基于肺脏病理改变进行活产鉴定的回顾性研究

A retrospective study on live birth identification according to the lung pathological examination

目的研究基于肺脏病理改变进行活产鉴定。方法回顾分析130例围产儿尸检资料。结果公安机关委托鉴定12例肺浮沉试验阳性,肺完全膨胀,肺泡扩张。11例死胎HTL阴性,肺部分膨胀7例,未膨胀4例,肺泡未扩张10例,1例肺泡扩张、羊水吸入、肺出血和炎性渗出。6例死产儿接受人工通气处置后HTL阳性,均有肺泡扩张,5例有羊水吸入,2例有肺出血和炎性渗出。18例死产儿HTL阴性,有6例肺泡扩张,均有羊水吸入,1例肺出血,2例炎性渗出。37例活产儿HTL阳性,肺不同程度膨胀,其中肺泡无明显扩张11例。46例活产儿HTL阴性,肺完全膨胀13例,12例有AV;肺部分膨胀26例,18例有AV;肺未膨胀7例,均有AV。肺泡扩张22例,12例有羊水吸入,11例有肺出血,10例有肺炎性渗出。结论人工通气可导致HTL假阳性。仅凭肺脏组织学表现无法甄别死后泵入空气。排除AV、肺部病变及尸体腐败,HTL可为判定活产提供可靠依据。

Objective To investigate whether live birth could be identified based on the lung macroscopic and microscopic findings.Methods The records of 130 perinatal autopsies were collected to perform a retrospective study.Results In the 12 perinatal autopsies performed with the behest of the public security bureau,the hydrostatic tests of lung(HTL)results were positive.The lungs of the neonates were fully inflated and the alveoli were dilated.The HTL results of all the 11 intra-uterine fetal deaths were negative.The lungs of 7 of the 11 fetuses were partial inflated,and the other 4 fetuses had non-inflated lungs.The alveoli were non-dilated in 10 of the 11 fetuses,while were dilated in the other 1 fetus with amniotic fluid aspiration,pulmonary hemorrhage and inflammatory exudation.The HTL results were positive in the 6 stillborn neonates who received artificial ventilation(AV).Alveolar dilation was observed in all these 6 stillborn neonates,and 5 of whom had amniotic fluid aspiration and 2 of whom had pulmonary hemorrhage and inflammatory exudation.Within the 18 stillborn neonates with negative result of HTL,6 neonates exhibited dilation of alveoli and amniotic fluid aspiration,1 neonate exhibited pulmonary hemorrhage,and 2 neonates exhibited inflammatory exudation.The HTL results of the 37 live births were positive.The lungs were inflated to some extent with no significant dilation of the alveoli in 11 of the 37 neonates.The result of HTL were negative for the remained 46 live births,in which 13 neonates exhibited completely lung inflation(AV were applied in 12 cases),26 neonates exhibited partial lung inflation(AV were applied in 18 cases),and 7 neonates exhibited non-inflated lungs in spite of the AV had been applied.Alveolar dilation was observed in 22 neonates,12 of whom had amniotic fluid aspiration,11 had pulmonary hemorrhage,and 10 had inflammatory exudation.Conclusion AV could lead to false positive result of HTL.The solitary microscopic findings could not provide enough information to make a differential diagnosis of postmortem pumping of air in lung.When AV,pulmonary lesions and decomposition were all excluded,HTL could be reliable evidence for identification of live birth.