国外医学（医学地理分册）
國外醫學（醫學地理分冊）
국외의학（의학지리분책）
FOREIGN MEDICAL SCIENCES(SECTION OF MEDGEOGRAPHY)
2014年
2期
117-121
,共5页
杨林%赵溯%王跃兵%李灿彪%段炳华%陆步来%赵红%马琳%董毅%唐雪%习严梅%施国庆%黄文丽%曾光
楊林%趙溯%王躍兵%李燦彪%段炳華%陸步來%趙紅%馬琳%董毅%唐雪%習嚴梅%施國慶%黃文麗%曾光
양림%조소%왕약병%리찬표%단병화%륙보래%조홍%마림%동의%당설%습엄매%시국경%황문려%증광
云南不明原因猝死%猝死病例%同发病例%资料分析
雲南不明原因猝死%猝死病例%同髮病例%資料分析
운남불명원인졸사%졸사병례%동발병례%자료분석
sudden unexplained death in yunnan%cases of sudden death%cases suffering from the same diseases%data analysis
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S T-T 异常、Q-T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。
目的：總結事件的流行病學特點、臨床錶現、實驗室結果及病理學特徵，為雲南不明原因猝死病因探討和防控提供依據。方法對事件現場進行流行病學調查；對死者傢屬及村民包括心電圖在內的健康體檢；採集死者傢屬及村民血清，標本採集後及時送大理州人民醫院，作電解質、肝腎功能、血糖、血脂、心肌酶、肌鈣蛋白、肌紅蛋白、C反應蛋白等指標檢測；對符閤尸體解剖取材條件的病例進行尸體解剖取材；收集同髮病例的流行病學資料和住院治療期間的所有資料併對所有資料進行認真、客觀、繫統的分析。結果本次事件髮生在雲南不明原因猝死流行的高髮季節（8月），20 h之內7口之傢猝死4人，有傢庭聚集現象，猝死者均為青壯年農民，女性多于男性（3/1），死前均無特殊臨床錶現和不適，從髮病到死亡僅幾分鐘時間，死前1箇月內死者傢庭無特殊飲食史；對傢屬及村民的健康檢查中，42例自訴有頭昏、胸悶、乏力，均給予瞭治療；對村民做瞭4次心電圖檢查，4次結果變化比較明顯，第2天改變率為最高（77．27％），其次是第1天（69．57％），第3天（58．82％），最低是第15天（35．71％）；改變項目較多的是S T-T 異常、Q-T間期延長、頻髮室性早搏等；血清結果，死者傢屬中1例心肌酶5項均輕度升高，1例心肌酶3項和堿性燐痠酶輕度升高；病理結果，3例均有淋巴細胞性心肌炎，2例齣現急性肺水腫，房室結動脈內膜偏心性纖維性增厚緻管腔狹窄、卵圓孔未閉各佔1例。同髮病例于8月5日下午18時在死者傢幫忙時突然暈厥倒地，21時40分送往縣醫院住院治療，生命體徵平穩，8月13日齣院。結論本次事件符閤雲南不明原因猝死病例定義的診斷標準，按雲南不明原因猝死衛生應急處置及時上報。
목적：총결사건적류행병학특점、림상표현、실험실결과급병이학특정，위운남불명원인졸사병인탐토화방공제공의거。방법대사건현장진행류행병학조사；대사자가속급촌민포괄심전도재내적건강체검；채집사자가속급촌민혈청，표본채집후급시송대리주인민의원，작전해질、간신공능、혈당、혈지、심기매、기개단백、기홍단백、C반응단백등지표검측；대부합시체해부취재조건적병례진행시체해부취재；수집동발병례적류행병학자료화주원치료기간적소유자료병대소유자료진행인진、객관、계통적분석。결과본차사건발생재운남불명원인졸사류행적고발계절（8월），20 h지내7구지가졸사4인，유가정취집현상，졸사자균위청장년농민，녀성다우남성（3/1），사전균무특수림상표현화불괄，종발병도사망부궤분종시간，사전1개월내사자가정무특수음식사；대가속급촌민적건강검사중，42례자소유두혼、흉민、핍력，균급여료치료；대촌민주료4차심전도검사，4차결과변화비교명현，제2천개변솔위최고（77．27％），기차시제1천（69．57％），제3천（58．82％），최저시제15천（35．71％）；개변항목교다적시S T-T 이상、Q-T간기연장、빈발실성조박등；혈청결과，사자가속중1례심기매5항균경도승고，1례심기매3항화감성린산매경도승고；병리결과，3례균유림파세포성심기염，2례출현급성폐수종，방실결동맥내막편심성섬유성증후치관강협착、란원공미폐각점1례。동발병례우8월5일하오18시재사자가방망시돌연훈궐도지，21시40분송왕현의원주원치료，생명체정평은，8월13일출원。결론본차사건부합운남불명원인졸사병례정의적진단표준，안운남불명원인졸사위생응급처치급시상보。
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&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 (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 anoth-er 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 infiltra-tion was discovered on one case's lymphatic cells of liver and kidney ,while one case's foramen oval was un-closed ,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 after-noon 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 13th 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 un-explained deaths in Yunnan and shall be handled and reported as sudden unexplained death in this area .
