亡病例330例。结果:不同年代心脑血管疾病均是导致2型糖尿病患者死亡的主要原因,位居死因第一,占总死亡人数的38.2%。肿瘤作为2型糖尿病患者的死因所占比例明显增加,占总死亡人数的19.4%。以感染为直接死因逐渐下降,但仍为重要死因,占14.2%。而糖尿病酮症酸中毒、高渗昏迷和低血糖昏迷等急性并发症所占比例显著减少,占8.8%。结论:糖尿病慢性并发症尤其是心脑血管病变是2型糖尿病的主要死因,近年来肿瘤已经成为2型糖尿病患者的重要死因,以感染为直接死因逐渐下降,但仍为重要死因,而糖尿病酮症酸中毒、高渗昏迷和低血糖昏迷等急性并发症所占比例显著减少。     

初发急性ST段抬高心肌梗死患者预后的影响因素分析

目的:研究初发急性ST段抬高心肌梗死患者预后的影响因素。方法:选取我院2010年收治的发病24小时内初发急性ST段抬高心肌梗死(ST-segment elevation myocardial infarction,STEMI)258例,收集患者病史、化验检查、心脏彩超、冠状动脉造影结果等住院资料,并随访主要心血管事件,通过相关分析求出对预后有统计学意义的因素,再分别通过Logistic回归及Cox回归分析急性心肌梗死患者近期及远期预后的影响因素。结果:AMI患者住院死亡率6.2%(16/258例),影响住院死亡率因素为PCI治疗(r=-0.253,P=0.000,OR=0.318,95%CI:0.101-0.997)、血糖(Glu)(r=0.24,P=0.01,OR=1.136,95%CI:1.020-1.265)两个因素;平均随访7.6±3.8月,总终点事件10.3%(25/242例),心源性死亡患者6例(2.5%);经Cox回归分析与远期死亡相关的因素是高敏C反应蛋白(Hs CRP)(r=0.182,P=0.008,OR=1.223,95%CI:1.065-1.403)。结论:急性心肌梗死预后受多种因素影响,影响住院死亡率的因素为PCI治疗及血糖,影响远期死亡的因素是Hs CRP。     

住院老年高血压患者死亡相关因素的分析

目的：调查和分析1993～2012年19年间住院的老年高血压患者的死亡原因及影响因素,为北京地区老年高血压防治中靶器官的保护和并发症的减少提供重要临床依据。方法：回顾性分析我院1993～2012年19年间住院死亡的2866例1〉60岁老年高血压患者,通过病历采集,收集性别、年龄、并发症及死亡原因等临床资料,按性别、年龄及高血压分期和危险程度将病人分组。采用卡方检验的方法比较各组病人的死亡原因。结果：①按疾病：与死亡相关性最高的疾病为心脏病1294例（45．15％）,脑卒中985例（34．37％）,肾功能衰竭340例（11．88％）,感染性疾病131例（4．58％）,恶性肿瘤116例（4．06％）,心脏病是导致老年高血压患者死亡的首要原因;②按性别：男性占老年高血压死亡的53．31％,女性占46．69％,差异具有统计学意义（P〈0．01）。而心脏病（男性46．73％比女性43．35％]和脑卒中（男性37．04％比女性31．32％）均占据高血压死亡原因构成比的前两位;③按年龄：90岁以上高血压患者因心脏病（43．02％）、肾功能衰竭（20．54％）和感染（6．59％）死亡的比例低于其他各年龄组。因脑卒中死亡的比率低于60—69岁组（38．71％）和70～79岁组（33．37％）。因恶性肿瘤死亡的老年高血压患者在70～79岁组最高（4．80％）;④按高血压分期和危险程度：I．Ⅱ期高血压患者因心脏病（49．70％）和恶性肿瘤（7．55％）死亡的比例高于Ⅲ期高血压患者（分别为43．78％和2．99％）,而Ⅲ期高血压患者因脑卒中（35．84％）和肾功能衰竭（12．79％）死亡的比例高于I．Ⅱ期高血压患者（分别为29．45％和8．76％）。高危组的老年高血压患者因心脏病（38．15％）死亡的比例低于其他三组（低危组51．05％、中危组47．64％和极高危组47．38％）,而其因肾功能衰竭（19．54％）死亡的比例则高于其他三组（低危组1．63％、中危组3．07％和极高危组11．69％）,但中危组的老年高血压患者因脑卒中死亡的比例最高（42．69％）。结论：男性患者、60～79岁患者在老年高血压的根本死亡原因中所占的比率较高。不同的高血压分期和危险分层对根本死亡原因有不同的影响。     

