交通伤临床特点及伤情评估

各类交通伤具有不同的致伤机制,而且与其它伤因引起的损伤相比,如坠落伤等,交通伤具有自身独特的临床特点。了解这些特点,将有助干临床的诊断和治疗。笔者在此就交通伤临床特点及伤情评估的主要评分法作一简要介绍。     

高速公路交通事故伤情影响因素研究

目的 研究高速公路交通事故伤情的影响因素.方法 对2005-2006年杭州地区高速公路涉及人员伤亡的交通事故资料行非条件单因素Logistic回归分析和非条件多因素Logistic回归分析.结果 (1)2005-2006年立案伤亡交通事故共220起,涉及伤亡327例,其中死亡64例,重度损伤(ISS≥16分)121例,轻、中度损伤(1分≤ISS≤15分)142例,分别占19.6%、37.0%和43.4%.(2)非条件单因素Logistic回归分析显示,影响高速公路交通事故伤情的相关因素有性别、一周时间分布、天气、事故形态、车辆类型、驾驶员类型、车辆使用性质、出行目的、责任原因等.(3)非条件多因素I~gistic回归分析显示,影响高速公路交通事故伤情的相关因素为性别、事故形态、驾驶员类型、责任原因等.结论 通过对高速公路交通事故资料的分析,明确了交通事故伤情影响因素,可为预防和降低高速公路交通事故的危害提供帮助.     

Comparison of the injury severity and medical history of disease-related versus trauma-related bicyclist fatalities

The objective of this study was to clarify the relationship between injury severity and mechanism of death in bicycle fatalities resulting from trauma compared with those resulting from disease, to propose effective measures to prevent fatal bicyclist accidents.Autopsy and accident records were reviewed for bicyclist fatalities who had undergone forensic autopsy at the Dokkyo Medical University School of Medicine between September 1999 and March 2014. Victims’ health histories, blood alcohol levels, causes of death, mechanisms of injury, Abbreviated Injury Scale (AIS) scores and Injury Severity Scores (ISSs) were determined.Fifty-five bicyclists (43 male and 12 female) with a mean age of 62.5 ± 17.3 years were included in this study. Sixteen victims had driven under the influence of alcohol (mean blood concentration of 1.8 ± 0.7 mg/ml). Mean ISS was 32.4 and the chest had the highest mean AIS score (2.6), followed by the head (2.1) and the neck (1.8). Thirty-nine victims (70.9%) had died of trauma and 16 had died of disease. The disease-death victims had significantly higher prevalence of having diabetes mellitus, hyperlipidemia, hypertension, heart disease or cerebrovascular diseases (50.0% vs. 22.2%, p = 0.03) and a lower rate of drunk driving (6.3% vs. 41.0%, p = 0.01) than the trauma-death group. All victims who were affected by disease, and 33.3% of trauma-death victims, had fallen on the road without a vehicle collision (p < 0.001). The mean ISS of the trauma-death group was significantly higher than that of the disease-death group (44.0 vs. 4.2, p < 0.001). Except for facial injuries, the AIS scores were significantly higher in trauma-death victims than in the disease-death group (p < 0.005).To effectively reduce bicyclist fatalities, the authors strongly advocate efforts that will increase compliance with drunk driving prohibitions. For victims of fatal bicycle accidents with a medical history of diseases, a forensic autopsy should be performed to establish a disease-related death while bicycle riding. We must also put into effect preventative safety measures, which take into consideration the physical condition of bicyclists, to reduce the incidence of these types of accidents.     

Postmortem computed tomography findings as evidence of traffic accident-related fatal injury

PURPOSE: Most traumatic deaths in Japan are due to nonpenetrating injuries, especially those that result from traffic accidents; however, the autopsy rate of traffic accident-related deaths is only about 5%. We investigated the diagnostic ability of postmortem computed tomography (PMCT) in cases of fatal trauma after traffic accidents. MATERIALS AND METHODS: Our subjects were 78 subjects (59 males, 19 females; mean age 50 years, range 15-87 years) who were brought to our institution in cardiopulmonary arrest on arrival after traffic accidents and died despite resuscitation attempts. PMCT findings of damage to the head, neck, thorax, abdomen, and pelvis were classified into three grades according to the Abbreviated Injury Scale (AIS) severity: A: 1 (minor), 2 (moderate); B: 3 (serious), 4 (severe), 5 (critical); C: 6 (maximum). RESULTS: The percentage ratio of A/B/C in 78 head injuries was 32/60/8, in 41 neck injuries 83/5/12, in 76 thorax injuries 5/38/57, in 76 abdominal injuries 70/24/7, and in 76 pelvic injuries 79/21/0, respectively. CONCLUSION: PMCT can detect or presume fatal trauma when diagnosing the cause of death after traffic accidents.     

