질식사의 새로운 분류에 따른 2012년도 법의부검의 질식사 분류

나주영,박종필,양경무,정낙은,이한영 대한법의학회 2014 대한법의학회지 Vol.38 No.1

No accepted standard currently exists to classify asphyxia and define its subtypes. Sauvageau and Boghossian proposed an asphyxia classification system in 2010 thatdivided asphyxia into suffocation, strangulation, mechanical asphyxia, and drowning. Here, we present a modification of this classification system. We propose to classifyasphyxia into four main categories: suffocation, strangulation, mechanical asphyxia,and complicated asphyxia. Suffocation includes smothering and choking as well asconfined spaces, entrapment, and vitiated atmosphere. Strangulation is subdividedinto hanging, ligature strangulation, manual strangulation, and other unspecified strangulation. Mechanical asphyxia includes positional and traumatic asphyxia. Finally,complicated asphyxia is defined as cases with two or more identifiable mechanisms ofasphyxia. In this study, we review autopsy cases from 2012 diagnosed as asphyxiaand classify them according to our proposed asphyxia classification system. In 24.7%of cases, the age range was 40-49 years, and 51.9% were men. The most commonmethod of asphyxia was hanging (245 cases, 55.1%), followed by ligature or manualstrangulation (53 cases, 11.9%). Most hangings were suicides; smothering, ligature,and manual strangulation were usually homicides. Eighteen cases were complicatedasphyxia. This classification provides a simplified, unified, and useful tool to classifyand understand deaths due to asphyxia.

신생아 질식 환아에서 저산소성 허혈 뇌증의 정도와 급성신부전 발생과의 연관성

박성신,정성훈,송준혁,김선경,조병수,김성도,Park, Sung-Shin,Chung, Sung-Hoon,Song, Jun-Hyuk,Kim, Sun-Kyoung,Cho, Byoung-Soo,Kim, Sung-Do 대한소아신장학회 2007 Childhood kidney diseases Vol.11 No.1

목적 : 급성신부전은 질식 신생아의 사망률과 신경학적 예후와 관련이 있는 것으로 알려져 있다. 이에 본 저자들은 신생아 질식 환아에서 급성신부전의 발생률을 알아보고, 질식과 저산소성 허혈 뇌증의 정도와 급성신부전과의 연관성을 알아보고자 이번 연구를 시행하였다. 방법 : 신생아 질식으로 진단 받은 환아 33명과 임신 기간과 출생체중으로 짝지어진 환아 33명의 의무기록을 후향적으로 검토하였다. 5분 아프가 점수에 의해 신생아 질식의 정도를 경증(6 또는 7), 중등도(4 또는 5), 중증(3 이하)으로 세분하였으며, Sarnat and Sarnat stage에 의해 저산소성 허혈 뇌증의 단계를 분류하였다. 생후 3일에 측정한 혈청 크레아티닌, 혈액요소질소, 전해질 수치와 소변배출량, 혈뇨와 단백뇨 유무에 대한 기록을 검토하였다. 영상 검사를 통해 진단 받은 뇌실 내 출혈의 유무와 정도를 비교하였다. 결과 : 질식군 8명(24.2%)에서 급성신부전이 발생하였다. 이 중 3명(37.5%)이 감뇨성 급성신부전을 보였다. 경증 질식 1명(10.0%), 중등도 질식 2명(18.2%), 중증 질식 5명(41.7%)에서 급성 신부전이 발생하였다(P>0.05). 뇌증 1단계 1명(25%), 뇌증 2단계 4명(50%), 뇌증 3단계 3명(75%)에서 급성신부전이 발생하였다(P<0.01). 5분 아프가 점수에 의한 질식의 정도와 저산소성 허혈뇌증 단계와의 통계학적 연관성은 없었다. 뇌실내 출혈 1단계 1명(7.7%), 2단계 0명, 3단계 2명(66.7%), 4단계 2명(100%)에서 급성신부전이 발생하였다(P<0.01). 급성신부전이 발생한 집단에서 발생하지 않은 집단보다 사망률이 더 높았다. (P<0.05). 감뇨성과 비감뇨성 급성신부전 간의 차이는 없었다. 결론 : 저산소성 허혈 뇌증이 심할수록 급성신부전 발생률이 높았으며, 급성신부전 발생 집단에서 예후가 더 좋지 않았다. 저산소성 허혈 뇌증환아에서 급성신부전을 조기에 진단하여 적절한 수액 및 전해질 공급을 하여야겠다. Purpose : We performed this study to determine the incidence of acute renal failure(ARF) in birth asphyxia and to correlate the severity of asphyxia and hypoxic-ischemic encephalopathy (HIE) and ARF in asphyxiated neonates. Methods : Data was retrospectively collected from the medical records of 33 patients with neonatal asphyxia and of 33 neonates with no asphyxia. On the basis the 5-minute Apgar score, the asphyxiated neonates were further grouped into mild(6 or 7), moderate(4 or 5), and severe asphyxia(3 or less). Asphyxiated neonates with HIE were staged by the Sarnat and Sarnat scoring system. We compared serum creatinine, blood urea nitrogen, electrolytes, and urine output on day 3 of life and the incidence and severity of intraventricular hemorrhage(IVH) between each group. Results : ARF occurred in 8(24.2%) asphyxiated neonates. Of these, 3(37.5%) were oliguric, while 1(10.0%) patient with mild asphyxia, 2(18.2%) of moderate asphyxia, and 5(41.7%) with of severe asphyxia had ARF(P>0.05). One(25%) patient with stage I HIE, 4(50%) with stage II HIE, and 3(75%) of HIE with stage III HIE developed ARF(P<0.01). There was no statistical correlation between the severity of asphyxia and HIE stage. One(7.7%) patient with grade 1 IVE, 0(0.0%) with grade 2 IVH, 2(66.7%) with grade 3 IVH, and 2(100.0%) with grade 4 IVH had ARF(P<0.01). Mortality was higher in asphyxiated neonates with ARF(P<0.05). There was no significant difference between the oliguric and non-oliguric renal failure. Conclusion : We found that the greater the degree of HIE, the higher was the incidence of ARF. Asphyxiated neonates with ARF had a poorer prognosis.

