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大鼠电击死后心肌骨骼肌脑的病理学观察
http://www.100md.com 《温州医学院学报》 1999年第1期
     作者:李兴彪1 董缪武1 朱金昌1 方周溪2

    单位:1 温州医学院病理解剖学教研室(325027); 2 温州医学院电镜室

    关键词:电击死;心脏损伤 骨骼肌损伤;脑损伤;病理学

    温州医学院学报990106

    摘 要 目的 探讨电击死后心肌骨骼肌脑的损伤病理机制。方法 将电线连接大白鼠左前肢和右后肢,右前肢和左后肢,左耳和右后肢,右耳和左后肢,用220V,5MA交流电定时电击,制造电击死时心肌(左心室)、骨骼肌(四肢)、脑的损伤的动物模型。结果 光镜下心肌纤维广泛断裂,间质出血,小血管周围水肿,心肌灶性坏死;骨骼肌肌纤维呈碎裂及断裂,部分肌纤维发生凝固性坏死;脑神经细胞变性,尼氏小体消失,染色质溶解。电镜下心肌线粒体嵴排列紊乱,个别嵴溶解,轻度水肿,有透明血栓形成,内皮细胞不清楚,基底膜疏松,肌纤维中部分线粒体肿胀,嵴消失,其排列紊乱,集合成束;骨骼肌肌纤维中间可见两条带状坏死,部分肌丝有溶解现象,上图局部放大,可见肌丝排列紊乱、断裂、均质化,肌浆网扩张;脑组织神经胶质细胞核肿胀,胞浆结构模糊,核蛋白体部分消失,部分不正常聚集成堆,基底膜水肿,Will’s间隙扩张,未见足突,神经胶质细胞胞浆见大量空泡。结论 本实验光镜和电镜的研究对电击死法医学鉴定提供病理学基础。
, 百拇医药
    Experimental study on cardiac muscle skeletal muscle brain after electrocution Li Xingbiao,Dong Miaowu,Zhu Jincang,et al.Department of Pathology,Wenzhou Medieal College,325027

    Abstract Objective:To explore the pathogenesis of muscle injury skeletal muscle injury brainl injury after electrocution.Methods:for the purpose of establishing on animal model of cardial injury,skeletal muscle injury,brainal injury after electrocution,the right from limbs and the right hind limbs,the right from limbs and left hind limbs,the right ear and the left hind limbs,the left ear and the right hind limbs of the rabbits were connected to the electric apparatus within the alternative of 5mA,220V.Results:Under light microscope,there are fragmentation of myocardical fibrils,the edema around small vasculars,focal necrosis of myocardium;the skeltal muscle fibers are breaking and rupturing,part of muscle fibers become coagulative necrosis;the neuron's cells of brain become degeneration,Nissl body disappeared,chromation become lysis.Under electron microscope,cardiac muscle derangement of mitochoudrious crista,dissolution and slight edema of indivianal crista,transparent thrombogensis,obscure epithelium cells,loose basement memebrane are found.Part of mitochoudrious in muscle fiber are swollen and loss of deranged and fasciculated crista are observed Necrosis of two band material in the skeletal muscle's fiber and dissolution of myofilament are seen.Derangement,fragmentation,swelling and homogenesis of myofilanent and dilifation of sacroplasm net can be found in the local magnified picture of the above.Swollen neuroglia neucleus obscure plasma structure,partial loss of ribosome and abnormal accumulation are found of cerebral tissues.Basement membrane edema,dilitation and exparsion of Will's interittence are also observed.No foot process is seen.There's large amount of vacuole in neuroglia plasma.Conclusion:This study provide the pathological basis for the forensic investigation of cases died from the electric cution of the light microscope and the electric microscope.
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    Key words Electrocution Heart injuries Skeletal Muscle injurieo Brain injuries Pathology