胸部创伤严重度评价与救治结局探讨

目的探讨以简明损伤定级标准（AIS）为基础的ISS与胸部创伤救治结局的关系。方法采用AIS-98最新修订本对我院1995年1月-2005年6月救治的3057例胸部创伤病例资料进行回顾性分析。结果总治愈率93．8％（2866／3057），病死率6．2％（191／3057）。死亡组ISS、GCS、修正创伤评分（RTS）、国人创伤严重度特征评分[ASCOT_CHINA]_生存概率（Ps）、创伤与损伤严重度评分（TRISS）_Ps、ASCOT_Ps与生存组比较，差异具有统计学意义（P〈0．01）。穿透伤病死率11．4％（75／655），显著高于钝性伤4．8％（116／2402）（P〈0．01），穿透伤组ISS值显著高于钝性伤组，但穿透伤组TRISS_Ps、ASCOT_Ps和ASCOT_CHINA_Ps明显低于钝性伤组。ISS值越高，RTS值越低，ASCOT_CHINA_Ps越低，病死率越高。ISSt〉20，病死率高达7．2％-28．8％；RTS≤6，病死率高达52．7％以上。TRISS和ASCOT准确性、特异性高，生存误判低，而ASCOT-CHINA灵敏度高，死亡误判低。结论以AIS-98为基础的ISS、TRISS、ASCOT、ASCOT_CHINA_Ps等方法评价胸部创伤或胸伤合并多发伤的严重度及其结局预测是可行的，TRISS、ASCOT和ASCOT_CHINA_Ps的各项预测性指标以及误判性指标趋于合理。     

简明损伤定级/损伤严重度评分的研究进展与误用解析

创伤评分、创伤登记和创伤数据库建设是创伤中心质量改进的基石.简明损伤定级(AIS)/损伤严重度评分(ISS)自2008年起被各国用作创伤中心评审的依据,现已发展为全球公认的创伤评分系统.笔者介绍自1971年以来发布的9个版本AIS中代码数量和分值设定的变化,以及近年来AIS/ISS评分体系的应用效果,并结合临床多发伤患...     

交通事故所致肝脏损伤76例急救分析

目的探讨交通事故所致肝脏损伤的特点、手术时机与救治成功率的关系。方法对76例交通事故所致肝脏损伤病例的病例资料进行回顾性分析,探讨其多发伤的临床特点,比较不同手术时机与救治成功率的关系。结果本组67例(88．2％)合并多脏器损伤,伤后6小时内行了肝止血术的伤者有较高的救治成功率。结论早期诊断,及时实施合理的手术以及行有效止血是提高救治成功率的关键。     

1062例道路交通事故伤的伤残评定分析

目的探讨道路交通事故受伤人员伤残发生、分布特点,以及合理评定时限。方法应用GA35-92标准,对1062例道路交通事故伤进行伤残评定和分析。结果1062例中,男性656例(61．8％),女性406例(38．1％),25～40岁年龄段占总人数的51．2％;7～10级伤残者占总伤残人数的87．7％;四肢、头面部伤残人数较高;乘客、行人伤残人数均较多,但伤残烈度较驾车人低。入院科室以骨科、脑外科为主(83．1％);手术治疗者伤残烈度较高;伤后评定时间中位数188天,四分位间距202天。结论道路交通事故伤残预防应注重对青壮年男性与行人的安全防护及教育,加强安全设施研究,建立以骨科、脑外科为主的及时有效的统一救治体系。伤残评定时机选择需综合判断。     

