甲醇中毒后视力损害法医学损伤程度鉴定2例  

Forensic Clinical Evaluation of Visual Impairment after Methanol Poisoning:Two Cases Reports

作　　者：鲁婷 占梦军 范飞[1] 陈新[2] 邓振华[1] LU Ting;ZHAN Mengjun;FAN Fei;CHEN Xin;DENG Zhenhua(West China School of Basic Medical Sciences&Forensic Medicine,Sichuan University,Chengdu 610041,China;Institute of Forensic Science,Shanghai Public Security Bureau,Shanghai Key Laboratory of Crime Scene Evidence,Shanghai 200083,China)

机构地区：[1]四川大学华西基础医学与法医学院,成都610041 [2]上海市公安局物证鉴定中心,上海市现场物证重点实验室,上海200083

出　　处：《刑事技术》2024年第5期537-542,共6页Forensic Science and Technology

基　　金：上海市现场物证重点实验室开放课题(2020XCWZK04)。

摘　　要：视功能障碍的客观准确评定一直是法医学鉴定难点之一。鉴定实践中视力障碍的致伤因素多为物理性因素,少数是化学性致伤因素,如甲醇中毒。甲醇及其代谢产物可直接损害眼球组织和引起血管麻痹扩张,损害神经系统。中毒数小时至2~3 d后即可出现视力障碍,表现为复视、视物不清及眼球胀痛等,之后视力急剧减退、甚至失明。眼科检查可见瞳孔散大、固定,对光反射减弱或消失。眼底检查可见静脉扩张,视神经乳头充血、水肿,继之苍白或视神经萎缩。视神经损害很少完全恢复正常。本文介绍2例甲醇中毒后视力损害的损伤程度鉴定案例,并围绕甲醇中毒的确证、视觉障碍的客观评定以及甲醇中毒与视力损害之间的因果关系分析等方面进行对比论证,以期为类似案件提供参考。Objective and accurate assessment of visual impairment has been one of the challenging tasks in forensic identification.In forensic practice,visual impairments are commonly seen as caused by physical factors,but rarely by chemical factors such as methanol poisoning.Methanol and its metabolites can directly damage eye tissues and cause vascular paralysis and dilatation,damaging the nervous system.Visual impairment can appear after a few hours to 2~3 days of poisoning,manifesting as diplopia,blurred vision,and eyeball swelling and pain,followed by rapid vision loss and even blindness.Ophthalmologic examination reveals dilated and fi xed pupils and diminished or absent light refl exes.Funduscopic examination reveals dilated veins,optic nerve papilla congestion,and edema,followed by pallor or optic nerve atrophy.Optic nerve damage rarely returns to normal completely.The mechanism of visual function impairment in methanol poisoning is mainly its metabolite formic acid or format,which is excreted very slowly in vivo and has a selective affi nity for the eye’s neural tissues,inhibiting the oxidative phosphorylation process,affecting cellular respiration,and inhibiting ATP synthesis in mitochondria,leading to tissue toxicity and hypoxia and then degenerative changes of the cells,oligodendrocytes and astrocytes swelling myelin sheath loss,optic nerve edema and pressure on the optic nerve in the posterior sieve plate region,thus resulting in toxic optic neuropathy.Toxic optic neuropathy occurs when the optic nerve is compressed in the posterior region of the sieve plate,etc.Optic nerve atrophy often occurs after 1 to 2 months,and irreversible damage to the optic nerve and visual function can occur at a later stage.Two injury degree identification cases of visual impairment after methanol poisoning were reported.The methanol poisoning confi rmation,the objective assessment of visual impairment,as well as the causal relationship between methanol poisoning and visual impairment,were discussed and comparatively analyzed,with

关 键 词：法医临床学 甲醇中毒 视力损害 损伤程度 

分 类 号：DF795.4[医药卫生—法医学]