CAJ | 학술논문

目的探讨急性中毒致死的病理学诊断依据.方法收集2001年10月至2012年6月受理的28例急性中毒致死尸检案例,其中10例有毒气体、7例农药、6例毒品、3例酒精和2例药物.采用大体和HE镜下观察.结果 28例急性中毒致死尸检中22例有肉眼改变,其中7例一氧化碳中毒者尸斑、肌肉、内脏器官和血液呈樱桃红色,11例胃黏膜点片状出血和8例心外膜点状出血；光镜下有9例心肌间质出血,18例肺出血,12例支气管痉挛,4例脑出血,11例肝细胞坏死,7例肾小管坏死和11例胃黏膜出血.6例口服农药中毒者除胃黏膜出血外,其中有3例胃内容物性状改变和3例胃内逸出农药气味；光镜下均见胃壁急性炎伴坏死.吸毒者常患有慢性肝病、心肌脂肪浸润伴心肌萎缩、间质性肺疾病、肺异物肉芽肿等多个器官的慢性病变.结论病理学检查有助于某些急性中毒致死的诊断,并可为急性中毒治疗研究提供形态学基础.
목적 탐토급성중독치사적병이학진단의거.방법 수집2001년10월지2012년6월수리적28례급성중독치사시검안례,기중10례유독기체、7례농약、6례독품、3례주정화2례약물.채용대체화HE경하관찰.결과 28례급성중독치사시검중22례유육안개변,기중7례일양화탄중독자시반、기육、내장기관화혈액정앵도홍색,11례위점막점편상출혈화8례심외막점상출혈；광경하유9례심기간질출혈,18례폐출혈,12례지기관경련,4례뇌출혈,11례간세포배사,7례신소관배사화11례위점막출혈.6례구복농약중독자제위점막출혈외,기중유3례위내용물성상개변화3례위내일출농약기미；광경하균견위벽급성염반배사.흡독자상환유만성간병、심기지방침윤반심기위축、간질성폐질병、폐이물육아종등다개기관적만성병변.결론 병이학검사유조우모사급성중독치사적진단,병가위급성중독치료연구제공형태학기출.
Objective To investigate the value of pathological examination in the diag-nosis of lethal cases due to acute poisoning.Methods The macroscopic and microscopic find-ings in 28 autopsy cases (10 cases of toxic gas,7 cases of pesticide,6 cases of drug,3 cases of alcohol and 2 cases of chinese herbal medicine) died of acute poisoning during the period from October,2001 to June,2012 were retrospectively reviewed.Results Gross Changes were found on gross examination in 22 of the 28 cases studied.Of them,7 cases died of acute carbon mono-xide poisoning had showed cherry red of Shiban,muscle,visceral organs and blood.In addition,11 and 8 cases had been found gastric mucosa hemorrhage and epicardium petechial hemorrhage respectively.Histologically,myocardial interstitial hemorrhage was observed in 9 cases,pulmonary hemorrhage in 18 cases,bronchospasm in 12 cases,cerebral hemorrhage in 4 cases,hepato-cyte necrosis in 11 cases,renal tubular necrosis in 7 cases and gastric mucosa hemorrhage in 11 cases.In 6 cases of oral pesticides poisoning,besides they had all gastric mucosa hemorrhage,the change of character of gastric contents was found in 3 cases and pesticide odor from stomach in 3 cases.In addition,acute inflammatory and necrosis of gastric wall in 6 cases of oral pesticides poisoning were observed under the light microscope.Drug addicts often suffered from chronic lesions in multiple organs,such as chronic liver disease,fatty infiltration of the myocardium with myocardial atrophy,interstitial lung disease and pulmonary foreign body granuloma.Conclusions Pathology examination is helpful in the diagnosis of some lethal cases due to acute ooisoning,and it can provide pathological basis to study on treatment of acute poisoning.