59例过敏反应死亡案例分析

Analysis of 59 Anaphylactic Death Cases

目的通过对过敏反应死亡案例分析，探索过敏反应死亡法医学鉴定标准，为法医学鉴定提供依据。方法收集上海地区1998-2008年59例诊断为过敏反应死亡案例，对案例中死者的临床病史、过敏反应临床表现、尸体检验结果等进行分析。结果59例过敏反应死亡案例中有58例死于药物过敏（其中77．6％为抗生素），正规医院与非法行医各占37．3％和61．O％。过敏症状主要为呼吸困难、颜面发绀等，自接触过敏原至死亡从1min到3d，血清总IgE浓度50～576．92IU／mL，临床表现和病理解剖检查结果也有明显改变。结论在排除其他死因基础上，综合分析案情、病史、临床表现、尸检结果，可以得出过敏反应死亡的鉴定结论。其中案情调查（包括过临床病史、过敏原接触史、临床表现）对诊断过敏反应死亡具有关键性作用。

Objective To analyze the cases of anaphylactic death cases and explore the standards of judi- cial expertise of anaphylactic death for providing evidence for judicial expertise. Methods Fifty-nine cas- es death due to allergic reaction in Shanghai were collected. And details of medical history, clinical manifestation of anaphylactic reaction and postmortem examination findings were reviewed for all cases. Results In the 59 cases, there were 58 cases died from drug allergy, including 77.6% of them were an- tibiotics. The rates of treating in standard hospital and illegal clinic were 37.3% and 61.0%, respectively. The allergic symptoms were dyspnea and facial cyanosis. The time from contacting allergens to death ranged from 1 min to 3 d. The concentration of total serum IgE ranged from 50 to 576.92 IU/mL. The results of clinical manifestation and pathological anatomy had obviously changes. Conclusion Based on the exclusion of all other cause of death and synthetically analysis of details of cases, medical history, clinical manifestation and anatomy, the conclusion of anaphylactic death can reached. The details of cas- es including clinical history, exposure to allergens, and clinical manifestation play an important role in diagnosis of anaphylactic death.