Zhu Bao-Li, Quan Li, Li Dong-Ri, Taniguchi Mari, Kamikodai Yasunobu, Tsuda Kohei, Fujita Masaki Q, Nishi Katsuji, Tsuji Tsutomu, Maeda Hitoshi
Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan.
Leg Med (Tokyo). 2003 Mar;5(1):20-6. doi: 10.1016/s1344-6223(02)00172-4.
There are several controversial findings and arguments about the lung weight as a marker of drowning. The aim of the present study was to examine the difference in the lung weight and the amount of pleural effusion between freshwater and saltwater drownings (n=70 and n=75, respectively), in comparison with asphyxiation (n=85) and acute cardiac death (n=82), for the diagnosis of drowning. In drowning cases, a gradual postmortem time-dependent decrease in the lung weight and a reciprocal increase in the pleural effusion suggested postmortem transudation from the lungs. The decrease in the total value of the combined lung weight and the amount of pleural effusion was marked in saltwater immersion after 3 days postmortem, suggesting a leakage of the effusion out of the thoracic cavity under an osmotic effect of the immersion medium. In cases within 3 days postmortem, when the combined lung weight and amount of pleural effusion were added to estimate possible combined lung weight at the time of death, there was a gross difference among the causes of death: the value was the largest in saltwater drowning, followed by freshwater drowning, acute cardiac death and asphyxiation. However, the value depended on the gender and age of the subjects, suggesting a relation to the individual physical constitution and survival time or vital activity. These factors should be taken into consideration in evaluation of the lung weight in the diagnosis of drownings.
关于肺重量作为溺水标志存在一些有争议的研究结果和观点。本研究的目的是，为了诊断溺水，对比窒息（n = 85）和急性心源性死亡（n = 82），研究淡水溺水（n = 70）和海水溺水（n = 75）之间肺重量和胸腔积液量的差异。在溺水案例中，死后肺重量随时间逐渐下降以及胸腔积液相应增加提示了肺的死后漏出。在死后3天的海水浸泡案例中，肺重量与胸腔积液总量的下降明显，提示在浸泡介质的渗透作用下积液漏出胸腔。在死后3天内的案例中，当将肺重量与胸腔积液量相加来估计死亡时可能的肺重量总和时，不同死因之间存在显著差异：该值在海水溺水中最大，其次是淡水溺水、急性心源性死亡和窒息。然而，该值取决于受试者的性别和年龄，提示与个体身体构成以及存活时间或生命活动有关。在评估溺水诊断中的肺重量时应考虑这些因素。