急性心肌梗死急诊救治临床观察

目的:探讨急性心肌梗死急诊救治的临床治疗方法。方法:选取2012年2月到2015年2月于我院就诊的急性心肌梗死患者共80例,采取相应的抢救措施为患者进行治疗,对出现所有并发症的患者进行抢救治疗。首先为患者镇痛吸氧,然后让患者镇静之后对其进行看护,严格观察患者的体征,对于一些没有出现相应并发症,或者只是心律失常的患者采用溶栓治疗的方式进行诊治。结果:在80位急性心肌梗死患者中,采用溶栓治疗的方式成功诊疗的患者有59例,占到总例数的73.7%,病情明显没有好转的为21例,占总例数的26.3%。接受观察的患者当中没有发生死亡的。然而,把患者往住院部转移的途中有两例患者死亡,占到总例数的2.5%,两例患者之中,有一例患者的死亡原因是顽固性心力衰竭,另外一例的死亡原因是心源性休克。结论:在临床上对心肌梗死患者进行诊疗时,早期可以对患者采用静脉溶栓的治疗方式,这种方式可以将患者的痛苦降到最低,也可以降低患者的死亡率。值得在临床上大力推广。     

55例烧伤死亡病例分析

目的总结影响烧伤死亡的相关因素,为进一步提高烧伤治疗水平提供参考。方法对我院2004年1月~2012年12月烧伤死亡患者55例的主要死亡原因、性别比、烧伤原因、烧伤面积、伤后入院时间与院前急救、致病微生物的影响等进行统计分析。结果烧伤的主要死亡原因依次为内脏功能衰竭、全身性感染、吸入性损伤。火焰烧伤,年龄,烧伤面积,内脏功能衰竭,创面革兰氏阴性菌及真菌感染与死亡呈现高度相关性。结论内脏功能衰竭、全身性感染、吸入性损伤为烧伤死亡的主要原因。改善主要脏器功能、有效控制细菌及真菌感染、积极处理吸入性损伤并在本地区范围内逐步建立烧伤治疗网络,有助于降低烧伤患者死亡率。     

急性脑血管病多系统并发症的临床分析

为了探讨急性脑血管病致单个或多个脏器系统衰竭的临床特点 ,作者分析近几年来本院住院患者中因急性脑血管病死亡的 93例患者及其多系统并发症。1　资料与方法　　 93例中男 52例 ,女 41例。脑梗死 2 4例 ,颅内出血 69例 ,其中脑出血 52例 ,小脑出血 5例 ,脑干出血 4例 ,蛛网膜下腔出血 8例。发病前全部病例均未发生单个或多个脏器系统衰竭。发病 1 2 h内急诊住院 ,并经 CT及临床确诊为脑血管病。同时严密观察各脏器系统功能状况 ,直至死亡。按脑以外其他单个或多个脏器系统衰竭的数量分为 3组 :(1 )无脏器系统衰竭组 ;(2 )单个脏器系统衰…     

中国肝细胞癌患者TACE术后死亡原因分析(英文)

目的:通过探讨中国肝细胞癌患者肝动脉化疗栓塞术(TACE)术后并发症及死亡原因,来提高临床治疗效果,并积累治疗经验。方法:通过联合检索CBM及CNKI上从1994年1月到2008年9月的关于中国肝细胞癌患者行TACE术后出现并发症的相关文章,分析总结肝细胞癌患者TACE术后死亡的原因及特点。结果:中国肝细胞癌患者TACE术后并发症较为危重,致死率较高,死亡原因有84%是肝功能衰竭、上消化道出血及肝癌破裂出血,且死亡病例发生在术后1月内的占78.7%,因此大多是早期死亡。结论:中国肝细胞患者TACE术后死亡原因主要是肝功能衰竭、上消化道出血及肝癌破裂出血,且术后死亡常为早期死亡,因此TACE术后严重并发症可直接影响患者的预后情况,我们需要提高对TACE术选择时机的重视程度,规范介入治疗手段和流程,尽量避免和减少严重并发症的发生。     

急性心力衰竭的重症护理研究

目的观察急性心力衰竭患者的重症护理干预护理效果。方法将我院2017年7月～2018年7月收治的40例急性心力衰竭患者作为研究对象,根据护理措施的不同分为对照组20例,实施常规护理措施,另外20例患者作为观察组,实施重症护理措施,对比观察两组患者左心室射血分数、6 min内步行距离、6个月内再住院率及死亡率。结果观察组患者经过护理后左心室射血分数以及6 min内步行距离改善情况较对照组明显(P0.05);经过护理后,观察组患者6个月内再住院率以及死亡率较对照组较低,差异具有统计学意义(P0.05)。结论对于急性心力衰竭患者在实施常规护理措施的基础上,增加重症护理措施,有助于稳定患者病情,改善患者临床不适症状,值得在临床上推广使用。     