신생아가사에서 청성뇌간유발반응의 변화

임순광,김성준,마득문,이광선 釜算慶南耳鼻咽喉科學會 1993 임상이비인후과 Vol.4 No.1

Prognostic factors of neurological outcomes in late-preterm and term infants with perinatal asphyxia

Sun Young Seo,Gyu Hong Shim,Myoung Jae Chey,Su Jeong You 대한소아청소년과학회 2016 Clinical and Experimental Pediatrics (CEP) Vol.59 No.11

Purpose: This study aimed to identify prognostic factors of neurological outcomes, including developmental delay, cerebral palsy and epilepsy in late-preterm and term infants with perinatal asphyxia. Methods: All late-preterm and term infants with perinatal asphyxia or hypoxic-ischemic insults who admitted the neonatal intensive care unit of Inje University Sanggye Paik Hospital between 2006 and 2014 and were followed up for at least 2 years were included in this retrospective study. Abnormal neurological outcomes were defined as cerebral palsy, developmental delay and epilepsy. Results: Of the 114 infants with perinatal asphyxia, 31 were lost to follow-up. Of the remaining 83 infants, 10 died, 56 had normal outcomes, and 17 had abnormal outcomes: 14 epilepsy (82.4%), 13 cerebral palsy (76.5%), 16 developmental delay (94.1%). Abnormal outcomes were significantly more frequent in infants with later onset seizure, clinical seizure, poor electroencephalography (EEG) background activity, lower Apgar score at 1 and 5 minutes and abnormal brain imaging (P<0.05). Infants with and without epilepsy showed significant differences in EEG background activity, clinical and electrographic seizures on EEG, Apgar score at 5 minutes and brain imaging findings. Conclusion: We should apply with long-term video EEG or amplitude integrated EEG in order to detect and management subtle clinical or electrographic seizures in neonates with perinatal asphyxia. Also, long-term, prospective studies with large number of patients are needed to evaluate more exact prognostic factors in neonates with perinatal asphyxia.

