Raymond J R, van den Berg E K, Knapp M J
Department of Medicine, Duke University Medical Center, Durham, NC 27710.
Arch Intern Med. 1988 Feb;148(2):303-8.
The clinical and/or autopsy records of 83 consecutive adults presenting with nontraumatic prehospital sudden death (NPSD) in a single county were reviewed. Coronary artery disease (CAD) was the primary cause of death in individuals 36 to 45 years old. Non-CAD cardiac disease was the second most common cause of NPSD in this age group. Between the ages of 18 and 35 years, non-CAD cardiac disease was the primary cause and toxic ingestions were the second most common. Patients with rhythms other than ventricular fibrillation/tachycardia, asystole, or electromechanical dissociation on presentation to the emergency room (ER) were more likely to survive. Patients with asystole in the ER were more likely to die in the ER than were patients with other rhythms. Patients with toxic ingestions tended to have a better prognosis for successful resuscitation and for ultimate survival. Age, sex, bystander cardiopulmonary resuscitation, and time in the field were not significant prognostic variables. Patients with abdominal hemorrhage (eight of 83) as the cause of NPSD may represent a subgroup for whom a special approach is warranted. None of these patients survived. Early detection by culdocentesis or paracentesis in female patients of reproductive age and nasogastric lavage or stool occult blood testing could lead to more vigorous fluid resuscitation and early surgical intervention in abdominal hemorrhage.
回顾了某一县连续83例非创伤性院前猝死（NPSD）成年患者的临床和/或尸检记录。冠状动脉疾病（CAD）是36至45岁个体的主要死因。非CAD心脏病是该年龄组NPSD的第二大常见原因。在18至35岁之间，非CAD心脏病是主要原因，毒物摄入是第二大常见原因。在急诊室（ER）就诊时出现除室颤/室速、心脏停搏或电机械分离以外节律的患者更有可能存活。在ER中出现心脏停搏的患者比其他节律的患者更有可能在ER中死亡。毒物摄入患者成功复苏和最终存活的预后往往更好。年龄、性别、旁观者心肺复苏和现场时间不是显著的预后变量。因腹腔出血导致NPSD的患者（83例中有8例）可能代表一个需要特殊处理方法的亚组。这些患者均未存活。对于育龄女性患者，通过后穹窿穿刺或腹腔穿刺早期检测，以及鼻胃管灌洗或粪便潜血试验，可导致在腹腔出血时进行更积极的液体复苏和早期手术干预。
