[1]王殿深,张付,孟运乐,等.钝性暴力、心肺复苏、急性心梗致心脏破裂及主动脉夹层破裂致心包填塞法医病理形态学特点[J].南方医科大学学报,2018,(12):1514.[doi:10.12122/j.issn.1673-4254.2018.12.19]
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钝性暴力、心肺复苏、急性心梗致心脏破裂及主动脉夹层破裂致心包填塞法医病理形态学特点()
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《南方医科大学学报》[ISSN:1673-4254/CN:44-1627/R]

卷:
期数:
2018年12期
页码:
1514
栏目:
出版日期:
2018-12-31

文章信息/Info

Title:
Morphological analysis of cardiac rupture due to blunt injury, cardiopulmonary resuscitation and myocardial infarction in forensic pathology
作者:
王殿深张付孟运乐余彦耿周恺孙乐平缪麒李冬日
关键词:
钝性暴力心肺复苏心脏破裂法医病理学司法鉴定
Keywords:
blunt violence cardiopulmonary resuscitation myocardial infarction forensic pathology judicial expertise
DOI:
10.12122/j.issn.1673-4254.2018.12.19
摘要:
目的探讨钝性暴力、急性心梗及心肺复苏致心脏破裂法医病理形态学特点,为法医病理鉴别诊断提供依据。方法本中 心自2013~2017年法医病理解剖心脏破裂案例共44例,包括心包完整的钝性暴力致心脏破裂11例、心梗致心脏破裂9例、心肺 复苏致心脏破裂4例及主动脉夹层破裂致心包填塞20例,分别对心脏破裂部位的大体和组织病理学特点及心包积液特点进行 比较分析。结果钝性暴力致心脏破裂形态多样,部位不确定,可有多处破裂,大多伴有肋骨或胸骨骨折,心包积液量可多可少, 镜下见出血、心肌收缩带坏死等病理学改变。心肺复苏所致心脏破裂部位均位于右心室前壁靠近心尖处,略呈斜行,伴有肋骨 骨折或胸骨骨折,心包积血量少且没有凝血块,镜下仅见少许出血。心梗致心脏破裂心包积血量多并伴有凝血块,与心肺复苏 相比有显著差异(P<0.05),心脏破裂部位均位于左室壁,镜下可见心肌细胞坏死、炎细胞浸润及附壁血栓形成。主动脉夹层破 裂致心包填塞心包积血量多并伴有凝血块,显著高于钝性暴力、心梗及心肺复苏(P<0.05)。结论心脏破裂处的出血、炎细胞浸 润、附壁血栓形成等及心包积血中有凝血块是生前损伤的依据。
Abstract:
Objective To analyze the morphological features and forensic pathological characteristics of cardiac ruptures of different causes for their differential diagnosis. Methods We analyzed the data of 44 autopsy cases of cardiac rupture from 2014 to 2017 in our institute, including 11 cases caused by blunt violence with intact pericardium, 4 caused by cardiopulmonary resuscitation (CPR), 9 by myocardial infarction, and 20 by aorta dissection rupture. The gross features and histopathological characteristics of cardiac rupture and pericardial effusion were analyzed and compared. Results Cardiac ruptures caused by blunt violence varied in both morphology and locations, and multiple ruptures could be found, often accompanied with rib or sternum fractures; the volume of pericardial effusion was variable in a wide range; microscopically, hemorrhage and contraction band necrosis could be observed in the cardiac tissue surrounding the rupture. Cardiac ruptures caused by CPR occurred typically near the apex of the right ventricular anterior wall, and the laceration was often parallel to the interventricular septum with frequent rib and sternum fractures; the volume of pericardial blood was small without blood clots; microscopic examination only revealed a few hemorrhages around the ruptured cardiac muscular fibers. Cardiac ruptures due to myocardial infarction caused massive pericardial blood with blood clots, and the blood volume was significantly greater than that found in cases of CPR-induced cardiac rupture (P<0.05); lacerations were confined in the left ventricular anterior wall, and the microscopic findings included myocardial necrosis, inflammatory cell infiltration, and mural thrombus. Cardiac tamponade resulting from aorta dissection rupture was featured by massive pericardial blood with blood clots, and the blood volume was much greater than that in cases of cardiac ruptures caused by blunt violence, myocardial infarction and CPR (P<0.05). Conclusion Hemorrhage, inflammatory cell infiltration, and lateral thrombi around the cardiac rupture, along with pericardial blood clots, are all evidences of antemortem injuries.

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[1]何青春,刘婷,周利平,等.轻中度亚低温对大鼠心肺复苏后脑细胞caspase-3、Bcl-2 和Bax蛋白表达的影响[J].南方医科大学学报,2013,(10):1489.

更新日期/Last Update: 1900-01-01