交通事故致弥漫性轴索损伤72例法医精神病伤残鉴定案例分析

Analysis of 72 cases of forensic psychiatric disability identification for diffuse axonal injury due to traffic accident

目的探讨交通事故致弥漫性轴索损伤(diffuse axonal injury,DAI)法医精神病伤残鉴定案例的特点、对伤残等级的影响,为此类案例的鉴定提供有益线索。方法收集浙江省嘉兴市康慈医院司法鉴定所2014年1月—2015年6月因交通事故致颅脑损伤伤残鉴定案例530例,分为研究组(合并DAI的颅脑损伤)72例与对照组(未合并DAI的颅脑损伤)458例,调查2组性别、年龄、职业、受教育年限、受伤至鉴定时间间隔、伤后格拉斯哥昏迷评分(Glasgow coma scale,GCS)、伤后昏迷时间、鉴定时头颅CT报告、鉴定时脑电图报告、鉴定诊断意见、鉴定伤残等级等资料,使用t检验、χ~2检验及多元线性回归等方法进行回顾性分析。结果 2组在年龄、受教育年限、受伤至鉴定时间、鉴定时CT报告方面比较差异无统计学意义(P>0.05),在伤后格拉斯哥昏迷评分、伤后昏迷时间、鉴定时脑电图报告比较差异有统计学意义(P<0.05)。研究组伤残等级为7.92±1.39,对照组为8.72±1.51,2组比较差异有统计学意义(P<0.05)。多元线性回归分析提示研究组轻度及中度异常脑电图、昏迷时间、GCS评分是影响伤残等级的相关因素,可以解释伤残等级70.6%的变化;对照组中度异常脑电图、昏迷时间、GCS评分是影响伤残等级的相关因素,可以解释伤残等级81.6%的变化。结论合并DAI的颅脑损伤案例伤残等级更高,伤残等级与伤后GCS评分、昏迷时间及轻度和中度异常脑电图相关。提高对DAI的认识对此类案例鉴定结论的判定会产生积极影响。

Objective To explore the characters of disability determination of forensic psychiatry for diffuse axonal injury( DAI) due to traffic accident and its influence on degree of disability so as to provide better clues for such similar cases.Methods From January 2014 to June 2015,total 530 cases of disability determination for craniocerebral injury due to traffic accident were collected and divided into experimental group( combined with DAI,72 cases) and control group( not combined with DAI,458 cases). The sex,age,occupation,degree of education,time interval from injury to determination,Glasgow Coma Scale scores after injury,coma time after injury,head CT and electroencephalogram when determination,the diagnosis of determination and degree of disability were investigated. The retrospective analysis was done by t-test,χ~2-test and multi-linear regression. Results There was no statistical differences in age,degree of education,time interval from injury to determination and head CT at the determination between the two groups( P > 0. 05). There were statistical differences in GCS( Glasgow Coma Scale) scores,coma time,electroencephalogram( EEG) at determination and degree of disability( P < 0. 05). The degree of disability of the experimental group was 7. 92 ± 1. 39,and of the control group was 8. 72 ± 1. 51. There was statistical difference in degree of disability between the two groups( P < 0. 05). The mild and moderate abnormal EEG,coma time and GCS scores by multiple linear regression analysis were the relative factors for the degree of disability in the experimental group,which accounted for 70. 6% of the variety of the degree of disability. The moderate abnormal EEG,coma time and GCS scores were the relative factors for the degree of disability in control group according to multiple linear regression analysis,which accounted for 81. 6% of the variety of the degree of disability. Conclusion There are higher degree of disability in craniocerebral injury combined with DAI,which had relations to the mild and moderate abnormal EEG,coma time and GCS scores. There would be positive influences on disability determination if the DAI are better identified.