201例交通事故导致膝关节损伤的法医学分析

目的 探讨交通事故导致膝关节损伤的特点,为其法医学鉴定提供客观依据. 方法 对2006 -2008年间经重庆法医验伤所鉴定的201例交通事故导致的膝关节损伤案例进行回顾性研究. 结果 根据膝关节的损伤类型,将本组案例分为骨损伤组、软组织损伤组及骨合并软组织损伤组.通过对各组膝关节功能情况的分析发现:对于负重情况,其正常率以及不能负重率,骨损伤组以及骨合并软组织损伤组均与软组织损伤组差异有统计学意义(P＜0.05). 结论 将患者的负重情况、行走功能以及步态情况纳入鉴定过程,会使交通事故导致膝关节损伤的法医学鉴定更为合理.     

应用ISS和NISS评估伴严重胸部损伤的多发伤患者并发症与救治结局

目的 探讨新的损伤严重度评分(new injury severity score,NISS)和ISS在评估伴严重胸部损伤的多发伤患者的并发症与救治结局中的应用价值.方法 采用简明损伤评分-2005(AIS-2005)对重庆市急救医疗中心2005年1月-2011年1月救治的1377例伴严重胸部损伤的多发伤患者资料(胸部AIS≥3分)进行回顾性分析.计算NISS和ISS,并分析其与死亡的相关性.结果 治愈率为93.2％,死亡率为6.8％,并发症发生率为28.5％.NISS值(r=0.569,P＜0.01)、ISS值(r=0.442,P＜0.01)分别与并发症发生率呈正相关,NISS值(r=0.693,P＜0.01)、ISS值分别与死亡率呈正相关(r=0.774,P＜0.01),其中NISS值与并发症发生率、ISS值与死亡率有更强的相关性.在并发症发生预测方面,NISS敏感性优于ISS,特异性不及ISS(P＜0.01),在死亡预测方面,ISS与NISS相当(P＞0.05).结论 NISS和ISS均能较好评价伴严重胸部损伤的多发伤患者的并发症与救治结局.利用NISS值预测并发症的发生,ISS值预测救治结局以尽可能提高预测的准确性.     

严重交通伤与坠落伤救治结局比较和创伤急救模式探讨

目的 进一步提高严重交通伤（ＲＴＴ）与坠落伤（ＦＩ）的救治水平。方法 为重庆急救中心１９９６年８月～１９９７年７月救治的严重ＲＴＴ和ＦＩ（ＩＳＳ≥１６或ＡＩＳ≥３）结局进行比较分析。结果 ＲＴＴ２１９例,ＦＩ１１７例。严重多发伤组的致死率及其死亡及其死亡组ＩＳＳ值ＦＩ显著高于ＲＴＴ（Ｐ〈０．０５）,其腹部和（或）盆腔脏器伤、上肢伤、下肢和（或）骨盆伤、脊柱的发生率ＦＩ显著高于ＲＴＴ（Ｐ〈０．０１或     

严重多发伤患者伤后调节性T细胞的变化及其与损伤严重度和脓毒症的关系

目的 观察严重多发伤患者伤后外周血调节性T细胞(Treg细胞)的变化及其与脓毒症和损伤严重度的关系. 方法 60例严重多发伤患者按ISS评分排序后分为严重组(30例),危重组(30例);按是否伴发脓毒症分为脓毒症组(22例)和非脓毒症组(38例).于伤后1,3,5,8 d用流式细胞仪检测各组患者外周血Treg细胞的比率. 结果 严重多发伤患者伤后5 dTreg细胞比率开始升高,与伤后3 d相比差异有统计学意义(P<0.01);伤后8 d仍持续升高(P<0.05).伤后8 d,危重组外周血Treg细胞比率显著高于严重组(P<0.01),脓毒症组外周血Treg细胞比率显著高于非脓毒症组(P<0.05).Spearman相关分析显示Treg细胞比率与ISS评分呈正相关(rs=0.654,P<0.01). 结论 Treg细胞在严重创伤后的免疫抑制中扮演着重要的角色,Treg细胞比率的变化有助于评估患者的预后及判断并发脓毒症的危险度.     

