247例老年人猝死病因和死亡节律分析

Clinical Analysis of 247 Cases of the Elderly Sudden Death on Etiology and Death Rhythm

目的：探讨老年人猝死的原因和死亡的时间节律。方法：利用Excel统计软件回顾性分析247例老年人猝死的病例资料。结果：247例老年人猝死病因中心血管系统161例（65．18％，95％CI=59．24％～71．12％，与呼吸系统、中枢神经系统比较，95％CI不重叠，P〈0．05），其中以冠心病最多，其次是心律失常和心衰。呼吸系统54例（21．86％，95％CI=16．71％～27．01％），以肺部感染和肺心病为主。中枢神经系统等32例（12．96％，95％CI=8．77％～17．73％），以老年性痴呆为主。对247例死亡时间段明确的死亡节律分析显示，05：00-11：00时猝死的发生率为78例（31．58％，95％CI=25．78％～37．38％，与11～17时比较，95％CI不重叠，p〈0．05），23时～次日5时72例（29．15％，95％CI=23．48％～34．82％），t7～23时53例（21．46％，95％CI：16．34％～26．58％），11～17时44例（17．81％，95％CI=13．04％～22．58％）。10～12月死亡率最高，共68例（27．53％，95％CI=21．96％～33．10％），其次是1-3月64例（25．91％．95％CI=20．46％－31．37％）。结论：老年人猝死原因主要以心源性猝死为主，冠心病是猝死的最常见死因。猝死有明显的昼夜节律，常发生于冬春季节，凌晨或上午5—11时是猝死的高峰期，老年猝死病人的死亡节律基本符合中医学阴阳学说及当代生物钟理论。

Obective： To investigate the cause and the temporal rhythm of the elderly sudden death. Method： The clinical data of 247 cases of the elderly sudden death was analyzed retrospectively by using Excel statistical software. Result： Among 247 eases of elderly sudden death, 161 cases （65.18% , 95% CI = 59. 24% - 71.12% ） were caused by cardiovascular system diseases （Contrasted with systema respiratorium and systema nervosum eentrale, there were significant difference between them, P 〈 0.05） , and coronary heart disease （CHD） , cardiac arrhythmia and congestive heart failure were the main etiological factors. 54 eases （21.86% , 95% CI = 16.71% -27.01% ） were caused by respiratory diseases in which the majority were pulmonary infection and pulmonary heart disease. And 32 cases （ 12.96% , 95% CI = 8.77% - 17.73% ） belonged to the central nervous system diseases, mostly Alzheimer＇s disease （AD）. The analysis of the temporal rhythm of 247 cases of sudden death with definite periods of death time showed that 78 cases （31.58% , 95% CI = 25.78% - 37.38% ） occurred at05： 00-11： 00, 72 ones （29.15%, 95%CI =23.48%-34.82%） at23： 00-05： 00 thenext day, 53 ones （21.46%, 95%CI =16.34% -26.58%） at 17： 00-23： 00, and44 ones （17.18%, 95%CI = 13.04% -22.58% ） at 11：00 - 17： 00. The month death rate was the highest from October to December, totally 68 cases （27.53 % , 95% CI = 21.96% -33.10% ） among them, then from January to March, 64 ones alto- gether （25.91% ,95% CI = 20.46% -31.37% ）. Conclusion： The main cause of the elderly sudden death is sudden cardiac death （SCD） , of which the most common is the coronary heart disease （CHD）. The sudden death shows obvious circadian rhythm, which often occurred during winters and springs, and the peak time is the wee hours of the morning fi＇om 5：00 to 11 ： 00 AM. The temporal rhythm of the elderly sudden death is basically in accordance with Yin - Yang Theory of traditional Chinese medical science and modern biochronometer theory.