猝死及法医学鉴定.pptVIP

第11章 猝死及法医学鉴定 (Sudden Death)阎春霞 副教授 医学博士yanchx@mail.xjtu.edu.cn西安交通大学医学院法医系 猝死的定义 猝死的特点 猝死的主要原因 猝死常见的诱因 猝死的法医鉴定(以冠心病猝死为例) 一. 猝死的定义 1. Sudden Death 外表看似健康的人由于潜在的疾病或者功能障碍所引起的突然的意外的死亡. 二. 猝死的特点 1. 心血管系统疾病导致猝死 2. 呼吸系统疾病猝死 3.中枢神经系统疾病猝死 4.泌尿生殖系统疾病猝死 5. 内分泌系统和造血疾病猝死 6. 其它原因导致的猝死 (1) 青壮年猝死综合症 (SMDS) (2) 婴幼儿猝死综合症 (SIDS) (3) 抑制死 四.猝死常见的诱因和发生环境 五. 猝死的法医鉴定 冠状动脉严重狭窄的镜下观 毒物分析结果 The lumen is large, without any narrowing by atheromatous plaque. The muscular arterial wall is of normal proportion. 正常的冠状动脉 There is a severe degree of narrowing in this coronary artery. It is complex in that there is a large area of calcification on the lower right, which appears bluish on this HE stain. Complex atheroma have calcification, thrombosis, or hemorrhage. This high magnification of the atheroma shows numerous foam cells and an occasional cholesterol cleft. A few dark blue inflammatory cells are scattered within the atheroma. 粥样斑块的高倍镜下观 In the first day myocardial infarction is contraction band necrosis. The myocardial fibers are beginning to lose cross striations and the nuclei are not clearly visible in most of the cells seen here. 心肌梗死显微病理观 (1d) 心肌梗死显微病理观 (3-4d) There is an extensive acute inflammatory cell infiltrate and the myocardial fibers are so necrotic that the outlines of them are only barely visible. Below these fibers are many macrophages along with numerous capillaries and little collagenization 心肌梗死显微病理观 (7-14d) 陈旧性心肌梗死灶(30d) The pale white collagen within the interstitium between myocardial fibers. 脾脏：重245g，大小为13.5×9×4cm。包膜皱缩，呈灰蓝色，切面呈暗红色。光镜下：脾组织自溶，脾内淋巴小结细胞密度降低；脾中央动脉管壁增厚、红染，管腔狭窄。 病理诊断：脾中央动脉硬化。 肝脏和胆囊：肝脏重1900g，右叶大小为19×19.5×7cm，左叶大小为14.5×9cm。表面光滑，质实，切面呈暗红色，未见其它异常。胆囊原位，胆囊内未见结石等异物。光镜下：肝小叶结构正常，多数肝细胞内可见大小不一的空泡；中央静脉和肝窦扩张、淤血；汇管区有少量淋巴和单核症细胞浸润。 病理诊断：肝细胞脂肪变性。 * * 概 述 2. 猝死在世界各地的发生率 突然性 (Rapidly) (1) The time from the symptom to death is within 24 hours. (WHO) (2) Instantaneous Death. 2. 意