法医学杂志

法医学杂志 ›› 2018, Vol. 34 ›› Issue (6): 644-647.DOI: 10.12116/j.issn.1004-5619.2018.06.014

• 案例分析 • 上一篇    下一篇

24例长期服用精神类药物致猝死的法医学分析

叶  星1，史  程2，沈忆文1，赵子琴1，姜  宴1，李立亮1   

  1. 1. 复旦大学基础医学院法医学系，上海 200032； 2. 上海市公安局虹口分局刑事科学技术研究所，上海 200434
  • 发布日期:2018-12-25 出版日期:2018-12-28
  • 通讯作者: 李立亮，男，博士，主要从事法医病理学和法医毒理学研究；E-mail：liliangli11@fudan.edu.cn
  • 作者简介:叶星（1990—），男，硕士研究生，主要从事法医病理学研究；E-mail：15211010070@fudan.edu.cn
  • 基金资助:
    中国博士后科学基金面上资助项目（2016M601507）；国家自然科学基金青年科学基金资助项目（81701861）

Forensic Analysis of 24 Cases of Long-term Antipsychotics Use-Induced Sudden Unexpected Deaths#br#

YE Xing1, SHI Cheng2, SHEN Yi-wen1, ZHAO Zi-qin1, JIANG Yan1, LI Li-liang1   

  1. 1. Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China; 2. Institute of Criminal Science and Technology, Hongkou Branch of Shanghai Public Security Bureau, Shanghai 200434, China
  • Online:2018-12-25 Published:2018-12-28

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摘要： 目的 分析24例精神病患者因长期服用精神类药物猝死的法医学特征。 方法 收集 2011—2016年精神病患者猝死的案例，通过系统的案情调查、尸体解剖及毒（药）物检验结果，对精神病患者猝死的法医学特征进行回顾性分析。 结果 24例因长期服用精神类药物致猝死的精神病患者中，男女性比例为1.7∶1，平均年龄为（59.0±8.8）岁。15例患者有明确的患病年限［（14.4±8.2）年］，另9例已知患病年限超过3年。62.5%患者的死亡时间是工作日白天，91.7%患者的死亡地点在家中，大多数患者死亡前有不同程度的躯体不适主诉。精神分裂症患者（20例）最常见，其次为抑郁症患者（4例）。患者均有服用精神类药物史，以氯氮平及氯丙嗪最多见。死亡原因以循环系统疾病（15例）为主，最常见的为心肌炎（11例），其次为肺炎（4例）。 结论 对精神病患者尤其是精神分裂症患者，需要警惕使用精神类药物引起猝死的风险。

关键词: 法医病理学, 司法精神病学, 猝死, 精神治疗药物, 回顾性研究, 案例分析

Abstract:

Objective To analyze the forensic characteristics of 24 psychiatric patients who died of long-term use of psychotropic drugs. Methods Cases of sudden death of psychiatric patients from 2011 to 2016 were collected. The forensic characteristics of these sudden deaths were retrospectively analyzed by systematic investigation plus results of autopsy and toxics （drugs）. Results Among the 24 psychiatric patients who died of long-term use of psychotropic substances, the ratio of male to female was 1.7∶1, and the average age was （59.0±8.8） years. Fifteen patients had clear disease durations （14.4±8.2） years, and other the nine were known to have disease durations of over 3 years. The death time of 62.5% of patients was the daytime in working days, and 91.7% of the patients died at home. Most patients complained different degrees of physical discomfort before death. Patients with schizophrenia （20 cases） were the most common, followed by depression （4 cases）. All patients had the history of taking psychotropic drugs, with clozapine and chlorpromazine being the mostly detected ones. The causes of death were mainly circulatory diseases （15 cases）, with the most common being myocarditis （11 cases） followed by pneumonia （4 cases）. Conclusion Critical attention should be paid to the risk of antipsychotics-induced sudden unexpected deaths for psychiatric patients, particularly for those with schizophrenia.

Key words: forensic pathology, forensic psychiatry, death, sudden, psychotropic drugs, retrospective stu-dies, case analysis