Hashimoto Yoshiaki, Moriya Fumio, Nakanishi Akinori
Department of Legal Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku City, Kochi 783-8505, Japan.
Leg Med (Tokyo). 2003 Mar;5 Suppl 1:S328-31. doi: 10.1016/s1344-6223(02)00163-3.
Intramuscular bleeding of the tongue is frequently observed in autopsy cases of house fire victims. The meaning of this finding has not yet been fully discussed. We examined 69 autopsy cases of house fire victims and investigated several factors contributing to intramuscular bleeding of the tongue. Victims comprised 45 males and 24 females, ranging in age from 1 to 95 years old. Sixty-four cases (93%) involved severely charred bodies, while the remaining five bodies displayed slight burns. Factors studied were age, sex, posture of the body at the scene of the fire, degree of burn injury and carboxyhemoglobin (CO-Hb) levels in blood. CO-Hb level proved to be the only factor relevant to intramuscular bleeding of the tongue. Of 69 autopsy cases, 23 (33%) demonstrated intramuscular bleeding of the tongue (13 cases of slight bleeding, ten cases of severe bleeding). Low concentrations of CO-Hb (</=30%) were observed in six of ten cases (60%) with severe intramuscular bleeding. Of 46 cases without intramuscular bleeding, ten (22%) displayed low concentrations of CO-Hb. These results may indicate that severe burn injuries occurring before inhaling air containing high levels of carbon monoxide represent the cause of intramuscular bleeding of the tongue in fire victims. The burned regions of the body in the early stage of the fire process were unclear due to severe charring in most victims. However, asphyxiation due to neck compression is known to often induce intramuscular bleeding of the tongue. Lack of skin elasticity following burns, particularly in the neck, might act in a similar manner to asphyxial neck compression. In conclusion, intramuscular bleeding of the tongue in fire victims may occur as a vital reaction to burns.
在房屋火灾受害者的尸检案例中，经常观察到舌部肌肉内出血。这一发现的意义尚未得到充分讨论。我们检查了69例房屋火灾受害者的尸检案例，并调查了导致舌部肌肉内出血的几个因素。受害者包括45名男性和24名女性，年龄在1岁至95岁之间。64例（93%）涉及严重烧焦的尸体，其余5具尸体有轻微烧伤。研究的因素包括年龄、性别、火灾现场尸体的姿势、烧伤程度和血液中的碳氧血红蛋白（CO-Hb）水平。结果证明，CO-Hb水平是与舌部肌肉内出血相关的唯一因素。在69例尸检案例中，23例（33%）出现舌部肌肉内出血（13例轻度出血，10例重度出血）。在10例重度肌肉内出血的案例中，有6例（60%）观察到低浓度的CO-Hb（≤30%）。在46例没有肌肉内出血的案例中，10例（22%）显示出低浓度的CO-Hb。这些结果可能表明，在吸入含有高浓度一氧化碳的空气之前发生的严重烧伤是火灾受害者舌部肌肉内出血的原因。由于大多数受害者严重烧焦，火灾过程早期身体的烧伤区域不明确。然而，已知颈部受压导致的窒息常诱发舌部肌肉内出血。烧伤后皮肤弹性丧失，尤其是颈部，可能起到与窒息性颈部受压类似的作用。总之，火灾受害者舌部肌肉内出血可能是对烧伤的一种重要反应。
