【摘要】 目的 探讨颅脑损伤(BI)死亡的法医病理学特点,以及继发性脑干损伤、并发症的发生与死亡之间的因果关系。方法 从性别、年龄、致伤方式、损伤类型、生存时间、死亡原因等方面,对四川大学华西法医学鉴定中心1998年1月-2008年12月127例BI死亡尸检案例进行回顾性统计研究分析。结果 127例法医病理学检案中,原发性BI死亡51例(402%),继发性脑干损伤死亡61例(480%),并发症死亡15例(118%),其中伤后12 h内死亡者直接死因均为严重原发性脑损伤,存活12 h～1周者直接死因以继发性脑干损伤居多,生存时间超过1周者约半数死于并发症。结论 在BI案例的死亡原因确定时,应在全面系统的病理学检验基础上,结合案情及临床资料进行综合分析。【Abstract】 Objective To explore the characteristics of forensic pathology in traumatic brain injury and the relationships between secondary brainstem damage, complications and the causes of death. Methods 127 cases were reviewed from gender, age, manner of injury, survival time and the direct causes of death from January 1998 to December 2008. Results Of the 127 cases, the key direct cause of death was secondary brainstem damage, followed by severe primarily brain injury and complications. For those who died within 12 hours after injury, the direct cause was severe primarily brain injury; for those who survived between 12 hours to one week, secondary brainstem damage was in the majority of the causes and for those who survive more than one week time, complication was an important cause. Conclusion In the cases of traumatic brain injury, we should take comprehensive and systematic examination of forensic pathology, and refer to clinical data at the same time to determine the direct cause of death.
Objective To analyze death causes and relevant factors in victims of Wenchuan earthquake．Methods Medical records of 27 dead patients admitted to W est China Hospital during the first 30 days after Wenchuan earthquake were analyzed retrospectively．Patient census data，diagnoses，dispositions，and prognoses were collected． Results A total of 2702 patients with earthquake related injuries were admitted to West China Hospital．The overall mortality rate was 1％(27／2702 patients)．The death were associated with age≥70．severe cerebral injuries and severe underlying illness．Mortality rate was highest in aged patients with comorbidities．Conclusions Insufficient pre-hospital treatment and inappropriate transfer procedure may contribute to the early death．Complicated with comorbidities is the leading cause of late death．Earlier involvement of intensivist in medical intervention in such a disaster is demanded．
Objective To retrospectively analyze the characteristics and death causes among the Wenchuan earthquake victims in The Third People’s Hospital of Chengdu so as to provide information for reducing mortality in future earthquake disasters. Methods The analysis was based on the data provided by the Department of Information, the Medical Record Library, and the Emergency Room of the hospital through July 12. Microsoft EXCEL was used for data input and SPSS 13.0 was used for statistical analyses. Results Through July 12, 9 (1.57%) out of the 575 wounded patients died, comprising 3 males and 6 females. Of those, 5 died in the outpatient department. The death causes were all related to severe cerebral injuries. The other 4 died in the inpatient department and the death causes were related to severe underlying illnesses and infection. Conclusion Screening and early treatment for cerebral injuries is very important in the period directly following the earthquake. Later, more attention should be paid to the treatment of underlying illnesses as well as the prevention and control of infection.
Objective To explore the risk factors of premature infants death. Methods The medical records of hospitalized premature infants admitted to West China Second University Hospital of Sichuan University between January 2015 and December 2022 were collected. Premature infants were divided into the death group and the non-death group (control group) based on discharge diagnosis of death. Parturient and premature infants related information were collected, and the disease classification and diagnosis of premature infants were analyzed. Results A total of 13 739 premature infants were included, with 53 deaths and a mortality rate of 3.85‰ (53/13 739). The ages of death were 1-49 days, and the median age of death was (9.68±9.35) days. According to the matching method, 212 premature infants were ultimately included. Among them, there were 53 premature infants in the death group and 159 premature infants in the control group. Compared with the control group, premature infants in the death group had lower gestational age, birth weight, lower 1-minute Apgar scores, lower 5-minute Apgar scores and shorter hospital stay (P<0.05), and received more delivery interventions (P<0.05). There was no statistically significant difference in other indicators between the two groups of premature infants (P>0.05). A total of 212 parturient were included. Among them, there were 53 parturients in the death group and 159 parturients in the control group. The use rate of prenatal corticosteroids in the control group was higher than that in the death group (55.35% vs. 54.72%). There was no statistically significant difference in other related factors between the two groups of parturient (P>0.05). The results of logistic regression analysis showed that longer hospital stay [odds ratio (OR)=0.891, 95% confidence interval (CI) (0.842, 0.943), P<0.001], prenatal use of corticosteroids [OR=0.255, 95%CI (0.104, 0.628), P=0.003] reduced the risk of premature infant death. However, tracheal intubation [OR=10.738, 95%CI (2.893, 39.833), P<0.001] increased the risk of premature infant death. Conclusions Clinicians should pay attention to prenatal examination of newborns and pay attention to evaluation of newborn status. Obstetricians and neonatologists should make joint plans for women with high risk factors for preterm delivery. During the hospitalization, after the diagnosis is clear, standardized treatment should be carried out in strict accordance with the guidelines for systemic diseases and expert consensus.
