限制性体位窒息死亡的法医学鉴定

Forensic Expertise of Death Caused by Restraint Positional Asphyxia

限制性体位窒息是一种特殊类型的窒息,其死亡机理、过程复杂,体表损伤轻微,尸体表现缺乏特异性,鉴定难度大,目前还没有一个客观、准确、公认的鉴定标准,通过文献复习总结有关体位性窒息的研究成果,结合窒息死亡的组织病理改变和鉴定实践,提出限制性体位窒息的检验鉴定要点,在确定有长时间限定在某一影响呼吸的体位,且自己不能解脱;有明显的窒息尸体征象;排除损伤、疾病致死;常见毒物检测阴性;膈肌Fn免疫荧光检测阳性或透射电镜检查证明有膈肌损伤的可以诊断。如果合并有损伤或疾病,还应该有肺SP-A检查阳性或HIF1-α免疫组化染色核阳性表达。某些特定部位的损伤检查有助于分析体位关系。

Restraint positional asphyxia is a special asphyxia which is difficult to determine due to the complex death mechanism and death process as well as the lack of body injuries and particular corpse indicators. So far, there is no accepted forensic in- vestigation standard. Having reviewed the researches and autopsy cases on positional asphyxia, the following forensic investiga- tion key points are drawn out： to make sure there is a position which restraints the breath for a long time and the dead couldn＇t cast off; to find asphyxia evidence in autopsy; to exclude other possible death causes such as the mechanical injury, disease and poisoning. Immuno-fluorescence positive result for FN in diaphragmatic muscle or morphologic finding for diaphragmatic muscle injury in a transmission electron microscope examination is a definite evidence for positional asphyxia. For those cases associated with other injuries or diseases, the immunohistochemieal examination positive results for SP-A in lung and HIF1-α in tissue con- tribute to define the exact death cause. And the injuries in the special body parts contribute to define there is a restraint Position.