CAJ | 학술논문

目的：通过对肺动脉血栓栓塞（pulmonary thromboembolism，PTE）死亡的实际案例分析，探讨相关高危因素，并分析其与创伤及医疗因素的因果关系。方法对司法部司法鉴定科学技术研究所2000—2014年33例PTE致死案件进行回顾分析。结果33例中，男性16例，女性17例；死者死亡前多表现为不同程度呼吸困难、胸闷、晕厥症状；血栓主要分布于左、右肺动脉，栓子主要来源于下肢深静脉，左侧多见；创伤、限制体位、手术及自身血管病变为常见的高危因素；D-二聚体检测、凝血实验和CT肺动脉造影可作为PTE诊断的手段；部分案例中创伤因素及医疗因素可参与死亡原因的构成。结论 PTE猝死案件，多数存在临床症状不典型，往往合并有多种高危因素，法医学鉴定中应注重损伤或医疗因素的因果关系判断。
목적：통과대폐동맥혈전전새（pulmonary thromboembolism，PTE）사망적실제안례분석，탐토상관고위인소，병분석기여창상급의료인소적인과관계。방법대사법부사법감정과학기술연구소2000—2014년33례PTE치사안건진행회고분석。결과33례중，남성16례，녀성17례；사자사망전다표현위불동정도호흡곤난、흉민、훈궐증상；혈전주요분포우좌、우폐동맥，전자주요래원우하지심정맥，좌측다견；창상、한제체위、수술급자신혈관병변위상견적고위인소；D-이취체검측、응혈실험화CT폐동맥조영가작위PTE진단적수단；부분안례중창상인소급의료인소가삼여사망원인적구성。결론 PTE졸사안건，다수존재림상증상불전형，왕왕합병유다충고위인소，법의학감정중응주중손상혹의료인소적인과관계판단。
Objective To explore the related risk facts of pulm onary throm boem bolism (PTE ) and analyze the relation betw een PTE and the traum a or m edical behavior by investigating the cases of PTE . Methods Thirty-three cases w ere selected from Institute of Forensic Science (IFS) from 2000 to 2014. Results In 33 cases, 16 decedents w ere m ale, 17 decedents w ere fem ale;different degrees of dyspnea, chest tight-ness and syncope sym ptom s w ere the clinical m anifestation of the deceased; the throm bus w as mainly distributed in the left and right pulm onary arteries. The main source of em bolism w as the deep vein of low er lim b and the left probability w as higher. Traum a, lim ited position, operation and cardiovascular disease show ed high-risk factors of PTE; D-D im er test, hem olytic test and com puter tom ography pul-m onary angiography w ere the diagnostic tools for PTE . In som e cases, traum a and m edical m alpractice could be involved in the cause of death. Conclusion N on-typical clinical sym ptom s present in the m ost cases caused by PTE , and these cases alw ays show m any high-risk factors. The relation betw een PTE and injury or m edical behavior should be considered carefully in the forensic pathological practice.