Trends in schistosomiasis-related mortality in Brazil, 2000–2011

Schistosomiasis is an important public health problem, with high morbidity and mortality in endemic countries. We analysed the epidemiological characteristics and time trends of schistosomiasis-related mortality in Brazil. We performed a nationwide study based on official mortality data obtained from the Brazilian Mortality Information System. We included all deaths in Brazil between 2000 and 2011, in which schistosomiasis was mentioned on the death certificate as an underlying or associated cause of death (multiple causes of death). We calculated crude and age-adjusted mortality rates (per 100,000 inhabitants), and proportional mortality rates. Trends over time were assessed using joinpoint regression models. Over the 12-year study period, 12,491,280 deaths were recorded in Brazil. Schistosomiasis was mentioned in 8,756 deaths, including in 6,319 (72.2%) as an underlying cause and in 2,437 (27.8%) as an associated cause. The average annual age-adjusted mortality rate was 0.49 deaths/100,000 inhabitants (95% confidence interval: 0.46–0.52) and proportional mortality rate was 0.070% (95% confidence interval: 0.069–0.072). Males (0.53 deaths/100,000 inhabitants), those aged ⩾70 years (3.41 deaths/100,000 inhabitants), those of brown race/colour (0.44 deaths/100,000 inhabitants), and residents in the Northeast region of Brazil (1.19 deaths/100,000 inhabitants) had the highest schistosomiasis-related death rates. Age-adjusted mortality rates showed a significant decrease at a national level (Annual Percent Change: −2.8%; 95% confidence interval: −4.2 to −2.4) during the studied period. We observed decreasing mortality rates in the Northeast (Annual Percent Change: −2.5%; 95% confidence interval: −4.2 to −0.8), Southeast (Annual Percent Change: −2.2%; 95% confidence interval: −3.6 to −0.9), and Central-West (Annual Percent Change: −7.9%; 95% confidence interval: −11.3 to −4.3) regions, while the rates remained stable in the North and South regions. Despite the reduced mortality, schistosomiasis is still a neglected cause of death in Brazil, with considerable regional differences. Sustainable control measures should focus on increased coverage, and intensified and tailored control measures, to prevent the occurrence of severe forms of schistosomiasis and associated deaths.     

Defining the Cause of Death in Hospitalised Patients with Acute Kidney Injury

Background

The high mortality rates that follow the onset of acute kidney injury (AKI) are well recognised. However, the mode of death in patients with AKI remains relatively under-studied, particularly in general hospitalised populations who represent the majority of those affected. We sought to describe the primary cause of death in a large group of prospectively identified patients with AKI.

Methods

All patients sustaining AKI at our centre between 1^st October 2010 and 31^st October 2011 were identified by real-time, hospital-wide, electronic AKI reporting based on the Acute Kidney Injury Network (AKIN) diagnostic criteria. Using this system we are able to generate a prospective database of all AKI cases that includes demographic, outcome and hospital coding data. For those patients that died during hospital admission, cause of death was derived from the Medical Certificate of Cause of Death.

Results

During the study period there were 3,930 patients who sustained AKI; 62.0% had AKI stage 1, 20.6% had stage 2 and 17.4% stage 3. In-hospital mortality rate was 21.9% (859 patients). Cause of death could be identified in 93.4% of cases. There were three main disease categories accounting for three quarters of all mortality; sepsis (41.1%), cardiovascular disease (19.2%) and malignancy (12.9%). The major diagnosis leading to sepsis was pneumonia, whilst cardiovascular death was largely a result of heart failure and ischaemic heart disease. AKI was the primary cause of death in only 3% of cases.

Conclusions

Mortality associated with AKI remains high, although cause of death is usually concurrent illness. Specific strategies to improve outcomes may therefore need to target not just the management of AKI but also the most relevant co-existing conditions.     

Congestive heart failure. New frontiers.

