主动脉夹层破裂致死20例分析  

Analysis of 20 deaths caused by rupture of aortic dissection

作　　者：张涛 李昊 郭华林 吴鹏 白雅琴 贠克明[1] 李建国[2] 高彩荣[1] 郭相杰[1] Zhang Tao;Li Hao;Guo Hualin;Wu Peng;Bai Yaqin;Yun Keming;Li Jianguo;Gao Cairong;Guo Xiangjie(School of Forensic Medicine,Shanxi Medicine University,Taiyuan 030001,Shanxi,China;China Academy of Radiation Protection,Taiyuan 030006,Shanxi,China)

机构地区：[1]山西医科大学法医学院,山西太原030001 [2]中国辐射防护研究院,山西太原030006

出　　处：《中国法医学杂志》2021年第3期322-325,共4页Chinese Journal of Forensic Medicine

基　　金：山西省自然科学基金资助项目(201601D102070);山西医科大学博士启动基金(03201536)。

摘　　要：目的分析主动脉夹层破裂致死的相关特征,以期为主动脉夹层破裂致死案例的法医学鉴定提供参考。方法收集主动脉夹层破裂致死的法医学鉴定案例20例,对死者年龄、性别、临床症状、死亡原因、病理特征、易患危险因素(高血压、冠心病等)、伤病关系等进行统计分析。结果(1)20例中涉及医疗纠纷有10例,涉及外伤有7例;1例首发症状为典型的胸背部撕裂样疼痛,其余19例均为非典型疼痛;死亡距发病平均时间为11.46±13.84(1.00~51.00)h。(2)心脏重量平均为432.29±61.94(340~540)g,左心室厚度平均为1.39±0.29(1.10~2.50)cm,均大于正常厚度;内膜破口位于主动脉瓣环口上方平均为2.47±1.43(1.0~6.5)cm处,形态多为横行,外膜破口多位于主动脉根部。(3)13例既往有高血压病史,11例存在主动脉粥样硬化。结论非典型痛性主动脉夹层破裂导致死亡更容易引发医疗纠纷,法医鉴定中需详细调查患者生前有无高血压、主动脉粥样硬化、妊娠、先天结缔组织疾病等高危因素,有无腹痛、头晕等不典型症状,进而通过全面系统尸检和病理检验寻找主动脉夹层的客观诊断依据。外伤后主动脉夹层破裂致死的案例,鉴定时应进行伤病关系的评定。Objective To analyze the related characteristics of the death of aortic dissection rupture,so as to provide reference for forensic identification of death cases of aortic dissection rupture.Methods 20 cases of forensic medical identification of the death of aortic dissection were collected,the age,sex,clinical symptoms,cause of death,pathological characteristics,risk factors(hypertension,coronary heart disease,etc.),and the relationship between injuries and illnesses of the deceased were statistically analysed.Results(1)Among the 20 cases,10 cases were involved in medical disputes,7 cases were involved in trauma;1 case had typical chest and back tearing pain as the first symptom,and the other 19 cases had atypical chest and back pain;the average time from onset to death was 11.46±13.84 h(1.00~51.00)h.(2)The average weight of the heart was 432.29±61.94(340~540)g,the average thickness of the left ventricle was 1.39±0.29(1.10~2.50)cm,which was greater than the normal range;most of the intimal breaks were located above the aortic annulus with an average of 2.47±1.43(1.0~6.5)cm,most of them were transverse,and most of the outer membrane breaks were located at the aortic root.(3)13 patients had a history of hypertension and 11 had atherosclerosis.Conclusion Atypical painful aortic dissection is more likely to cause medical disputes.It is necessary to investigate in detail whether patients have high-risk factors such as hypertension,aortic atherosclerosis,pregnancy,congenital connective tissue disease,and atypical symptoms as abdominal pain,dizziness.Then through a comprehensive and systematic autopsy and pathological examination to find the objective basis for the diagnosis of aortic dissection.In the case of death from rupture of aortic dissection after trauma,the relationship between injury and illness should be assessed during identification.

关 键 词：法医病理学 主动脉夹层 法医学鉴定 伤病关系 

分 类 号：DF795.2[医药卫生—法医学]