30例心包填塞死亡案例法医学分析

Forensic Analysis of 30 Cases of Pericardial Tamponad

目的:分析心包填塞死亡案例法医病理学特点。方法:收集30例心包填塞死亡案例的临床及法医病理学资料,记录既往病史、发病到死亡时间、临床表现、尸体解剖特点及血管心脏破裂口处病理检查结果。结果:30例心包填塞案例中病因最常见为主动脉破裂(14例),其次为心脏破裂(12例,其中冠心病致心肌梗死后心脏破裂7例、外伤性心脏破裂5例);既往病史以冠心病和高血压为主,发病到死亡时间1 min^12 d;主要有胸闷、气促、腹痛、意识模糊等临床表现;心脏破裂案例破裂口以左心室壁为主,主动脉破裂口主要位于粥样硬化斑块处,心包积液量120~650 m L。结论:主动脉破裂及心脏破裂是心包填塞最常见原因,临床表现存在重叠部分,应注意防止误诊及漏诊。

Objective： To analyze the pathological characteristics of pericardial tamponade. Methods ： Clinical and pathological data of 30 cases died of pericardial tamponade were collected. The past history, duration of onset to death, the clinical manifestation, the autopsy features and the pathological findings of the vessel or cardiac rupture were recorded. Results： Of the 30 cases of pericardial tampon- ade, the most common causes were aortic rupture （14 cases）, followed by heart rupture （12 cases, 7 cases of heart rupture after coronary heart disease, and 5 cases of traumatic heart rupture） ; The main past medical history was coronary heart disease and hypertension, duration of onset to death was 1 min - 12 d, the main clinical manifestations were chest tightness, shortness of breath, abdominal pain, confusion and so on ; The rupture of the heart was dominated by the left ventricular wall, the rupture of aorta was mainly located in atherosclerotic plaques, and the amount of pericardial effusion was 120 650 mL. Conclusion： Aortic rupture and cardiac rupture are the most common causes of pericardial tamponade, and there are overlap part of clinical manifestations between them, so we should pay more attention to prevent misdiagnosis and missed diagnosis.