【摘要】 目的 分析心脏瓣膜置换术后死亡案例的法医病理学特点，探讨有关瓣膜置换术后死亡案例的法医病理学鉴定思路及原则。 方法 从手术方式、术前心脏状况及术中所见、法医病理检验所见、死亡时间、死亡原因等方面，对2008年1月-2010年2月4例心脏瓣膜置换术后死亡案例进行综合研究分析。 结果 4例均患有风湿性心脏病，且术前心功能较差；3例二尖瓣瓣膜置换术，3例主动脉瓣瓣膜置换术，2例三尖瓣成形术；二尖瓣瓣膜置换术1例平行房间沟的左房纵行切口，1例右心房-房间隔切口，1例右心房-房间隔-左房联合切口；主动脉瓣瓣膜置换术均行升主动脉根部斜形切口或S状切口；死亡时间为1例术中，1例术后30 min，1例术后2 d，1例术后8 d；死亡原因为1例心肌炎，1例传导系统出血，2例失血性休克；1例术前有潜在感染灶。 结论 对有关心脏瓣膜置换术后死亡案例的法医病理学鉴定时，应在了解患者瓣膜置换术前心脏情况以及手术方式、手术路径和缝合方法的基础上，结合法医病理组织学检查进行综合分析。【Abstract】 Objective To analyze the forensic pathological characteristics of those who died after cardiac valve replacement and explore the mentality and principle of documentary evidence of medicolegal expertise. Methods Four death cases after cardiac valve replacement between January 2008 and February 2010 were comprehensively analyzed from various aspects of surgery style, preoperational heart condition, peri-operational observations, results of forensic pathological tests, time of death, and causes of death. Results All cases were rheumatic heart disease and the preoperational heart function was poor. Of the four cases, three had mitral valve replacement (MVR), three had aortic valve replacement (AVR) and two had tricuspid valvuloplasty. Of the three MVR cases, cutting on the left atrium paralleling the interatrial groove was performed in one case, cutting through right atrium and interauricular septum was performed in one case, and cutting left atrium and right atrium through interauricular septum was performed in another case. For all the three AVR cases, cutting on the root of aorta with the shape of diagonal or ’S’ was carried out. One patient died during operation, one died thirty minutes after operation, one died two days after operation and one died eight days after operation. Among them, one died of myocarditis, one died of hemorrhage in the conducting system and two died of hemorrhagic shock. Besides, one patient had potential bacterial infection before surgery. Conclusion For patients who died after cardiac valve replacement, we should acquaintance ourselves with the preoperational heart condition, surgery style, surgical approach and the methods of stitch to make a comprehensive analysis with forensic pathology examination.
【摘要】 目的 探讨新生儿死亡医疗纠纷中临床及法医病理学特点,启示儿科医护人员在防范此类医疗纠纷时应注意的相关问题。方法 对四川大学华西基础医学与法医学院法医病理教研室1998年1月—2007年12月的60例新生儿死亡尸检案例进行回顾性统计分析。结果 60例中除3例非正常死亡外,57例为自然性疾病死亡。其中出生后24 h死亡32例(56.1%),死亡男婴40例(70.2%)。死亡原因主要为胎粪吸入综合征、肺透明膜病、肺出血等窒息性疾病(49.1%)。其中医疗过失性纠纷21例(36.8%),医疗过失的原因主要为观察不仔细、处理不及时、误诊漏诊、产前检查或助产处理不当、告知不足等。涉及纠纷的医院以市级医院居多(58.7%)。结论 医护人员应严格遵守诊疗常规和操作规范,对新生儿加强监护,及时抢救,同时应积极与家属沟通,以减少医疗纠纷的发生。
目的 分析主动脉夹层的临床及病理特点。 方法 回顾性分析1998年1月－2011年10月26例主动脉夹层致死的临床及法医尸检病理资料，对其发病、死亡经过、诊断、死因进行总结。 结果 26例主动脉夹层平均发病年龄为39.2岁，男女比例为3.3︰1；26例中6例无临床诊断，17例误诊，3例疑似诊断。26例主动脉夹层中，夹层破裂致心包填塞死亡20例，夹层破裂致失血性休克死亡5例，主动脉夹层未破裂1例系心衰致死；26例按DeBakey分类标准9例为Ⅰ型，14例为Ⅱ型，3例为Ⅲ型。 结论 临床应警惕主动脉夹层的特殊临床表现并采取必要的辅助检查，有助于主动脉夹层的诊治和减少医疗纠纷的发生。
ObjectiveTo analyze the cause of death in low-risk cardiac surgery patients during postoperative period and discuss the prevention and treatment methods to increase the survival rate.MethodsWe retrospectively analyzed the clinical data of 132 patients dead after cardiac surgery from January 2014 to December 2018, among whom 35 patients had a EuroSCORE Ⅱ score <4% (low-risk cardiac surgery patients), including 20 males and 15 females aged 62.7±13.4 years. The cause of death in these low-risk patients was analyzed.ResultsThe main causes of death were cardiogenic and brain-derived causes (60.0%), and infections and ogran failure (45.7%). Pulmonary infection and low cardiac output after surgery were the main causes of death. Cerebral infarction, malignant arrhythmia and multiple organ failure were the common causes of death. There were 4 deaths (11.4%) caused by accidents, including gastrointestinal bleeding caused by esophageal ultrasound probe, cough and asphyxia caused by drinking water, postoperative paralytic ileus and multiple perioperative allergic reactions caused by allergic constitution.ConclusionPostoperative treatment and prevention for low-risk cardiac surgery patients should be focused on postoperative infection, and cardiac and brain function protection. Changes in various organ functions need to be closely monitored for preventing organ failure, accidents should be strictly controlled, and more details of intraoperative and postoperative treatment still need to be further improved.