心脏震荡的法医病理学鉴定及鉴别
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摘要
心脏震荡是指既往无心脏疾病的健康人心前区突然遭受钝性外力后,突发的心律失常所致的急性死亡。作为心脏暴力性损伤的种类之一,心脏震荡因其较为罕见,且所受外力较轻微、死亡急骤,常常引发纠纷。本文就心脏震荡的流行病学、发病机制及法医学鉴定要点进行综述,主要探讨心脏震荡与心肌挫伤、心脏性猝死及抑制死的法医病理学鉴定及鉴别要点,以期为广大法医病理学工作者对于此类死亡原因的鉴别提供帮助。
Commotio cordis(CC) is the acute death caused by the cardiac rhythm disorder after a sudden blunt external force to the precordium of a healthy person without previous heart disease. As one type of violent heart damage, CC is rare with relatively small external force and sudden death, therefore causing disputes. This paper reviews the epidemiology, mechanisms and the key points in forensic identification of CC, discusses the identification and antidiastole of CC, myocardial contusion, sudden cardiac death and death from inhibition, and provides assistance to forensic pathologists to identify such causes of death.
Commotio cordis(CC) is the acute death caused by the cardiac rhythm disorder after a sudden blunt external force to the precordium of a healthy person without previous heart disease. As one type of violent heart damage, CC is rare with relatively small external force and sudden death, therefore causing disputes. This paper reviews the epidemiology, mechanisms and the key points in forensic identification of CC, discusses the identification and antidiastole of CC, myocardial contusion, sudden cardiac death and death from inhibition, and provides assistance to forensic pathologists to identify such causes of death.
引文
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[2]陈曦,李峰.心脏震荡伤致死尸检资料分析[J].吉林医药学院学报,2016,37(5):359-360.
[3] MU J, ZHANG J, LIU L, et al. Homicidal commotio cordis caused by domestic violence:a report of two cases[J]. Med Sci Law,2016,56(2):138-141.
[4] OTA K, BRATINCSAK A. Atrial fibrillation induced by commotio cordis secondary to a blunt chest trauma in a teenage boy[J]. Pediatrics,2015,135(1):e199-e201.
[5] ZHENG N, LIANG M, LIU Y, et al. Commotio cordis--a report of two similar cases[J]. J Forensic Sci,2013,58(1):245-247.
[6] MU J, CHEN Z, CHEN X, et al. Commotio cordis caused by violence in China:epidemiological characteristics detected at the Tongji Forensic Medical Center[J]. Medicine(Baltimore),2015,94(51):e2315.
[7] HIQUET J, TOVAGLIARO F, GROMB-MON NOYEUR S. A fatal case of commotio cordis caused by an accidental fall on the beach[J]. J Forensic Leg Med,2014,21:22-23.
[8]穆娇,徐伦武,刘龙清,等.心脏震荡研究现状及法医学鉴定[J].中国法医学杂志,2015,30(5):482-484.
[9]官大威,贾静涛,朱宝利,等.实验性心脏震荡的法医病理学研究[J].法律与医学杂志,1996,3(3):105-106,144.
[10] JONES L A, SULLIVAN R W. Ventricular tachycardia:a rare commotio cordis presentation[J]. Pediatr Emerg Care,2017,33(2):109-111.
[11] LINK M S. Pathophysiology, prevention, and treatment of commotio cordis[J]. Curr Cardiol Rep,2014,16(6):495.
[12]谢锋.心肌挫伤研究进展[J].中华实用诊断与治疗杂志,2016,30(3):212-214.
[13]单亚明,曹明,王广川,等. 28例心脏挫伤的法医病理学观察[J].中国法医学杂志,2008,23(4):260-262.
[14]刘昶忠,陈立军.胸外按压致肋骨骨折1例[J].法医学杂志,2016,32(1):79.
[15]高卫民,毛瑞明,杜中波,等.脑钠尿肽作为心功能评价指标在法医学上的应用价值[J].法医学杂志,2011,27(5):369-371,375.
[16]官大威,李德祥,贾静涛.心脏震荡与心肌挫伤(综述)[J].法医学杂志,1993,9(3):126-129.
[17]亢登峰,李晓英,王英元. 1 294例心源性猝死的回顾性分析[J].中西医结合心脑血管病杂志,2007,5(1):63-65.
[18]刘奇,王杰,于燕妮,等. 300例心源性猝死案例的法医学鉴定分析[J].中国法医学杂志,2015,30(3):283-285,288.
