Pham Hang, Enzenauer Robert W, Elder James E, Levin Alex V
Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
Am J Forensic Med Pathol. 2013 Jun;34(2):122-4. doi: 10.1097/PAF.0b013e31828c38f9.
Retinal hemorrhages in children in the absence of risk factors are regarded to be pathognomonic of shaken baby syndrome or other nonaccidental injuries. The physician must decide whether the retinal hemorrhages in children without risk factors are due to abuse or cardiopulmonary resuscitation with chest compression (CPR-CC). The objective of this study was to determine if CPR-CC can lead to retinal hemorrhages in children. Twenty-two patients who received in-hospital CPR-CC between February 15, 1990, and June 15, 1990, were enrolled. Pediatric ophthalmology fellows carried a code beeper and responded to calls for cardiopulmonary arrest situations. At the scene of CPR-CC, an indirect funduscopic examination was conducted for presence of retinal hemorrhages in the posterior pole. Follow-up examinations were performed at 24 and 72 hours. Of the 22 patients, 6 (27%) had retinal hemorrhages at the time of CPR-CC. Of these 6 patients, 5 had risk factors for retinal hemorrhages. The sixth patient had no risk factors and may have represented the only true case of retinal hemorrhages due to CPR-CC. Retinal hemorrhages are uncommon findings after CPR-CC. Retinal hemorrhages that are found after CPR-CC usually occur in the presence of other risk factors for hemorrhage with a mild hemorrhagic retinopathy in the posterior pole.
在无风险因素情况下儿童出现视网膜出血被认为是摇晃婴儿综合征或其他非意外性损伤的特征性表现。医生必须判定无风险因素的儿童视网膜出血是由虐待还是胸外按压心肺复苏术（CPR - CC）导致的。本研究的目的是确定CPR - CC是否会导致儿童视网膜出血。选取了1990年2月15日至1990年6月15日期间在医院接受CPR - CC的22例患者。儿科眼科住院医师携带呼叫器，对心脏骤停情况的呼叫做出响应。在CPR - CC现场，对后极部视网膜出血情况进行间接眼底镜检查。在24小时和72小时进行随访检查。22例患者中，6例（27%）在CPR - CC时出现视网膜出血。在这6例患者中，5例有视网膜出血的风险因素。第6例患者无风险因素，可能是唯一因CPR - CC导致视网膜出血的真实病例。CPR - CC后视网膜出血是不常见的表现。CPR - CC后发现的视网膜出血通常在存在其他出血风险因素且后极部有轻度出血性视网膜病变的情况下出现。