Prognostic factors of neurological outcomes in late-preterm and term infants with perinatal asphyxia

Seo, Sun Young,Shim, Gyu Hong,Chey, Myoung Jae,You, Su Jeong The Korean Pediatric Society 2016 Clinical and Experimental Pediatrics (CEP) Vol.59 No.11

Purpose: This study aimed to identify prognostic factors of neurological outcomes, including developmental delay, cerebral palsy and epilepsy in late-preterm and term infants with perinatal asphyxia. Methods: All late-preterm and term infants with perinatal asphyxia or hypoxic-ischemic insults who admitted the neonatal intensive care unit of Inje University Sanggye Paik Hospital between 2006 and 2014 and were followed up for at least 2 years were included in this retrospective study. Abnormal neurological outcomes were defined as cerebral palsy, developmental delay and epilepsy. Results: Of the 114 infants with perinatal asphyxia, 31 were lost to follow-up. Of the remaining 83 infants, 10 died, 56 had normal outcomes, and 17 had abnormal outcomes: 14 epilepsy (82.4%), 13 cerebral palsy (76.5%), 16 developmental delay (94.1%). Abnormal outcomes were significantly more frequent in infants with later onset seizure, clinical seizure, poor electroencephalography (EEG) background activity, lower Apgar score at 1 and 5 minutes and abnormal brain imaging (P<0.05). Infants with and without epilepsy showed significant differences in EEG background activity, clinical and electrographic seizures on EEG, Apgar score at 5 minutes and brain imaging findings. Conclusion: We should apply with long-term video EEG or amplitude integrated EEG in order to detect and management subtle clinical or electrographic seizures in neonates with perinatal asphyxia. Also, long-term, prospective studies with large number of patients are needed to evaluate more exact prognostic factors in neonates with perinatal asphyxia.

특이한 형태의 질식사 2예 보고

나윤설,박지혜 대한법의학회 2020 대한법의학회지 Vol.44 No.3

Asphyxia is primarily observed in either suicide or homicide. We encountered two unusual autopsy cases, which were extremely rare and atypical, with respect to the manner or cause of death. The first victim demonstrated external findings of a transverse ligature mark around his neck and foreign material in the form of flour or kneaded flour in the whole airway, including the oral and nasal cavity. Based on the scene investigation images and autopsy findings, we identified that the victim attempted to strangle himself with a necktie first, but failed. He then inhaled flour and suffocated. The second victim, who died while sleeping, had a transverse ligature mark around her neck with marked facial congestion, multiple petechia of the conjunctiva and oral mucosa, and extensive hemorrhage of the neck muscles. Police investigation found the deceased stuck in a massage machine without the protective cover that prevents small objects being sucked into the machine. Her death was ruled to be accidental. We present two unusual cases of asphyxia, discuss the mechanism of asphyxia in each case, and review the literature.

외상성 가사 : 3 Case Report 3례 보고

김정택,백광제,선 경,김광호,전영진,이용주,이성우,김준식 대한응급의학회 1997 대한응급의학회지 Vol.8 No.3

Traumatic asphyxia is a clinical symptom complex characterized by craniofacial cyanosis, subconjunctival hemorrhage, and head and neck vascular engorgement due to sudden compressive injury on the thoracic cage. It is occasionally combined with mental deterioration, lung contusion, and edema. It is considered due to increased intrathoracic pressure in state of closed epiglottis. Recently, we had experienced three cases of traumatic asphyxia of which clinical courses were somewhat different. The first case developed by a compression between a elevator and the ground while the victim did not realized the accident happening, and the patient showed nonspecific facial edema and ecchymosis but mental deterioration and ultimate respiratory failure. The second case by a compression between cars, while the impending accident was noticed by the victim, showed full-blown asphyxia without mental or respiratory symptoms. The last case by forceful coughing and vomiting showed facial edema and ecchymosis without any other symptoms. Hospital course of all cases were uneventful. We believe that "fear response" or "closure of the epiglottis" might be an important mechanism on developing symptom of traumatic asphyxia.