    低压电电击死的法医学鉴定在形态上主要依据皮肤电流斑来确定,但在实际检案工作中尚有电流斑不明显,甚至不存在的案例,使鉴定工作产生一定难度。因此有必要研究电击对其它脏器损伤特别是心脏损伤、骨骼肌损伤及脑损伤的病理机制。本文通过动物实验从病理组织学和超微结构水平观察电击死后大白鼠的心脏、骨骼肌、脑损伤的病理改变,对电击死的法医学鉴定提供病理学基础。

    1 材料和方法

    1.1 动物及动物分组:大白鼠6只(温医动物房提供),体重250~300g,雌雄不限。随机分为电击死组(4只)和对照组(2只)。

    1.2 方法:将电线两端分别固定在电击死组动物的左前肢和右后肢,右前肢和左后肢,左耳和右后肢,右耳和左后肢,接上220V、5mA交流电,触电死后即刻分别取出心脏、骨骼肌、脑组织,用2.5%戊二醛作前固定,1%锇酸作后固定,Epon 812包埋,LKB-V型超薄切片机切片,H-500型透射电镜观察,其它部分组织用10%福尔马林固定,石蜡包埋,常规切片,HE染色光镜观察。
, 百拇医药
    2 结果

    2.1 光镜观察:左心室心肌纤维广泛断裂,间质出血,小血管周围水肿,心肌灶性坏死(见封3图1);骨骼肌纤维呈碎裂及断裂,部分肌纤维发生凝固性坏死(见封3图2);脑神经细胞变性,尼氏小体消失,染色质溶解。电镜观察:心肌线粒体嵴排列紊乱,个别嵴溶解,轻度水肿,有透明血栓形成,内皮细胞不清楚,基底膜疏松,肌纤维中部分线粒体肿胀,嵴消失,其排列紊乱,集合成束(见封3图4,5);骨骼肌肌纤维中间可见两条带状坏死,部分肌丝有溶解现象,上图局部放大,可见肌丝排列紊乱,断裂,均质化,肌浆网扩张(见封3图6);脑组织神经胶质细胞核肿胀,胞浆结构模糊,核蛋白体部分消失,部分不正常聚集成堆,基底膜水肿,扩张,Will's间隙扩张,未见足突,神经胶质细胞胞浆见大量空泡。

    图1(HEX400)心肌纤维广泛断裂,间质出血,心肌灶性坏死。
, 百拇医药
    Photo 1.Cardiac mucles show widespread myocardial fragment, focal necrosis of myocardium

    图2(HEX400)四肢骨骼肌纤维呈断裂,部分肌纤维发生凝固性坏死。

    Photo 2.The skeletal muscle fibers are rupturing and breaking, part of muscle fibersbecome coagulative necrosis

    图3(EMX12000)心肌线粒体嵴排列紊乱,个别嵴溶解,轻度水肿。
, 百拇医药
    Photo 3. Cardiac muscle derangement of mitochoudrious crista, dissolution and slight edema of individnal crista

    图4(EXM12000)血管腔小,有透明血栓形成,内皮细胞不清楚,基底膜疏松、肌纤维中部分线粒体肿胀、嵴消失部分线粒体排列紊乱、集合成束。

    Photo 4. Transparent thrombogensis,obscure epithelium cells loose basement membrane are found. Part of fiber are swollen and loss of deranged and mitochoudrious in muscle fasciculated crista are observed
, 百拇医药
    图5(EMX12000)四肢骨骼肌纤维中间可见两条带状坏死,部分肌丝有溶解现象。

    Phtot 5. Necrosis of two band material in the skeletal musce's fiber and dissolution of mylilament are seen

    图6(EMX16000)上图部分放大,可见肌纤维排列紊乱,断裂,均质化,肌浆网扩张。

    Photo 6. Derangement, fragmention, swelling and homogenesis of myofilament and dilitation of sacroplasm net can be found in the local magnified picture of the above
, 百拇医药
    3 讨论

