Kroll Mark W, Luceri Richard M, Efimov Igor R, Calkins Hugh
Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota.
Jim Moran Heart & Vascular Research Institute, Holy Cross Hospital (Emeritus), Fort Lauderdale, Florida.
Heart Rhythm O2. 2023 Jun 9;4(7):457-462. doi: 10.1016/j.hroo.2023.06.004. eCollection 2023 Jul.
Electrocution is a death caused by an application of electrical current to the human body. Our present understanding of electrocution-as the induction of ventricular fibrillation (VF)-followed a nearly century-long path of misunderstandings and speculation primarily focused on hypotheses of asphyxia as well as central nervous system trauma. It is hard for us today to appreciate the past mystery of an unexpected sudden death usually bereft of visible trauma. Even today, a false dogma exists that direct-current shocks can cause asystole instead of VF. A lightning discharge (up to 500 megavolts) is differentiated because it can cause substantial acute and chronic neural effects leading to other cardiac arrest rhythms. The human heart is exquisitely sensitive to alternating currents, and VF can be induced with currents of one-eighth that required for mere pacing. Because of these low currents, this effect obtains only in the TQ interval, and low-power electrocution does not involve the vulnerable period. If a current is strong enough to electrocute, generally it will do so in 1-2 seconds; longer shocks do not tend to be more dangerous. Regardless of concomitant drug dosing, the electrocution cardiac arrest rhythm is still VF, suggesting that electrocution is a stand-alone cause of death; the electrical current does not potentiate the effects of the drug. The experimental and clinical data supporting VF as the mechanism for electrocution are provided.
触电是指电流作用于人体导致的死亡。我们目前对触电的理解——即诱发心室颤动（VF）——经历了近一个世纪的误解和猜测，主要集中在窒息以及中枢神经系统创伤的假说上。如今我们很难体会过去那种没有明显外伤却意外突然死亡的谜团。即便在今天，仍存在一种错误的教条，认为直流电击会导致心搏停止而非心室颤动。闪电放电（高达500兆伏）有所不同，因为它会引发大量急性和慢性神经效应，导致其他心脏骤停节律。人类心脏对交流电极为敏感，仅用八分之一用于单纯起搏的电流就能诱发心室颤动。由于这些电流强度低，这种效应仅在TQ间期出现，低功率触电并不涉及易损期。如果电流强度足以致人触电，通常在1至2秒内就会发生；电击时间更长并不一定会更危险。无论同时服用何种药物，触电导致的心脏骤停节律仍是心室颤动，这表明触电是一种独立的死因；电流并不会增强药物的作用。文中提供了支持心室颤动作为触电机制的实验和临床数据。
