Mizukami Hajime, Mori Shinjiro, Kato Yukihisa, Hamamatsu Akihiko, Tanifuji Takanobu, Dasai Norio, Hara Shuichi, Endo Takahiko, Misawa Shogo
Department of Forensic Medicine, Tokyo Medical University, Tokyo 160-8402, Japan.
Nihon Hoigaku Zasshi. 2005 Oct;59(2):149-59.
We reviewed the records of 118 medicolegal autopsy cases, in which psychotropic drugs were detected in blood, in the Tokyo Medical Examiner's Office in 1997, to explore how the drug levels were considered in determining the cause of death. Names and doses of the drugs were clear in 70 of 118 cases, and in most cases of the 70 cases, multiple drugs (up to 13 drugs) were prescribed to a person. It was also evident that 75 of the 118 cases had demonstrated psychosis for several months to 38 years prior to death. No information concerning prescriptions or history of psychosis could be obtained in the other cases. The causes of death in these 118 cases were as follows: deaths from specific diseases, 30 cases (25.4%); deaths from extrinsic factors excluding drug intoxication, 22 cases (18.6%); suicide related to drug intoxication, 31 cases (26.3%); deaths from extrinsic factors related to drug intoxication suggestive of suicide, but not confirmed, 19 cases (16.1%); non-suicide, including probable drug intoxication, 13 cases (11.0%); and deaths from malignant syndrome, 3 cases (2.5%). There were cases diagnosed as death from specific diseases based on morphological findings, though drug concentrations in blood were at a toxic or even lethal level. In some cases, drug intoxication was suspected, but drug levels in their blood were at a therapeutic level and there were no identifiable morphological changes directly associated with deaths, resulting in a cause of death other than drug intoxication being indicated. Thus, drug levels detected in the cadaver's blood are not always useful for determining the cause of death. This might be due to poor information on interactions between drugs (including alcohol), pathological changes or genetic variability of drug metabolism and excretion, and so on. Thus, further studies of these aspects are needed in order to make information on drugs detected in the cadaver more useful for determination of cause of death.
我们回顾了1997年东京法医办公室118例法医学尸体解剖病例的记录，这些病例血液中检测出了精神药物，以探究在确定死因时如何考虑药物水平。118例中有70例药物名称和剂量明确，在这70例中的大多数情况下，一个人被开了多种药物（多达13种）。同样明显的是，118例中有75例在死亡前数月至38年表现出精神病症状。在其他病例中无法获得有关处方或精神病病史的信息。这118例的死因如下：特定疾病死亡30例（25.4%）；排除药物中毒的外部因素导致的死亡22例（18.6%）；与药物中毒相关的自杀31例（26.3%）；与提示自杀但未得到证实的药物中毒相关的外部因素导致的死亡19例（16.1%）；非自杀，包括可能的药物中毒13例（11.0%）；恶性综合征死亡3例（2.5%）。有些病例根据形态学发现被诊断为特定疾病死亡，尽管血液中的药物浓度处于中毒甚至致死水平。在某些情况下，怀疑有药物中毒，但他们血液中的药物水平处于治疗水平，并且没有可识别的与死亡直接相关的形态学变化，导致给出的死因不是药物中毒。因此，尸体血液中检测到的药物水平并不总是有助于确定死因。这可能是由于关于药物（包括酒精）之间相互作用、病理变化或药物代谢和排泄的基因变异性等信息不足。因此，需要对这些方面进行进一步研究，以便使尸体中检测到的药物信息在确定死因方面更有用。
