肺动脉栓塞研究及法医学鉴定

Research on Pulmonary Artery Embolism and Forensic Medical Appraisal

摘要: 肺动脉栓塞(PE)是栓子阻塞肺动脉及其分支引发的肺循环与呼吸功能障碍疾病，其中静脉血栓栓塞(VTE)最为常见，栓子多来源于下肢深静脉。血栓栓塞的发病核心为Virchow三联征，血栓随血流阻塞肺动脉后，可引发肺动脉高压、右心功能不全等连锁反应，还会激活凝血纤溶系统诱发全身炎症反应，刺激迷走神经加重器官损害。PE的临床表现以呼吸困难、胸闷为常见初始症状，晕厥、恶心呕吐等亦较为典型，严重时可致休克，高危群体包括长期卧床者、血液透析患者及肺癌患者等。急性PE早期溶栓治疗关键但风险较高，危重症患者机械性与药物预防联合应用效果更优。法医学尸检需通过观察血栓形态、组织病理学检查明确诊断，排除其他致死因素，结合多类资料依据规范判定死因。PE起病急、死亡率高，常涉纠纷案件，鉴定需全面结合案情与检验结果综合评估。

Abstract: Pulmonary embolism (PE) is a disease that causes dysfunction of the pulmonary circulation and respiratory function due to the obstruction of the pulmonary artery and its branches by emboli. Among them, venous thromboembolism (VTE) is the most common, and the emboli mostly originate from deep veins of the lower extremities. The core of thromboembolism pathogenesis is Virchow’s triad. After the thrombus blocks the pulmonary artery with the blood flow, it can trigger a series of reactions such as pulmonary hypertension and right heart failure, and also activate the coagulation and fibrinolysis system to induce systemic inflammatory response and stimulate the vagus nerve to aggravate organ damage. The common initial symptoms of PE include dyspnea and chest tightness, while syncope, nausea and vomiting are also typical. In severe cases, it can lead to shock. High-risk groups include long-term bedridden patients, hemodialysis patients and lung cancer patients. Early thrombolytic therapy for acute PE is crucial but risky. For critically ill patients, the combined application of mechanical and drug prevention is more effective. In forensic autopsy, the diagnosis of PE needs to be confirmed by observing the morphology of the thrombus and conducting histopathological examination, excluding other fatal factors, and determining the cause of death based on multiple types of data in accordance with the norms. PE has an acute onset and a high mortality rate, and is often involved in dispute cases. The identification needs to comprehensively evaluate the case and the test results.