Grellner W, Madea B, Sticht G
Institute of Forensic Medicine, University of Cologne, Koeln, Germany.
J Forensic Sci. 1996 May;41(3):433-7.
For an evaluation of the survival period in morphine-involved deaths, changes of pulmonary histopathology were investigated in a total of 90 morphine-associated fatalities. Although pulmonary histopathology proved to be heterogeneous, several distinctive histological patterns emerged. While the subgroup with short courses of intoxication ( < 1 h, n = 15) was mostly characterized by slight/moderate alveolar edema (12/15), severe hemorrhages (12/15) and marked acute emphysema (9/15), the phenomena of massive edema (8/15), missing/slight hemorrhages (8/15) and absent/slight emphysema (11/15) dominated in the group with intermediate survival times (1-24 h, n = 15). Intravascular leukocyte accumulations (shock equivalent) occurred in the first group only once, but in the group with the longer survival time in 10 of 15 cases. Delayed deaths ( > 24 h, n = 4) were mainly characterized by purulent bronchitis/pneumonia. Those fatalities (n = 56) that could not be classified by anamnestic data were assessed by histological criteria. In comparison with the evaluation of the survival period by toxicological analyses, concordance was found in 46 cases. Pulmonary histopathology is not a tool for an exact graduation of survival time, but the combination of several key parameters can provide criteria for a differentiation between short ( < 1 h) and longer courses of intoxication.
为评估吗啡相关死亡的生存期，我们对90例吗啡相关死亡病例的肺部组织病理学变化进行了研究。尽管肺部组织病理学表现各异，但出现了几种独特的组织学模式。中毒病程较短（<1小时，n = 15）的亚组主要表现为轻度/中度肺泡水肿（12/15）、严重出血（12/15）和明显的急性肺气肿（9/15），而在生存期中等（1 - 24小时，n = 15）的组中，大量水肿（8/15）、无/轻度出血（8/15）和无/轻度肺气肿（11/15）的现象更为常见。血管内白细胞聚集（类似休克）在第一组仅出现1次，但在生存期较长的组中，15例中有10例出现。延迟死亡（>24小时，n = 4）主要表现为化脓性支气管炎/肺炎。那些无法通过记忆数据分类的死亡病例（n = 56）通过组织学标准进行评估。与通过毒理学分析评估生存期相比，46例病例结果一致。肺部组织病理学并非精确划分生存时间的工具，但几个关键参数的组合可为区分短（<1小时）和长中毒病程提供标准。
