127例蛛网膜下腔出血案例的法医学研究

目的探讨蛛网膜下腔出血(SAH)对保险公司的直接请求权,从而缓解了患者在请求赔偿方面的特点及法医学鉴定要点。方法通过对华西医科大学法医鉴定中心1983-2001年尸检检出的127例各种原因所致的SAH案例进行回顾性分析。结果各类SAH案例,男性明显多于女性,男女性别比为3:1,高峰年龄为21~40岁。按SAH常见特征可分为外伤性、脑血管畸形、动脉瘤、脑血管粥样硬化、中毒、伴发于心脏疾患、其他等八类。其中,外伤性与脑血管畸形最为多见。外伤性SAH与脑血管畸形出血可见于任何年龄,多见于11~50岁,脑血管粥样硬化出血仅见于50岁以上者,动脉瘤破裂出血者并不多见,见于11~50岁。以SAH为死亡原因者,32例,占25%,多见于脑血管畸形与动脉瘤破裂,出血部位多见于脑底及小脑天幕以下。大多数SAH,出血部位多见于大脑表面,较为局限,出血量较少,非死亡的主要原因。结论多数SAH并非导致死亡的主要原因,SAH死亡者,其死亡性质多属自然死亡。

Forensic pathological study of 127 cases of subarachnoid hemorrhage

Objective To study the characteristics of subarachnoid hemorrhage and the main points of forensic medical identification. Methods Data was collected from 127 autopsy cases of subarachnoid hemorrhage(SAH) of various etiology in Forensic Medical Identification Center of West China University of Medical Science between 1983 and 2001. Results In these cases there were obviously more male than female (male vs female ratio was 3:1). The age was usually between 21 and 40 year old. SAH can be classified into eight categories according to its characteristics, e.g., traumatic SAH, vascular malformation, intracranial aneurysm, cerebrovascular atherosclerosis, poisonous diseases, comorbid with cardiac and other diseases. Traumatic SAH and vascular malformation were more common and could be found at any age, but the peak was 11 to 50 years old. Atherosclerosis was only seen in individuals of 50 years old or above. Ruptured intracranial aneurysm was not common seen.SAH accounted for only 32 death cases (25%), most often caused by cerebrovascular malformation and ruptured intracranial aneurysm in the basis of brain or under tentorium of cerebellum. However SAH most frequently occurred on the surface of celebrum and the hemorrhage was limited, in small volume and not the main death reason. Conclusion The majority of SAH was not the main direct causes of death. Deaths in SAH cases were mostly natural deaths.