33例肺动脉血栓栓塞死亡的法医学分析  

Forensic Analysis of 33 Cases of Fatal Pulmonary Thromboembolism

作　　者：孙杰[1] 张建华[2] 邹冬华[2] 陈忆九[2] 

机构地区：[1]复旦大学上海医学院法医学系,上海200032 [2]司法部司法鉴定科学技术研究所上海市法医学重点实验室,上海200063

出　　处：《法医学杂志》2015年第5期361-365,共5页Journal of Forensic Medicine

摘　　要：目的通过对肺动脉血栓栓塞(pulmonary thromboembolism,PTE)死亡的实际案例分析,探讨相关高危因素,并分析其与创伤及医疗因素的因果关系。方法对司法部司法鉴定科学技术研究所2000—2014年33例PTE致死案件进行回顾分析。结果 33例中,男性16例,女性17例;死者死亡前多表现为不同程度呼吸困难、胸闷、晕厥症状;血栓主要分布于左、右肺动脉,栓子主要来源于下肢深静脉,左侧多见;创伤、限制体位、手术及自身血管病变为常见的高危因素;D-二聚体检测、凝血实验和CT肺动脉造影可作为PTE诊断的手段;部分案例中创伤因素及医疗因素可参与死亡原因的构成。结论 PTE猝死案件,多数存在临床症状不典型,往往合并有多种高危因素,法医学鉴定中应注重损伤或医疗因素的因果关系判断。Objective To explore the related risk facts of pulmonary thromboembolism （PTE） and analyze the relation between PTE and the trauma or medical behavior by investigating the cases of PTE. Methods Thirty-three cases were selected from Institute of Forensic Science （IFS） from 2000 to 2014. Results In 33 cases, 16 decedents were male, 17 decedents were female; different degrees of dyspnea, chest tight- ness and syncope symptoms were the clinical manifestation of the deceased; the thrombus was mainly distributed in the left and right pulmonary arteries. The main source of embolism was the deep vein of lower limb and the left probability was higher. Trauma, limited position, operation and cardiovascular disease showed high-risk factors of PTE; D-Dimer test, hemolytic test and computer tomography pul- monary angiography were the diagnostic tools for PTE. In some cases, trauma and medical malpractice could be involved in the cause of death. Conclusion Non-typical clinical symptoms present in the most cases caused by PTE, and these cases always show many high-risk factors. The relation between PTE and injury or medical behavior should be considered carefully in the forensic pathological practice.

关 键 词：法医病理学 肺动脉 血栓栓塞 案例分析 

分 类 号：R563.5[医药卫生—呼吸系统]