死亡学与因果关系学.ppt

法医因果关系学 Medicolegal Causationism  法医死亡学( medicolegal thanatology) ■概念 concept:研究死亡案件的生物医学证据的检验鉴 定科学 examination of biomedical evidence on the death 内容 content:①死因原因 cause of death;②死亡机理 mechanism of death;③死亡过程 process of death;④死亡 概念 concept of death;⑤死亡标志 determination of death; ⑥死因分析 analysis of death cause;⑦死亡性质 nature of death;⑧死亡方式 manner of death;⑨死亡证明 certification of death;⑩相关立法 lawmaking 网网  法医学实用法医学定新进展 法医病理司法鉴定实务 变上 法医学 法医学 法医学 法医学 第三版 FORENSIC MEDICINE 法医学 Forensic 法医学 医 Medicine 第2版  死亡的确定 Determination of death 呼吸循环标准: traditional signs of death→ cardio-respiratory arrest before 1960s 挑战 challenge: stop of heartbeat or respiration≠ death ①人工器官: artificial respirator/ heart/kidney /liver., cardiac activator-maintenance of an oxygenated circulation on corpse ②器官移植 transplantation of heart/ lung /liver/ kidney,etal 脑死亡 brain death criteria:1968, America brain stem death, whole brain death cortical death  脑死亡的标准 Criteria of brain death 临床诊断标准 criteria of clinical diagnosis on brain death:国 (1)不可逆性脑损害 irremediable brain damage (2)意识丧失 consciousness loss( deep coma (3)自主呼吸丧失 losing spontaneous respiration (4)脑干反射丧失 losing brain- stem reflex:①中脑 unreactive to light → midbrain( mesencephalon), dilatation and fixed pupil;②桥脑 corneal reflex, vestibule-ocular reflex loss -,pon no responses to ainful stimuli;③延脑 vomit reflex→ oblongata( upper medullar 仪器诊断 Assistant test on brain death: ① Electroencephalography→“ flat wave”;② Cerebral angiography “ cold brain”;③ Cerebral blood flow→stop 诊断权利分离原则 Principle of diagnostic right separation 1by tow doctors, a treating and a independent (at least 5 years and experience of such case); diagnosis again in 6-12 hours interval 3none of the doctor concerned with the transplant organ  脑死亡与植物状态的鉴别 Distinction of brain death and vegetative state 项目 脑死亡 植物状态 概念全脑功能丧失 大脑认知功能丧失 病理基础脑干或全脑中枢损害脑皮质广泛损害 意识状态意识丧失 无意识醒觉状态 自主呼吸无 脑干反射无 复苏可能无 有有有 维持心跳72小时 3个月 Concept: cort