[19] CAO Z, ZHANG Y, MI L, et al. The Expression of B-type natriuretic peptide after CaCl2-induced arrhythmias in rats[J]. Am J Forensic Med Pathol,2016,37(3):133-140.
[20]张圆,张赫娱,李振强,等.致死性心律失常的法医学研究进展[J].中国法医学杂志,2014,29(4):329-332.
[21] ZHU B L, ISHIKAWA T, MICHIUE T, et al. Postmortem cardiac troponin I and creatine kinase MB levels in the blood and pericardial fluid as markers of myocardial damage in medicolegal autopsy[J]. Leg Med(Tokyo),2007,9(5):241-250.
[22]赵子琴.法医病理学[M].4版.北京:人民卫生出版社,2009:12.
[23]王立广,于波.胸部遭受外力作用致抑制死1例[J].中国司法鉴定,2009(5):S10,S12.
[2]陈曦,李峰.心脏震荡伤致死尸检资料分析[J].吉林医药学院学报,2016,37(5):359-360.
[3] MU J, ZHANG J, LIU L, et al. Homicidal commotio cordis caused by domestic violence:a report of two cases[J]. Med Sci Law,2016,56(2):138-141.
[4] OTA K, BRATINCSAK A. Atrial fibrillation induced by commotio cordis secondary to a blunt chest trauma in a teenage boy[J]. Pediatrics,2015,135(1):e199-e201.
[5] ZHENG N, LIANG M, LIU Y, et al. Commotio cordis--a report of two similar cases[J]. J Forensic Sci,2013,58(1):245-247.
[6] MU J, CHEN Z, CHEN X, et al. Commotio cordis caused by violence in China:epidemiological characteristics detected at the Tongji Forensic Medical Center[J]. Medicine(Baltimore),2015,94(51):e2315.
[7] HIQUET J, TOVAGLIARO F, GROMB-MON NOYEUR S. A fatal case of commotio cordis caused by an accidental fall on the beach[J]. J Forensic Leg Med,2014,21:22-23.
[8]穆娇,徐伦武,刘龙清,等.心脏震荡研究现状及法医学鉴定[J].中国法医学杂志,2015,30(5):482-484.
[9]官大威,贾静涛,朱宝利,等.实验性心脏震荡的法医病理学研究[J].法律与医学杂志,1996,3(3):105-106,144.
[10] JONES L A, SULLIVAN R W. Ventricular tachycardia:a rare commotio cordis presentation[J]. Pediatr Emerg Care,2017,33(2):109-111.
[11] LINK M S. Pathophysiology, prevention, and treatment of commotio cordis[J]. Curr Cardiol Rep,2014,16(6):495.
[12]谢锋.心肌挫伤研究进展[J].中华实用诊断与治疗杂志,2016,30(3):212-214.
[13]单亚明,曹明,王广川,等. 28例心脏挫伤的法医病理学观察[J].中国法医学杂志,2008,23(4):260-262.
[14]刘昶忠,陈立军.胸外按压致肋骨骨折1例[J].法医学杂志,2016,32(1):79.
[15]高卫民,毛瑞明,杜中波,等.脑钠尿肽作为心功能评价指标在法医学上的应用价值[J].法医学杂志,2011,27(5):369-371,375.
[16]官大威,李德祥,贾静涛.心脏震荡与心肌挫伤(综述)[J].法医学杂志,1993,9(3):126-129.
[17]亢登峰,李晓英,王英元. 1 294例心源性猝死的回顾性分析[J].中西医结合心脑血管病杂志,2007,5(1):63-65.
[18]刘奇,王杰,于燕妮,等. 300例心源性猝死案例的法医学鉴定分析[J].中国法医学杂志,2015,30(3):283-285,288.
[19] CAO Z, ZHANG Y, MI L, et al. The Expression of B-type natriuretic peptide after CaCl2-induced arrhythmias in rats[J]. Am J Forensic Med Pathol,2016,37(3):133-140.
[20]张圆,张赫娱,李振强,等.致死性心律失常的法医学研究进展[J].中国法医学杂志,2014,29(4):329-332.
[21] ZHU B L, ISHIKAWA T, MICHIUE T, et al. Postmortem cardiac troponin I and creatine kinase MB levels in the blood and pericardial fluid as markers of myocardial damage in medicolegal autopsy[J]. Leg Med(Tokyo),2007,9(5):241-250.
[22]赵子琴.法医病理学[M].4版.北京:人民卫生出版社,2009:12.
[23]王立广,于波.胸部遭受外力作用致抑制死1例[J].中国司法鉴定,2009(5):S10,S12.