Meng Y L, Sun L P, Zhou Y H, Jing C, Wang Q, Li D R
School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China.
Institute of Forensic Medicine, National Taiwan University, Taipei 100, China.
Zhonghua Shao Shang Za Zhi. 2019 May 20;35(5):395-397. doi: 10.3760/cma.j.issn.1009-2587.2019.05.014.
On September 7th, 2017, one female patient, aged 48 years with deep partial-thickness flame burn on face, upper limbs, trunk, and lower limbs of 40% total body surface area was admitted to the First People's Hospital of Foshan City. After admission, active fluid replacement, anti-infection, nutritional support, and other treatments were performed. After debridement and skin grafting for 3 times and blood transfusion for 2 times, the patient recovered well. On the 20th day post admission, sudden heartbeat and respiratory arrest happened, and the patient died after ineffective rescue. Autopsy showed that thrombus formed in right internal jugular vein and deep veins of lower extremities, and vascular lumina of the bilateral pulmonary artery. The direct cause of death was acute pulmonary thromboembolism, but whether the embolus originated from deep vein of lower extremity or right internal jugular vein was not clear. This case suggests that clinician should not only pay attention to the prevention of deep venous thrombosis of lower extremities of burn patients, but also the possibility of internal jugular vein thrombosis, especially for patients with internal jugular vein access.
2017年9月7日,一名48岁女性患者因面部、上肢、躯干及下肢深Ⅱ度火焰烧伤,烧伤面积达体表面积的40%,入住佛山市第一人民医院。入院后,给予积极补液、抗感染、营养支持等治疗。经过3次清创植皮及2次输血治疗后,患者恢复良好。入院第20天,患者突然心跳呼吸骤停,经抢救无效死亡。尸检显示右颈内静脉及双下肢深静脉、双侧肺动脉血管腔内均有血栓形成。直接死亡原因为急性肺血栓栓塞症,但栓子究竟来源于下肢深静脉还是右颈内静脉尚不清楚。该病例提示临床医生不仅要重视烧伤患者下肢深静脉血栓的预防,还要关注颈内静脉血栓形成的可能性,尤其是有颈内静脉置管的患者。