云南省44例主动脉夹层破裂死亡法医学分析

Forensic analysis of 44 cases caused death by aortic dissection rupture in Yunnan province

目的对云南省44例主动脉夹层破裂死亡的案例进行回顾性分析,为此类案件的法医学鉴定提供一定参考。方法收集2002~2017年昆明医科大学司法鉴定中心受理的44例主动脉夹层破裂死亡案例,对其一般情况、临床分期、临床表现、危险因素、病理分型、内外膜破裂情况、直接死因等进行统计分析。结果主动脉夹层高发于在40~49岁,男性多于女性,大多数为急性主动脉夹层。冬季死亡数最高,春季死亡数最低;疼痛为最常见首发症状,动脉粥样硬化是重要危险因素;A型主动脉夹层占比高于B型主动脉夹层,破口主要发生在升主动脉,其形态多为横行;心脏压塞是主要死因。结论主动脉夹层破裂前多有明确首发症状,可合并多种高危因素,注重与损伤的鉴别以及医疗因素的因果关系判断,对法医学鉴定具有较大意义。

Objective Retrospectively analysis on death cases related with aortic dissection provides support for further forensic investigation on such cases. Methods 44 Cases on aortic dissection are collected from the Forensic Medical Center in Kunming Medical University from 2002to2017.Statistic anaylisis was applied to each case＇s general information,clinical stage,clinical manifestation,risk factors,pathological type,rupture state,and direct case of death. Results The results showed that aortic dissection occurs moslty in middle age male who ranges from 40 to 49 years old. Most cases were aute aortic dissection, and the death rate was the highest in winter and the lowest in spring. Furthermore, pain is shown to be the most common symptom. Atherosclerosis is a critical factor that contributes to the occurance of aortic dissection. In general, type A aortic dissection occurs more frequently than type B. The rupture, located in ascending aorta, often is in a transverse shape. Cardiac tamponade is the primary cause of death.Conclusion Definite initial symptoms arises before aortic dissection rupture and always show many high-risk factors. It is beneficial to forensic identification of the relation between aortic dissection and injury or medical behavior should be considered carefully.