Congestive heart failure is a common syndrome with high mortality in its advanced stages. Current therapy includes the use of vasodilator drugs, which have been shown to prolong life. Despite current therapy, mortality remains high in patients with severe heart failure. Potent new inotropic vasodilators have improved ventricular performance but have not prolonged life in patients with end-stage heart failure. Serious arrhythmias are implicated in the sudden deaths of 30% to 40% of patients with severe heart failure, but the benefits of antiarrhythmic therapy have not been established. Upcoming trials will address this question. Ventricular remodeling and progressive dilatation after myocardial infarction commonly lead to congestive heart failure; early unloading of the ventricle with an angiotensin-converting enzyme inhibitor may attenuate these events. These findings support the concept that angiotensin-converting enzyme inhibitors may be useful in managing heart failure of all degrees of severity, including left ventricular dysfunction and end-stage heart failure. Part of the damage that may occur with acute myocardial infarction, particularly in this era of thrombolysis therapy, is reperfusion injury, which may be mediated by oxygen-derived free radicals. Better knowledge of the mechanisms and treatment of myocardial infarction, the leading cause of congestive heart failure, may help prevent or attenuate the development of this syndrome.     

Using birth defects registry data to evaluate infant and childhood mortality associated with birth defects: an alternative to traditional mortality assessment using underlying cause of death statistics

BACKGROUND: Although birth defects are a leading cause of death in infancy and early childhood, the proportion of all deaths to children with clinically diagnosed birth defects is not well documented. The study is intended to measure the proportion of all deaths to infants and children under age 10 occurring to children with birth defects and how and why this proportion differs from the proportion of deaths due to an underlying cause of congenital anomalies using standard mortality statistics. METHODS: A linked file of Michigan livebirths and deaths was combined with data from a comprehensive multisource birth defects registry of Michigan livebirths born during the years 1992 through 2000. The data were analyzed to determine the mortality rate for infants and children with birth defects and for children with no reported birth defect. Mortality risk ratios were calculated. The underlying causes of death for children with birth defects were also categorized and compared to cause- specific mortality rates for the general population. RESULTS: Congenital anomalies were the underlying cause of death for 17.8% of all infant deaths while infants with birth defects were 33.7% of all infant deaths in the study. Almost half of all Michigan deaths to children aged 1 to 2 were within the birth defects registry, though only 15.0% had an underlying cause of death of a congenital anomaly based upon standard mortality statistics. The mortality experience among children with birth defects was significantly higher than other children throughout the first 9 years of life, ranging from 4.6 for 5 year olds to 12.8 for children 1 to 2. Mortality risk ratios examined by cause of death for infants with birth defects were highest for other endocrine (28.1), other CNS (28.1), and heart (21.9) conditions. For children 1 through 9, the highest differential risk was seen for other perinatal conditions (39.0), other endocrine (29.7), other CNS (24.5), and heart (21.4). CONCLUSIONS: Childhood mortality analyses that incorporate birth defects registry data provide a more comprehensive picture of the full burden of birth defects on mortality in infant and children and can provide an effective mechanism for monitoring the survival and mortality risks of children with selected birth defects on a population basis.     

Child Deaths Due to Injury in the Four UK Countries: A Time Trends Study from 1980 to 2010

Background

Injuries are an increasingly important cause of death in children worldwide, yet injury mortality is highly preventable. Determining patterns and trends in child injury mortality can identify groups at particularly high risk. We compare trends in child deaths due to injury in four UK countries, between 1980 and 2010.

Methods

We obtained information from death certificates on all deaths occurring between 1980 and 2010 in children aged 28 days to 18 years and resident in England, Scotland, Wales or Northern Ireland. Injury deaths were defined by an external cause code recorded as the underlying cause of death. Injury mortality rates were analysed by type of injury, country of residence, age group, sex and time period.

Results

Child mortality due to injury has declined in all countries of the UK. England consistently experienced the lowest mortality rate throughout the study period. For children aged 10 to 18 years, differences between countries in mortality rates increased during the study period. Inter-country differences were largest for boys aged 10 to 18 years with mortality rate ratios of 1.38 (95% confidence interval 1.16, 1.64) for Wales, 1.68 (1.48, 1.91) for Scotland and 1.81 (1.50, 2.18) for Northern Ireland compared with England (the baseline) in 2006–10. The decline in mortality due to injury was accounted for by a decline in unintentional injuries. For older children, no declines were observed for deaths caused by self-harm, by assault or from undetermined intent in any UK country.

Conclusion

Whilst child deaths from injury have declined in all four UK countries, substantial differences in mortality rates remain between countries, particularly for older boys. This group stands to gain most from policy interventions to reduce deaths from injury in children.     

