法医学杂志

法医学杂志 ›› 2020, Vol. 36 ›› Issue (4): 525-530.DOI: 10.12116/j.issn.1004-5619.2020.04.018

• 案例分析 • 上一篇    下一篇

72例交通事故致多器官功能障碍综合征的法医学分析

王耀宾1， 龚道银2， 王丽丽3   

  1. 1. 河北盛唐司法鉴定中心，河北 石家庄 050800； 2. 成都中医药大学，四川 成都 610041； 3. 河北省人民医院，河北 石家庄 050800
  • 发布日期:2020-08-25 出版日期:2020-08-28
  • 作者简介:王耀宾（1983—），男，硕士，主检法医师，主要从事法医病理学和法医临床学鉴定；E-mail：wangyaobin119@163.com

Forensic Analysis of 72 Cases with Multiple Organ Dysfunction Syndrome Caused by Traffic Accidents

WANG Yao-bin1, GONG Dao-yin2, WANG Li-li3   

  1. 1. Hebei Shengtang Judicial Forensic Center, Shijiazhuang 050800, China; 2. Chengdu University of Traditional Chinese Medicine, Chengdu 610041, China; 3. Hebei General Hospital, Shijiazhuang 050800, China
  • Online:2020-08-25 Published:2020-08-28

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摘要： 目的 研究严重创伤后多器官功能障碍综合征（multiple organ dysfunction syndrome，MODS）的流行病学及法医学特征，探索判定创伤性MODS的参考指标。 方法 从MODS累及器官或系统的数目、各器官或系统发生衰竭的例数、首个衰竭器官以及器官衰竭后生存时间方面，对72例道路交通事故致MODS死亡案件进行回顾性分析。根据损伤严重程度评分（injury severity score，ISS）均值将案例分为两组，采用t检验分析两组MODS累及器官或系统数目的差异，采用χ2检验分析首个衰竭器官类型的差异以及两组MODS各器官或系统衰竭发生例数的差异，采用Wilcoxon符号秩和检验分析两组创伤后MODS生存时间的差异，同时绘制Kaplan-Meier生存曲线并进行Log-Rank检验。 结果 创伤后MODS累及器官或系统数目在ISS≤35分组为3~5个，在ISS>35分组为2~4个（P<0.05）。两组创伤后MODS衰竭器官以脑、肺发生例数较多，创伤后首个衰竭器官以肺、肾居多，创伤后首个器官发生衰竭的中位时间为2.00 d。创伤后MODS中位生存时间在ISS≤35分组为6.00 d，在ISS>35分组为2.33 d（P<0.05）。ISS≤35分组生存曲线较高、下降比较平缓，ISS>35分组生存曲线较低、下降陡峭（P<0.05）。 结论 道路交通事故致MODS的流行病学和法医学特点具有一定特异性，ISS和ISS>35分时的MODS法医学特征可作为评价创伤、MODS、死亡三者之间因果关系的可靠参考指标。

关键词: 法医病理学, 创伤和损伤, 多器官功能障碍综合征, 损伤严重程度评分, 案例分析

Abstract: Objective To investigate the epidemiological and forensic characteristics of multiple organ dysfunction syndrome （MODS） after severe trauma and explore the reference indexes for determining traumatic MODS. Methods In terms of the number of organs or systems involved in MODS, the number of failures of each organ or system, the first failing organ and the survival time after organ failure, 72 cases of MODS death caused by traffic accidents were retrospectively analyzed. The cases were divided into two groups according to the mean injury severity score （ISS）. The t test was used to analyze the differences in the number of organs or systems involved in MODS in the two groups. Chi-square test was used to analyze the differences in the types of first failing organs and the differences between the two groups in the number of cases of organ or system failure involved in MODS. Wilcoxon signed-rank test was used to analyze the differences between the two groups in survival time of MODS after trauma. Kaplan-Meier survival curve was drawn and Log-Rank test was performed. Results The number of MODS involved organs or systems after trauma in ISS≤35 group was 3-5, and 2-4 in the ISS>35 group （P<0.05）. The cases of MODS organ or system failure after trauma occurred more in brain and lung in the two groups. The first failing organ after trauma was mainly the lung or kidney. The median time of first organ failure after trauma was 2.00 d, the median survival time of MODS after trauma in ISS≤35 group was 6.00 d, and 2.33 d in ISS>35 group （P<0.05）. The survival curve of ISS≤35 group was relatively high and declined gradually, while the survival curve of ISS>35 group was relatively low and the decline was steep （P<0.05）. Conclusion The epidemiological and forensic characteristics of MODS caused by traffic accidents have certain specificity. The ISS and the forensic characteristics of MODS at ISS>35 can be used as reliable reference indexes for evaluation of the causal relationship among trauma, MODS and death.

Key words: forensic pathology, wounds and injuries, multiple organ dysfunction syndrome, injury severity score, cases analysis