    3.1 电击死后心肌、骨骼肌、脑的主要病理变化

    3.1.1 低压电击死后心肌病理改变可以归纳如下 光镜观察:心肌纤维广泛断裂,断裂处间隙明显增宽、水肿、间质内多处出血,心肌灶性坏死;电镜观察:心肌线粒体嵴排列紊乱,个别嵴溶解,轻度水肿,有透明血栓形成,内皮细胞不清楚,基底膜疏松,肌纤维中部分线粒体肿胀,嵴消失,排列紊乱,集合成束,心肌肌膜与肌原纤维分开,肌原纤维灶性溶解,血管周围疏松水肿,部分线粒体水肿,其中充满水肿液。

    3.1.2 低压电电击死后骨骼肌病理改变可以归纳如下 光镜观察:骨骼肌纤维呈碎裂及断裂,部分肌纤维发生凝固性坏死;电镜观察:肌纤维中间可见两条带状坏死,部分肌丝有溶解现象,上图局部放大,可见肌丝排列紊乱,断裂,均质化,肌浆网扩张,线粒体重度水肿,线粒体嵴消失。

    3.1.3 低压电电击死后脑病理改变可以归纳如下 光镜观察:脑神经细胞变性,尼氏小体消失,染色质溶解;电镜观察:脑神经细胞结构模糊,基底膜水肿,扩张,Will's间隙扩张,未见足突。
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    3.2 产生上述病理变化的机理可能为 电流通过人体,克服人体组织电阻时产生的热能所致损伤,局部温度升高;使电流通过人体,能使人体细胞内的离子平衡发生变化,产生电泳、电渗反应,细胞发生极性化,细胞的化学成份发生变化[1,2],从而使心脏、骨骼肌、脑发生上述病理变化,电击死死因的机理一般认为是呼吸麻痹,脑干及颈髓上部受损或心室纤维颤动而致死[3],所以电流损伤程度与电流强度及持续时间成正比,与人体电阻成反比[4,5]

    3.3 心脏、骨骼肌、脑的病理变化的法医学意义

    对于大多数电击死的案例,皮肤电流斑形成是法医学鉴定的主要依据。对于少数电击死者可以没有电流斑无其它任何电击迹象[6,7]。据统计,220V或更低电压的电击死案例,仅1/3出现电流斑[8],触电而不产生电流斑的原因,主要是局部产生的焦耳热量不足以形成电流斑[9]。当电击死案例无皮肤电流斑形成时,心脏、骨骼肌、脑的病理改变则具有参考性鉴定价值。如出现上述病理变化,结合现场勘验,案情调查,可以确定为电触死。
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    4 参考文献

    [1] Art2,C P.Changing concepts of electrical injury.Am J Surg,1990,128∶600~604

    [2] Bernstein,T.Effects of electricity and lighting on man and animals.J Forensic Sci,1992,18∶3~10

    [3] Burris,L.Misra Al,Gustafsson,et al.Histchemical examination of elecrical injuries.Acta Histochem(Jena),1993,30∶355~361

    [4] Ponten,B.Vasallip,Matswki,et al.New observations on tissue changes along the pathway of the current in an electrical injury.Scand J plast Reconstr Surg,1995,4∶76~85
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    [5] Chang shong Ku,Ferak V,Kambon MI,et al.Myocardial damage associted with electrical injury.Am Heart J,1989,118∶621

    [6] James TN,Maples WR,Solheim T,et al.Cardiac abhormalities demonstrated postmontem in four cases of accident electrocution and their potenial significance ralative to nonfatal electrieal injuries of the heart.Am Heart J,1990,120∶143

    [7] Puschel K,Hongwei S,Jingtao J,et al.Ultrastructural alternation of skeletal muscles after electric shoch.Am J Forensic Med Pathol,1995,6(4)∶295

    [8] Walton As,Toyohito H,Hames B D,et al.Myocaridal infarction after electrocution.Med J Aust,1990,148(5)∶365

    [9] Holbrook,L.A.Delayed myelopathy.Arare complicatiow of severe electrical burns.Br Med J,1992,4∶245~300

    (收稿:1998-10-10,修回:1998-11-24), 百拇医药(李兴彪1 董缪武1 朱金昌1 方周溪2)