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目的探讨交通事故致弥漫性轴索损伤(diffuse axonal injury,DAI)法医精神病伤残鉴定案例的特点、对伤残等级的影响,为此类案例的鉴定提供有益线索。方法收集浙江省嘉兴市康慈医院司法鉴定所2014年1月—2015年6月因交通事故致颅脑损伤伤残鉴定案例530例,分为研究组(合并DAI的颅脑损伤)72例与对照组(未合并DAI的颅脑损伤)458例,调查2组性别、年龄、职业、受教育年限、受伤至鉴定时间间隔、伤后格拉斯哥昏迷评分(Glasgow coma scale,GCS)、伤后昏迷时间、鉴定时头颅CT报告、鉴定时脑电图报告、鉴定诊断意见、鉴定伤残等级等资料,使用t检验、χ~2检验及多元线性回归等方法进行回顾性分析。结果 2组在年龄、受教育年限、受伤至鉴定时间、鉴定时CT报告方面比较差异无统计学意义(P>0.05),在伤后格拉斯哥昏迷评分、伤后昏迷时间、鉴定时脑电图报告比较差异有统计学意义(P<0.05)。研究组伤残等级为7.92±1.39,对照组为8.72±1.51,2组比较差异有统计学意义(P<0.05)。多元线性回归分析提示研究组轻度及中度异常脑电图、昏迷时间、GCS评分是影响伤残等级的相关因素,可以解释伤残等级70.6%的变化;对照组中度异常脑电图、昏迷时间、GCS评分是影响伤残等级的相关因素,可以解释伤残等级81.6%的变化。结论合并DAI的颅脑损伤案例伤残等级更高,伤残等级与伤后GCS评分、昏迷时间及轻度和中度异常脑电图相关。提高对DAI的认识对此类案例鉴定结论的判定会产生积极影响。
Objective To investigate the characteristics of forensic psychiatric disability disability identification cases caused by traffic accidents and its impact on disability grade, and provide useful clues for the identification of such cases. Methods A total of 530 cases of brain injury and disability identification caused by traffic accidents from January 2014 to June 2015 were collected from the judicial appraisal office of Kangci Hospital, Jiaxing City, Zhejiang Province. They were divided into study group (72 cases with brain injury with DAI) The control group (458 subjects without brain injury with DAI) were enrolled in the study. The gender, age, occupation, years of education, duration of injury to identification, Glasgow coma scale (GCS) , Head CT examination on identification, EEG report on diagnosis, identification of diagnostic opinion, identification of disability grade and other data, and t-test, χ ~ 2 test and multiple linear regression were used for retrospective analysis. Results There was no significant difference in the age, years of education, duration of injury, time to identification and CT report in the identification of the two groups (P> 0.05). After injury, the scores of Glasgow coma, coma after injury and EEG reports The difference was statistically significant (P <0.05). The disability grade of the study group was 7.92 ± 1.39 and that of the control group was 8.72 ± 1.51, there was significant difference between the two groups (P <0.05). Multivariate linear regression analysis indicated that mild and moderate abnormal EEG, coma time and GCS score were the related factors affecting the grade of disability in the study group, which could explain the 70.6% change in disability grade. The control group had moderate abnormal EEG, Coma time, GCS score is related to the level of disability factors, can explain the level of disability 81.6% change. Conclusions The brain injury cases with DAI have higher level of disability, and the level of disability is related to post-injury GCS score, coma time and mild and moderate abnormal EEG. Increasing awareness of DAI will have a positive impact on the determination of such cases.