Sudden adult death: An autopsy series of 534 cases with gender and control comparison

The aim of our study was to highlight the epidemiological difference in adult sudden death between males and females. The type of pathologies found in adult victims of sudden death was compared to control cases in order to determine the most significant pathologies involved in sudden death.Among all autopsies performed between 1995 and 2009, 534 adult cases of sudden death and 154 cases who violently died were respectively selected. For each case, a complete autopsy was carried out, including systematic histological examination of all major organs.The sudden death population was composed of 369 males and 165 females. There was no statistical difference regarding age between males and female. Sudden death took place more often at home in women than in men (p < 0.0001). A stressful event was more frequently found in men than in women (p = 0.03). Deaths caused by cardiovascular diseases were more frequent in males than in females, especially Coronary Artery Disease (CAD) (p < 0.0001). Cardiomyopathy was more often the cause of death in women, particularly Arrythmogenic Right Ventricular Cardiomyopathy (ARVC). Cardiac pathologies were found in 45% of the control cases. CAD and ARVC were statistically more frequent in the sudden death group than in the control group.According to our study, profile of sudden death is different between males and females. Those data seem to be important for clinicians involved in prevention programs of sudden death, as they can adapt their screening according to the gender.     

公路交通事故伤950例流行病学分析

目的探讨桂林市特殊路况下交通事故伤的流行病学特征,为减少和规避公路交通事故的发生提供帮助。方法收集桂林近两年来发生的交通事故数据,分析其共性特征。结果伤亡人员年龄以21~60岁为多,男性为主。事故的主要原因是机动车驾驶员违章行驶与疲劳驾车;酒后驾驶为引发交通事故另一不容忽视的因素。结论加强道路的管理、维护和基础配套设施的完善,严格治理超载、超速行为,深化机动车驾驶员交通法规教育和普及全民的出行安全宣传,是最大限度减少交通事故的关键。建立健全各级医疗急救体系,提高院前救治水平和效率,事故发生后及时的医疗干预是有效降低伤残率和死亡率的有力措施。     

Determination of phosphatidyl ethanol (PEth) 16:0/18:1 in dried blood samples of drivers involved in traffic accidents: A pilot study

In routine forensic toxicology practices, blood alcohol concentration (BAC) levels are measured in traffic accidents that ended up in emergency departments. Nevertheless, since the elimination of ethanol from the blood is fast and the detection time is short, BAC cannot indicate the occurrence of chronic excessive alcohol consumption. Phosphatidylethanol (PEth) is a unique ethanol direct biomarker that occurs only in the presence of phospholipase D enzyme in erythrocyte membranes during alcohol intake, and it indicates alcohol intake.In this study, both whole blood and dried blood samples were collected from 50 patients who were admitted to Cukurova University Hospital Emergency Department due to a traffic accident. While studying BAC in whole blood samples, PEth 16:0/18:1 analysis was performed on dried blood samples by LC-MS/MS.According to the BAC (50 mg/dL) value, the legal limit in Turkey, the optimal threshold PEth 16:0/18:1 value was set as 160 ng/mL and over. This study determined that 15 people with above PEth 16:0/18:1 concentrations above 160 ng/mL were classified as excessive alcohol consumption.The data obtained in this study showed a positive correlation between BAC and PEth concentration when driving under the influence of ethanol.     

Sudden cardiac death during anabolic steroid abuse: morphologic and toxicologic findings in two fatal cases of bodybuilders

We report two cases of sudden cardiac death (SCD) involving previously healthy bodybuilders who were chronic androgenic–anabolic steroids users. In both instances, autopsies, histology of the organs, and toxicologic screening were performed. Our findings support an emerging consensus that the effects of vigorous weight training, combined with anabolic steroid use and increased androgen sensitivity, may predispose these young men to myocardial injury and even SCD.     

