单纯外伤性蛛网膜下腔出血的法医学临床鉴定时机

Opportunity of forensic medical identification for simple traumatic subarachnoid hemorrhage

目的探讨单纯外伤性蛛网膜下腔出血(simple traumatic subarachnoid hemorrhage,STSAH)的鉴定时机和鉴定注意事项。方法对四平市公安局司法鉴定中心2014—2016年受理的51例临床诊断为STSAH的法医临床学鉴定资料(如性别、年龄、出血部位、损伤方式、治疗转归等)进行统计。结果 51例STSAH的中46例经治疗后,随着时间的延长,CT呈现规律性变化(出血部位的高密度影逐渐变窄),临床症状逐渐消失,在临床鉴定中给予认定;另5例STSAH在伤后14天后多次复查颅脑CT均无明显变化,在法医临床学鉴定中未给予认定。结论 STSAH早期评定其损伤程度需慎重,应随访CT片防止出现假阳性。

Objective To investigate the identification time and attention issue for simple traumatic subarachnoid hemorrhage （STSAH）. Methods A total of 51 cases of STSAH from Center of Forensic Science, Siping Policy Security Bureau during 2014 to 2016 were analyzed retrospectively. Statistical methods used for sex, age, bleeding site, injury style and treatment outcome in forensic medical identification. Results In 46 cases of STSAH,high-density shadow in bleeding site narrowed gradually with regular change by CT scan, meanwhile clinical features disappeared gradually after longer treatment and was given the recognition in clinical identification. In addition,5 cases of STSAH had no obvious change 14 days after the injury confirmed by repeated CT,which were not given the recognition by forensic medical identification. Conclusions Early evaluation of injury degree in STSAH cases was carefully made to ensure the reliability of forensic medical identification; meantime false positive results could be avoided by follow-up CT scan.