OPERATING ROOM DEATHS—An Analysis of Mortality in a Veterans Administration Hospital Over a Ten-Year Period

A study of operating room and recovery room deaths which occurred during a ten-year period from 1948 through 1957 at one hospital revealed that there were 59 deaths associated with 57,132 surgical procedures.Factors which directly influenced the rate of operating room and recovery room death were the age of the patient and the length of operating time. Seventy-five per cent of the deaths occurred in cases in which the operation took longer than one hour. Combined anesthesia techniques may have indirectly contributed to death in some cases.Complications of operation requiring another surgical procedure sometimes occur. In this series, reoperation proved to be more hazardous in terms of mortality rate than did single operations. This is not surprising for most complications occur in the poorer risk patients.The operating room death rate steadily increased during the ten-year period studied. This increasing death rate can largely be attributed to the more intricate operations which are being done on poorer risk patients. The use of the curariform drugs had no influence on the increasing death rate.     

Operating room deaths; an analysis of mortality in a Veterans Administration hospital over a ten-year period

A study of operating room and recovery room deaths which occurred during a ten-year period from 1948 through 1957 at one hospital revealed that there were 59 deaths associated with 57,132 surgical procedures. Factors which directly influenced the rate of operating room and recovery room death were the age of the patient and the length of operating time. Seventy-five per cent of the deaths occurred in cases in which the operation took longer than one hour. Combined anesthesia techniques may have indirectly contributed to death in some cases. Complications of operation requiring another surgical procedure sometimes occur. In this series, reoperation proved to be more hazardous in terms of mortality rate than did single operations. This is not surprising for most complications occur in the poorer risk patients. The operating room death rate steadily increased during the ten-year period studied. This increasing death rate can largely be attributed to the more intricate operations which are being done on poorer risk patients. The use of the curariform drugs had no influence on the increasing death rate.     

Causes of Mortality for Indonesian Hajj Pilgrims: Comparison between Routine Death Certificate and Verbal Autopsy Findings

Background

Indonesia provides the largest single source of pilgrims for the Hajj (10%). In the last two decades, mortality rates for Indonesian pilgrims ranged between 200–380 deaths per 100,000 pilgrims over the 10-week Hajj period. Reasons for high mortality are not well understood. In 2008, verbal autopsy was introduced to complement routine death certificates to explore cause of death diagnoses. This study presents the patterns and causes of death for Indonesian pilgrims, and compares routine death certificates to verbal autopsy findings.

Methods

Public health surveillance was conducted by Indonesian public health authorities accompanying pilgrims to Saudi Arabia, with daily reporting of hospitalizations and deaths. Surveillance data from 2008 were analyzed for timing, geographic location and site of death. Percentages for each cause of death category from death certificates were compared to that from verbal autopsy.

Results

In 2008, 206,831 Indonesian undertook the Hajj. There were 446 deaths, equivalent to 1,968 deaths per 100,000 pilgrim years. Most pilgrims died in Mecca (68%) and Medinah (24%). There was no statistically discernible difference in the total mortality risk for the two pilgrimage routes (Mecca or Medinah first), but the number of deaths peaked earlier for those traveling to Mecca first (p=0.002). Most deaths were due to cardiovascular (66%) and respiratory (28%) diseases. A greater proportion of deaths were attributed to cardiovascular disease by death certificate compared to the verbal autopsy method (p<0.001). Significantly more deaths had ill-defined cause based on verbal autopsy method (p<0.001).

Conclusions

Despite pre-departure health screening and other medical services, Indonesian pilgrim mortality rates were very high. Correct classification of cause of death is critical for the development of risk mitigation strategies. Since verbal autopsy classified causes of death differently to death certificates, further studies are needed to assess the method’s utility in this setting.     

Myocardial Infarction: A Five-Year Follow-up of Patients

Patients with acute myocardial infarction (2,020) admitted to coronary care units (CCU) in Utah were studied for five years. Of these, 1,641 (81.4 percent) survived to leave the hospital. The male to female ratio was 3.5:1. At four months, one year and yearly thereafter from the date of admission to CCU, patients were mailed follow-up questionnaires. Cause of death was obtained from autopsy reports and death certificates. Patients were grouped yearly by the number of cardiac symptoms reported. Of patients discharged whose cases were followed, 925 (61.9 percent) were alive after five years. Reinfarction was the major cause of death in the hospital; however, during follow-up only 36.8 percent of deaths were attributable to myocardial infarction. At follow-up after a year, fewer cardiac symptoms were reported by patients who survived to the fifth year of follow-up than by patients who did not. Women were older and showed a higher death rate during follow-up. Increasing age was found to be a determining factor in long-term mortality after acute myocardial infarction.