呕吐物吸入致死的法医病理学鉴定

Forensic Pathological Appraisal of Death by Vomit Inhalation

目的旨在深入研究呕吐物吸入与死亡的关系,探讨认定呕吐物吸入致死的法医学鉴定要点。方法收集27例南京医科大学司法鉴定所于1999年1月1日—2019年12月31日受理的有呕吐物吸入表现的死亡案例,从一般情况、吸入原因、吸入物性质与吸入部位、死亡原因、法医学检验、基础疾病等方面进行回顾性分析。结果本组案例呕吐物吸入致死发生率男性大于女性,年龄集中于≤5岁和21~65岁。病理性因素是导致呕吐物吸入的最主要因素,其次为饮酒、生理性因素和外伤。吸入物性质和吸入深度的关系可提示是否为生前呕吐物吸入,吸入部位的深度或可帮助判断是否为呕吐物吸入致死。单因素作用下呕吐物吸入致死常见的死亡原因是吸入性窒息,多因素作用下呕吐物吸入参与致死需要关注呕吐物吸入的原因和与其他因素的联系。鉴别呕吐物吸入致死与其他原因致死伴呕吐物吸入表现的关键点在于窒息征象的严重程度、呕吐物进入呼吸道的程度和相关组织学反应。结论认定呕吐物吸入致死时,需要考虑死者的生前情况、致呕吐物吸入的因素、吸入物性质与吸入程度、法医学检验表现等,排除其他原因致死伴呕吐物吸入表现的情况,并分析呕吐物吸入在死亡中所起的作用,以进行综合评定。

Objective To study the relationship between vomitus inhalation and death in depth,and to explore the key points of forensic medicine to identify vomitus inhalation death.Methods 27 cases with the performance of vomit inhalation accepted by Forensic Expertise Institute of Nanjing Medical University from January 1,1999 to December 31,2019,were collected and analyzed retrospectively in terms of general situation,inhalation causes,nature and site of inhalation,causes of death,forensic examination and basic diseases.Results In this group,the incidence of vomitus inhalation death was higher in males than in females,and the ages were mainly distributed in less than 5 years old and 21-65 years old.Pathological factors were the most important factors,followed by alcohol,physiological factors and trauma.The relationship between the nature of inhalation and the depth of inhalation may indicate whether it is the inhalation of vomitus before death,and the depth of the inhalation site may help to judge whether it is vomitus inhalation death.Inhalation asphyxia is the common death mechanism of vomit inhalation under the action of a single factor.It is necessary to pay attention to the causes of vomit inhalation and the relationship with other factors when vomit inhalation is involved in death under multiple factors.The key points to distinguish between vomitus inhalation and other causes of death with vomitus are the severity of asphyxia,the degree of vomitus entering the respiratory tracts and the related histological reaction.Conclusion To determine vomitus inhalation death,we need to consider the pre-death situation of the dead,the factors causing vomitus inhalation,the nature and degree of the inhalation,and the results of forensic examination,to exclude other causes of death with a performance of vomitus inhalation,and analyze the role of vomitus inhalation in the death,finally make a comprehensive evaluation.