24例长期服用精神类药物致猝死的法医学分析

Forensic Analysis of 24 Cases of Long-term Antipsychotics Use-Induced Sudden Unexpected Deaths

目的分析24例精神病患者因长期服用精神类药物猝死的法医学特征。方法收集2011—2016年精神病患者猝死的案例,通过系统的案情调查、尸体解剖及毒(药)物检验结果,对精神病患者猝死的法医学特征进行回顾性分析。结果 24例因长期服用精神类药物致猝死的精神病患者中,男女性比例为1.7∶1,平均年龄为(59.0±8.8)岁。15例患者有明确的患病年限[(14.4±8.2)年],另9例已知患病年限超过3年。62.5%患者的死亡时间是工作日白天,91.7%患者的死亡地点在家中,大多数患者死亡前有不同程度的躯体不适主诉。精神分裂症患者(20例)最常见,其次为抑郁症患者(4例)。患者均有服用精神类药物史,以氯氮平及氯丙嗪最多见。死亡原因以循环系统疾病(15例)为主,最常见的为心肌炎(11例),其次为肺炎(4例)。结论对精神病患者尤其是精神分裂症患者,需要警惕使用精神类药物引起猝死的风险。

Objective To analyze the forensic characteristics of 24 psychiatric patients who died of long-term use of psychotropic drugs.Methods Cases of sudden death of psychiatric patients from 2011 to 2016 were collected.The forensic characteristics of these sudden deaths were retrospectively analyzed by systematic investigation plus results of autopsy and toxics(drugs).Results Among the 24 psychiatric patients who died of long-term use of psychotropic substances,the ratio of male to female was 1.7∶1,and the average age was(59.0±8.8)years.Fifteen patients had clear disease durations(14.4±8.2)years,and other the nine were known to have disease durations of over 3 years.The death time of 62.5%of patients was the daytime in working days,and 91.7%of the patients died at home.Most patients complained different degrees of physical discomfort before death.Patients with schizophrenia(20 cases)were the most common,followed by depression(4 cases).All patients had the history of taking psychotropic drugs,with clozapine and chlorpromazine being the mostly detected ones.The causes of death were mainly circulatory diseases(15 cases),with the most common being myocarditis(11 cases)followed by pneumonia(4 cases).Conclusion Critical attention should be paid to the risk of antipsychotics-induced sudden unexpected deaths for psychiatric patients,particularly for those with schizophrenia.