云南省116例不明原因猝死回顾性研究

施国庆; 张健; 黄文丽; 杨涛; 叶绍东; 孙晓冬; 李兆祥; 解晓华; 李芙蓉; 王跃兵; 任金马; RobertE.Fontaine; 曾光

Abstract

施国庆,张健,黄文丽,杨涛,叶绍东,孙晓冬,李兆祥,解晓华,李芙蓉,王跃兵,任金马,RobertE.Fontaine,曾光.云南省116例不明原因猝死回顾性研究[J].Chinese journal of Epidemiology,2006,27(2):96-101

云南省116例不明原因猝死回顾性研究

Retrospective study on 116 unexpected sudden cardiac deaths in Yunnan, China

Received:October 13, 2005

DOI：

KeyWord: 不明原因猝死家庭聚集性心源性疾病

English Key Word: Sudden unexpected cardiac death Familial clustering Cardiac disease

FundProject:科技部国家重大科技攻关资助项目(2003BA712A11-01)

Author Name	Affiliation	E-mail
Shi Guoqing	Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China
Zhang Jian	中国医学科学院阜外心血管病医院
Huang Wenli	云南省地方病防治所
Yang Tao	Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China
Ye Shaodong	中国医学科学院阜外心血管病医院
Sun Xiaodong	Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China
Li Zhaoxiang	云南省地方病防治所
Xie Xiaohua	Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China
Li Furong	Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China
Wang Yuebing	云南省地方病防治所
Ren Jinma	Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China
ROBERT E.Fontaine	Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China
Zeng Guang	Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China	Zeng4605@sina.com

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Abstract:

目的了解云南省不明原因猝死流行病学和临床特征。方法选择祥云、鹤庆、南涧和大姚4个县既往不明原因猝死病例作为调查对象。采用统一调查表,调查猝死者家庭成员、见证人和诊治医生,查阅诊治记录,收集病例信息。结果1984-2004年,21个自然村发生116例不明原因猝死;7月和8月病例分别占66%和29%,10~39岁年龄组发生率(1.6/1000)高于其他年龄组(χ2=16,P<0.01),女性高于男性(RR=1.6,95%CI:1.1~2.3);70%为家庭聚集性病例,61%家庭续发猝死发生在首例猝死后的24小时内(中位数20小时);63%病例死亡前主诉头晕、头昏、恶心、昏迷、晕厥、乏力、心悸等症状,急性发病至死亡时间中位数2小时。结论云南省不明原因猝死有明显的空间和时间聚集性,表明危险因素在特定条件下存在;家庭猝死集中,提示同源暴露;急性发病表现为心源性疾病症状,死亡突然。

English Abstract:

Objective To identify the epidemiological and clinical features of unexpected sudden cardiac deaths (SUD) in Yunnan. Methods Choosing the old SUD cases from Xiangyun, Heqing,Nanjian and Dayao counties and using the standardized verbal autopsy Form, we interv iewed the family members of the cases, w itnesses and doctors as well as rev iewing their medical files to g et relative information. Results We identified 116 SUDs in 21 villages from 1984 to 2004. T he village- specific annually st andardized incidence rates were ranged from 0. 2P1000 to 8. 9P1000 (median=0. 8P1000). 66% and 29% of the SUDs occur red in July and August respectively. The incidence rates of SUD w ere higher(1. 6P1000, V 2 =16, P< 0. 01) in 10- 39 year- olds, and higher in females than in males (RR =1. 6,95%CI : 1. 1- 2. 3). Sev enty percent of SUD o ccurred in families having cluster ing nature and 60% of the additional cases in the family were occurred w ithin 24 hours (median =20 hours) after the first SUD identified in the family. SUD occur red in 23 families followed the first affected family in a village dur ing the same season. In these 23 families, 61% of the first SUD occurred wit hin 8 days after the first SUD in the first affected family. 68% and 66% of the SUDs did not have any complaints or signs during the last 3 weeks or from 3 weeks to 2 days prior to the onset of the disease. 63% of the SUDs had cardiac symptoms within the last 2 days prior to the onset w ith major symptoms as dizziness, nausea, faintness,unconsciousness, weakness and palpitation. The median dur at ion from acute onset to death was 2 hours.Conclusions The ex treme time- space clustering of SUD in families and in v illages sugg ested that the risk factors occurred in specific time and location. Familial cluster red SUD cases had common ex posure pattern.Sudden onset of acute cardiac symptoms often follow ed by sudden death. Epidemiological study on new cases was necessary to identify r isk factors and to develop hypothesis for causation. In July 2005, we instituted a special SUD surveillance system for all the affected counties together w ith 10 counties which had no reported cases.

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