28例心脏挫伤的法医病理学观察

A study of pathological morphology on cardiac contusion with 28 autopsy cases

目的观察心脏挫伤的形态特点和分布规律,探讨心脏挫伤的分类和分级方法及与成伤机制的关系。方法用改良的心脏挫伤检查法对28例人体心脏挫伤标本进行肉眼和光镜观察并测量挫伤灶的大小。结果肉眼观察,心脏挫伤灶切面一般呈带状、楔形、类圆形或条纹状;观察连续切面,可见其相应的三维形态大致呈类圆盘状、类圆锥体、类球体或线状。显微镜下,挫伤区主要表现为轻重不等的出血、心肌纤维断裂和心肌细胞变性坏死,按出血和变性坏死的程度可将心脏挫伤分为出血型、坏死型和出血坏死型。心脏挫伤见于心脏各部位和心壁各层,不同部位的挫伤发生率和类型差异大。以挫伤灶的体积、数量和部位为依据,将心脏挫伤的程度分为4级。结论心脏挫伤的形态多样、分布广泛、各部位的挫伤类型和发生率差异大。

Objective By observing the morphological characteristic and distribution regularity, study the classification and the mechanism of injury about cardiac contusion. Methods Data were collected on 28 autopsy cases of heart with blunt injuries. Macroscopic and microscopic pathological changes were observed, the sizes of contusion were measured with the method improved by author. Results The macroscopic morphdogies of contusion were zonal, wedge-shaped, circular and stripe like in section and the 3-dimensional morphologies were discal, coniform, spherical and wirelike. The main microscopic cal changes were fracture, degeneration, necrosis of myocardial cells and hemorrhage. Cardiac contusion could be divided into hemorrhage type, necrosis type, and hemorrhagic necrosis type by the degree of microscopic pathological changes. Cardiac contusion could be found in heart everywhere, but the incidence rates and type of contusion were obviously different on different parts. It may be classified into four grades according to the size, number and site of contusion. Conclusions The results indicated that morphologically, distributed extensively, and had different incidence rate on different sites.