【摘要】 目的 分析心臟瓣膜置換術(shù)后死亡案例的法醫(yī)病理學(xué)特點(diǎn)，探討有關(guān)瓣膜置換術(shù)后死亡案例的法醫(yī)病理學(xué)鑒定思路及原則。 方法 從手術(shù)方式、術(shù)前心臟狀況及術(shù)中所見(jiàn)、法醫(yī)病理檢驗(yàn)所見(jiàn)、死亡時(shí)間、死亡原因等方面，對(duì)2008年1月-2010年2月4例心臟瓣膜置換術(shù)后死亡案例進(jìn)行綜合研究分析。 結(jié)果 4例均患有風(fēng)濕性心臟病，且術(shù)前心功能較差；3例二尖瓣瓣膜置換術(shù)，3例主動(dòng)脈瓣瓣膜置換術(shù)，2例三尖瓣成形術(shù)；二尖瓣瓣膜置換術(shù)1例平行房間溝的左房縱行切口，1例右心房-房間隔切口，1例右心房-房間隔-左房聯(lián)合切口；主動(dòng)脈瓣瓣膜置換術(shù)均行升主動(dòng)脈根部斜形切口或S狀切口；死亡時(shí)間為1例術(shù)中，1例術(shù)后30 min，1例術(shù)后2 d，1例術(shù)后8 d；死亡原因?yàn)?例心肌炎，1例傳導(dǎo)系統(tǒng)出血，2例失血性休克；1例術(shù)前有潛在感染灶。 結(jié)論 對(duì)有關(guān)心臟瓣膜置換術(shù)后死亡案例的法醫(yī)病理學(xué)鑒定時(shí)，應(yīng)在了解患者瓣膜置換術(shù)前心臟情況以及手術(shù)方式、手術(shù)路徑和縫合方法的基礎(chǔ)上，結(jié)合法醫(yī)病理組織學(xué)檢查進(jìn)行綜合分析。
【Abstract】 Objective To analyze the forensic pathological characteristics of those who died after cardiac valve replacement and explore the mentality and principle of documentary evidence of medicolegal expertise. Methods Four death cases after cardiac valve replacement between January 2008 and February 2010 were comprehensively analyzed from various aspects of surgery style, preoperational heart condition, peri-operational observations, results of forensic pathological tests, time of death, and causes of death. Results All cases were rheumatic heart disease and the preoperational heart function was poor. Of the four cases, three had mitral valve replacement (MVR), three had aortic valve replacement (AVR) and two had tricuspid valvuloplasty. Of the three MVR cases, cutting on the left atrium paralleling the interatrial groove was performed in one case, cutting through right atrium and interauricular septum was performed in one case, and cutting left atrium and right atrium through interauricular septum was performed in another case. For all the three AVR cases, cutting on the root of aorta with the shape of diagonal or ’S’ was carried out. One patient died during operation, one died thirty minutes after operation, one died two days after operation and one died eight days after operation. Among them, one died of myocarditis, one died of hemorrhage in the conducting system and two died of hemorrhagic shock. Besides, one patient had potential bacterial infection before surgery. Conclusion For patients who died after cardiac valve replacement, we should acquaintance ourselves with the preoperational heart condition, surgery style, surgical approach and the methods of stitch to make a comprehensive analysis with forensic pathology examination.
引用本文： 王耀賓,王麗麗,龔道銀,張岑岑,黃飛駿. 心臟瓣膜置換術(shù)后死亡案例的法醫(yī)病理學(xué)分析. 華西醫(yī)學(xué), 2011, 26(2): 174-176. doi: 復(fù)制
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- 1. Sidhu P, O’Kane H, Ali N, et al. Mechanical or bioprosthetic valves in the elderly: a 20-year comparison[J]. Ann Thorac Surg, 2001, 71(Suppl 5): 257-260.
- 2. 劉日輝, 聶榮華, 楊俊波, 等. 心臟瓣膜置換術(shù)267例臨床分析[J]. 實(shí)用醫(yī)學(xué)雜志, 2010, 26(4): 623-625.
- 3. 張文林, 楊晉平, 母存富, 等. 心臟人工瓣膜置換術(shù)102例臨床分析[J]. 川北醫(yī)學(xué)院學(xué)報(bào), 2006, 21(3): 258-259.
- 4. 張寶寧, 張磊, 何勇, 等. 心臟瓣膜置換術(shù)236例術(shù)后并發(fā)癥相關(guān)因素分析[J]. 第四軍醫(yī)大學(xué)學(xué)報(bào), 2007, 28(5): 400.
- 5. Lee KK, Yu HY, Chen YS. Off-pump tricuspid valve replacement for severe infective endocarditis[J]. Ann Thorac Surg, 2007, 84(1): 309-311.
- 6. 修宗誼, 谷天祥, 谷春久, 等. 主動(dòng)脈瓣人工瓣膜置換術(shù)168例臨床體會(huì)[J]. 中國(guó)醫(yī)科大學(xué)學(xué)報(bào), 2007, 36(2): 221.
- 7. 宋惠民, 徐光亞. 心血管外科技術(shù)風(fēng)險(xiǎn)與對(duì)策[M]. 濟(jì)南: 山東科學(xué)技術(shù)出版社, 2004: 216-238.
- 8. 楊衛(wèi)忠, 張國(guó)良, 梁日生, 等. 心臟換瓣術(shù)后晚發(fā)性顱內(nèi)血腫[J]. 臨床神經(jīng)科學(xué), 1995, 3(4): 190-193.
- 9. 陳朋, 黃志雄. 心臟換瓣術(shù)后心內(nèi)膜炎[J]. 中華外科雜志, 1991, 30(7): 415-416.
- 10. 徐英含, 來(lái)茂德, 周韌, 等. 法醫(yī)病理案例分析[M]. 北京: 高等教育出版社, 2007: 228-231.