Colloid cysts of the third ventricle with fatal outcome: a report of two cases and review of the literature

Two cases of sudden death due to colloid cysts of the third ventricle are presented with a review of the literature. In the first case, a 40-year-old woman suffered an acute onset of severe frontal headache after an intercontinental air flight. The next day, she was found comatous and died 7 h after admission to a hospital. In the second case, a 33-year-old man with a medical history of recurrent headaches was found dead in his car. Autopsy in both cases revealed a colloid cyst of the third ventricle and hydrocephalus involving the lateral ventricles. Received: 7 February 1997 / Received in revised form: 2 April 1997     

Technical parameters influencing the severity of injury of front-seat,belt-protected car passengers on the impact side in car-to-car side collisions with the main impact between the front and rear seats (B-pillars)

Summary Authentic car-to-car side collisions (n = 30) with the main impact area at the B-pillar were analyzed to find technical parameters corresponding with the injury severities of the front seat, belt-protected car passengers on the impact side. EES (Energy Equivalent Speed) and Av (delta v, change in velocity) were highly significant predictors of the severity of thoracic and abdominal injuries and total injury severity coded according to the Abbreviated Injury Scale (AIS). At an EES or v 40 km/h all front-seat car passengers on the impact side sustained a total injury severity of Maximum AIS (MAIS) 4 and died. Although a passenger could survive the crash without injury to one or more body regions up to the highest EES- and Av-values, at EES or v 40 km/h fatal injuries were sustained in at least one body region. At an EES 35 km/h or a Av 15 km/h no front-seat car passenger on the impact side remained uninjured.     

Fatal work-related injuries in the Genoa district (North-Western Italy): Forensic analysis of the 10-year period between 2011 and 2020

According to the ILO (International Labor Organization), an occupational accident is that which occurs in the course of work and results in either a fatal or non-fatal injury. Occupational-related deaths are increasingly a concerning issue, also worldwide, with severe social repercussions: it is clear that when a person loses their life, it has a permanent impact on all their family, as well as incurring direct and indirect costs for employers, workers and the community at large. The aim of the present retrospective-observational study is to investigate, from an autoptic and forensic point of view, the characteristics of occupational-related deaths of victims received between the 10-year period of 2011–2020 by the Municipal Morgue of Genoa, which forms part of the Institute of Forensic and Legal Medicine, for the purpose of providing a Forensic and Coroner's overview of this important phenomenon. The study comprises of a list of 47 people who died as a result of an occupational injury: 46 males and 1 female. It was observed that workers in the construction and steel manufacturing industries were in the category most at risk of fatal accidents (40.5%). In 41 cases (87.2%), death was related to major mechanical trauma, from falling from a height (42.5%) objects falling directly onto the victim (38.3%) and lastly, from pedestrian road accidents (6.4%). Fatal head traumas with endocranial haemorrhage accounted for deaths in 23 of all the cases studied (63.4%). As shown in our study, death in the workplace is still today having to be considered as an important social issue and it is still necessary to improve the workers' knowledge of the related hazards and risks involved at work, together with preventative procedures. An in-depth analysis of such risks in the workplace, as well as the monitoring and training of workers is fundamental if we are to achieve an overall improvement in working conditions.     

Homicide mechanisms,weapon types and causes of death in the autopsy material of the Department of Forensic Medicine Medical University of Gdańsk Poland in the years 2010–2019

The study objective was the analysis of homicides based on reports of 107 medicolegal autopsies of victims, which were carried out in 2010–2019 at the Department of Forensic Medicine of the Medical University of Gdańsk, Poland. The study focused on the analysis of homicide mechanisms, on the weapon type, injuries characteristics, and both pathomechanisms and causes of death. Alcohol and illicit drugs abuse, which is a predisposing factor, was also assessed. In the analysed cohort, 70.1% were males and 29.9% females. The most frequently used weapon was a blunt instrument (accounting for 47.7% of homicides), while the least common was a firearm (accounting for 4.7% of homicides). There were significant differences in homicide mechanisms related to victims’ gender. In males, blunt or sharp instruments predominated, while in females violent suffocation and chop injuries were more frequent. Fatal head injuries and their consequences predominated in the pathomechanisms of death (32.7% of cases). It was shown that the highest blood alcohol concentration (BAC) was found in homicides due to violent strangulation and sharp instrument use, while the lowest BAC was found in gunshot victims. Toxicological tests were performed in 18 cases and in 7 cases showed positive results for illicit drugs. The analysis of various elements involved in homicide may contribute to a conceptual framework for preventive measures aiming at the reduction of homicides number.