屍體口鼻出現泡沫在法醫學上代表之意義及影響因素之探討

人類在死亡時偶而會發現口鼻溢出泡沫，此種徵象是法醫學判斷死亡原因的一項重要依據。但實務上發現許多種死因均會有此表徵出現，例如溺水、海洛英中毒、有機磷農藥中毒、癲癇、觸電死亡，甚至急性心臟死亡者，口鼻也偶會發現泡沫，故本篇研究的目的在於探討各種死因死者出現口鼻泡沫的頻率，那些因素會影響口鼻泡沫的出現，以及出現口鼻泡沫死者的器官重量變化的評估。本篇研究選取2005年1月至2006年間12月共24個月南投地區相驗及解剖案例共120例，其中口鼻出現泡沫者31例（25.8%），另外口鼻未出現泡沫者89例（74.2%）。口鼻出現泡沫者中為呼吸死有26例（83.9%）；非呼吸死5例（16.1%）。若以口鼻出現泡沫者為實驗組，口鼻未出現泡沫者為對照組，將死者年齡、死後時間、有無送醫、季節溫度、屍體徵象（包括瞳孔大小、有無充血、有無點狀出血、指甲有無發紺）、有無病史、死亡方式、死亡原因分別進行卡方檢定，發現有無送醫、眼瞼有無充血、年齡、死亡方式、死後間隔時間與有無口鼻泡沫在統計上有顯著相關（p<0.05）；再進一步以此五項變因作為自變項，有無口鼻泡沫為依變項，進行二元邏輯式迴歸分析（binominal logistic regression），結果發現有無送醫、年齡影響口鼻泡沫的出現較顯著。另外將其中29例有進行解剖案例分析口鼻泡沫與肺臟重量、心臟重量、脾臟重量、肺-心重量比、肺-脾重量比的相關性，發現口鼻出現泡沫者的肺-脾重量比顯著高於口鼻未出現泡沫者的肺-脾重量比。屍體口鼻溢出泡沫雖非特異性症狀，但卻大部分出現在呼吸死的死者，在相驗屍體過程中，尤其應注意死者在發現死亡前有無送醫及死者年齡，是否因上述因素影響口鼻泡沫的出現。

關鍵字

口鼻泡沫；肺水腫；法醫學

並列摘要

The human was found to have external foam overflowing from nose and mouth while dying, and this is an important sign to judge the cause of death in forensic medicine. In practice, several cause of death, such as drowning, heroin poison, organic phosphorus poison, epilepsy, electric shock and acute heart death, will have this sign, frothy foam in oronostril. The purpose of this study was to distinguish the frequency of frothy foamy fluid from various causes of death and the factors that relate to the appearance of frothy foam in oronostril. Additionally, the weight of organs of victim who appears the frothy foam in oronostril were also assessed. A retrospective study was conducted into two-group using a two-year victim examination report from the County of Nantou in this study. All 120 cases were divided into two groups: 31 (25.8%) cases appearing the frothy foam in oronostril as experiment group and 89 (74.2%) cases not appearing frothy foam in oronostril as the control group. In all cases of victims appearing frothy foam in oronostril, respiratory death and non-respiratory death have 26 (83.9%) cases and 51 (6.1%) cases, respectively. Victim age, postmortem interval, resuscitation history, season and temperature, sign of body (including pupil size, congestion, petechiae, finger cyanosis), disease history, manner of death, cause of death were analyzed as independent variables in Chi-square analysis. The result indicated that there are statistically significant differences among resuscitation history, congestion, age, manner of death, and postmortem intervals. Furthermore, the statistically significance has been found among resuscitation history and age by binominal logistical regression. In addition the 29 cases that have been autopsied were used to analyze the relationship of appearing frothy foamy fluid in oronostril and lung weight, heart weight, spleen weight, lung-heart weight ratio, and lung-spleen weight ratio. The result indicated that the lung-spleen weight ratio of victims appearing frothy foamy fluid in oronotril was higher than victims not appearing frothy foamy fluid in oronostril. Although appearing frothy foamy fluid in oronostril is a non-specific sign, it exists in the most cases of respiratory death. In the course of examination of corpse, should be noticed the resuscitation history and age of victim whether or not it influence the appearing frothy foamy fluid in oronostril.

並列關鍵字

frothy foamy fluid in oronostril ； pulmonary edema ； forensic science

參考文獻

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屍體口鼻出現泡沫在法醫學上代表之意義及影響因素之探討

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