Ruas Francisco, Mendonça M Cristina, Real Francisco Corte, Vieira Duarte Nuno, Teixeira Helena M
Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
Faculty of Medicine, University of Coimbra, Coimbra, Portugal; National Institute of Legal Medicine and Forensic Sciences, Portugal; CENCIFOR - Forensic Sciences Centre, Portugal.
J Forensic Leg Med. 2014 May;24:1-6. doi: 10.1016/j.jflm.2014.02.002. Epub 2014 Feb 12.
This study presents the epidemiology and the postmortem forensic aspects in cases with a carboxihemoglobin (COHb) analysis, from autopsies performed at the Forensic Pathology Department of the Centre Branch of the National Institute of Legal Medicine and Forensic Sciences of Portugal. Between January 2000 and December 2010, 69 COHb analyses were requested in our institution. In approximately 70% of the situations, circumstantial information included a Carbon Monoxide (CO) source at the death scene. More than half of the cases presented thermal lesions, cherry-red lividity, and cherry-red blood and viscera coloration were found in, approximately, 30% of the cases. Fourteen cases were recorded as CO poisonings. The highest number of poisonings occurred in 2000, with most of the cases in winter (53.8%), in 51-60 years-old male individuals. 69.2% of the poisonings were accidental and the remainder were suicides, being fires the most frequent sources of CO (38.5%). Cherry-red lividity was present in 61.5% of the cases, and all of them presented cherry-red blood and viscera coloration. Older individuals and those with thermal lesions presented lower COHb levels, and politrauma was the most frequent cause of death among the negative cases. It is possible to conclude that the forensic aspects of CO poisonings interact in a complex way, and differential diagnosis is not straightforward. This study also emphasizes the role played by public prevention campaigns and improvement of heating appliances in reducing the number of accidental CO poisonings, and the importance of preventing urban and forest fires, the major source of CO among us.
本研究介绍了葡萄牙国家法医学和法医学科学中心分所法医病理科尸检中进行碳氧血红蛋白（COHb）分析的病例的流行病学及死后法医方面的情况。2000年1月至2010年12月期间，我们机构共收到69例COHb分析请求。在大约70%的情况下，间接信息包括死亡现场存在一氧化碳（CO）来源。超过一半的病例有热损伤，约30%的病例出现樱桃红色尸斑以及血液和内脏呈樱桃红色。记录有14例CO中毒病例。中毒病例数最多的年份是2000年，大多数病例发生在冬季（53.8%），患者为51至60岁的男性个体。69.2%的中毒为意外事故，其余为自杀，火灾是最常见的CO来源（38.5%）。61.5%的病例有樱桃红色尸斑，并且所有病例的血液和内脏均呈樱桃红色。年龄较大的个体以及有热损伤的个体COHb水平较低，在阴性病例中，多发性创伤是最常见的死亡原因。可以得出结论，CO中毒的法医方面情况以复杂的方式相互作用，鉴别诊断并非易事。本研究还强调了公共预防运动和改进取暖设备在减少意外CO中毒数量方面所起的作用，以及预防城市和森林火灾的重要性，火灾是我们当中CO的主要来源。
