Quan Li, Zhu Bao-Li, Ishida Kaori, Oritani Shigeki, Taniguchi Mari, Kamikodai Yasunobu, Tsuda Kohei, Fujita Masaki Q, Maeda Hitoshi
Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585 Osaka, Japan.
Leg Med (Tokyo). 2003 Mar;5 Suppl 1:S332-4. doi: 10.1016/s1344-6223(02)00164-5.
Hemorrhages in the root of the tongue have been considered to be a finding associated with asphyxiation. The aim of the present study was to examine the incidence and diagnostic value of the lingual hemorrhages in fire fatalities with reference to the related pathological and toxicological findings, in comparison with asphyxiation and drowning cases. In fire fatalities (n=90), small to marked hemorrhages were observed in 26 cases (28.9%). In the reference groups (asphyxiation and drowning), the hemorrhages were frequently observed in ligature strangulation (n=10/15), manual strangulation (n=5/7) and traumatic asphyxia (n=4/5). In fire fatalities, the hemorrhages were closely associated with a lower blood carboxyhemoglobin (COHb) level, suggesting an influence of fatal burns: n=16/32 (50.0%), n=8/26 (30.8%) and n=2/32 (6.2%), respectively, in cases of COHb<30%, 30-60% and >60%. These findings suggested possible acute hemodynamic disturbance in the head including brain (cranial congestion) in the dying process due to fires. A careful differentiation from neck compression may be necessary in such cases.
舌根出血被认为是与窒息相关的一种表现。本研究的目的是参照相关病理和毒理学发现，对比窒息和溺水案例，探讨火灾死亡案例中舌部出血的发生率及诊断价值。在90例火灾死亡案例中，26例（28.9%）观察到了小至明显的出血。在参照组（窒息和溺水）中，勒颈窒息（10/15）、手掐窒息（5/7）和创伤性窒息（4/5）中经常观察到出血。在火灾死亡案例中，出血与较低的血液碳氧血红蛋白（COHb）水平密切相关，提示致命烧伤的影响：在COHb<30%、30 - 60%和>60%的案例中，分别为16/32（50.0%）、8/26（30.8%）和2/32（6.2%）。这些发现提示在火灾死亡过程中，头部包括脑（颅内充血）可能存在急性血流动力学紊乱。在此类案例中，可能需要与颈部受压仔细鉴别。