만삭아에서 발생한 신생아 경련의 임상 양상과 위험인자

김민영(Min Young Kim),서은숙(Eun Sook Suh) 대한소아신경학회 2009 대한소아신경학회지 Vol.17 No.1

목적:신생아 경련은 신생아의 신경학적 문제를 초래하고 신생아 유병률 및 사망률과 중요한 연관성을 가진다. 그 중 만삭아 경련의 원인에 대해서는 아직 잘 알려져 있지 않다. 저자들은 만삭아 경련 발생의 위험인자에 대하여 알아보고, 임상적 특징에 관하여 분석해 보고자 하였다. 방 법:환자-대조군 빈도 짝짓기 연구 방법을 이용하여 후향적 의무기록을 분석하였다. 만삭아 경련에 대한 위험인자로 신생아와 모성 측면의 인자를 포함하였고 만삭아 경련의 발생 시기, 발생형태, 뇌파 및 영상학적 소견, 치료 반응 등을 분류하였다. 결 과:만삭 신생아의 경련 발생에 영향을 미치는 위험인자로서 신생아 가사가 대조군과 비교하여 통계적으로 유의한 차이를 보였다(P<.01). 모성 측면의 위험인자에 대한 연구가 다양하게 이뤄져 왔으나 본 연구에서는 통계적으로 유의한 인자는 관찰되지 않았다. 경련의 발생 시기는 전반적으로 고른 분포를 나타냈으나, 신생아 가사에 의한 경련은 9명 중 8명(88.9%)이 48시간 내 발생하면서 조기에 유발되었다. 경련 형태는 다양하였지만 신생아 가사를 보인 만삭 경련아의 9명 중 5명(55.5%)이 비전형적 경련 형태를 보이면서 신생아 가사에서 나타나는 가장 흔한 경련 형태로 관찰되었다. 그러나 전신 강직성 경련은 경련이 조절되지 않은 환아 6명 중 3명(50%)에서 관찰되었고 예후가 가장 좋지 못하였다. 뇌파는 검사를 시행한 34명의 환아 중 29명(85.3%)이 이상 뇌파 소견을 나타내어 진단적 도움이 되었다. 뇌영상학적 검사로 MRI, CT, 초음파를 44명에게 시행하였으나 진단적 특이 소견은 없었다. 만삭아 경련아에게 항경련제의 사용은 투여하지 않았을 경우보다 투여한 경우가 경련 조절에 효과적이었다. 1차 항경련제로 phenobarbital을 사용하였고 2차 항경련제로 phenytoin을 투여하였으며, 경련아 48명 중 23명(48.0%)은 1차 phenobarbital 투여만으로도 경련이 조절되었다. 대사성 장애에 의한 경련은 항경련제 도움 없이 대사 이상의 교정만으로도 경련이 조절되기도 하였으나, 항경련제를 동시에 투여하기도 하여 감별이 어려웠다. 그러나 신생아 경련은 급성 발작 형태로 나타나며 신경학적 장애를 더 악화시킬 수 있으므로 경련이 발생하면 우선적으로 항경련제를 투여하는 방향을 고려해야 할 것으로 여겨진다. 결론:만삭아에서 발생한 경련의 위험인자에 대한 연구를 통하여 신생아 가사는 만삭아 경련을 유발하는 가장 흔하고 중요한 인자였다. 그 외에 보고된 여러 위험인자들이 있으나 본 연구에서는 통계적 유의성을 발견하지 못하였으며, 앞으로 더 심도 있는 연구가 요구된다. 신생아 가사에 의한 만삭아 경련은 조기에 발생하고 항경련제에 대한 저항성이 크며 사망 혹은 심각한 신경학적 후유증을 남길 수 있다. 따라서, 신생아 가사에 의한 만삭아 경련을 규명하고 관련 위험인자에 대한 더 많은 연구를 통하여 경련의 발생을 예측하고 미리 관리하는 것이 도전 과제로 남는다. Purpose:Neonatal seizures reflect neurologic disorders, affecting neonatal morbidity and mortality. Nevertheless, risk factors for seizures in term infants have been less well defined. We studied risk factors and clinical manifestations associated with term neonatal seizures. Methods:We used retrospective case-control frequency matching study. We not only identified risk factors for term neonatal seizures, but also analyzed day of seizure onset, seizure types, findings of EEG and neuroimagings, and response to treatment. Results:Our data showed that asphyxia is the most important risk factor for neonatal seizures in term infants. We could not find the relationship between the maternal risk factors and the risk of term neonatal seizures. Days of seizure onset were diverse. The seizures caused by asphyxia occurred earlier, of which 90% did within the first 48 hours. Various types of seizures were observed of which subtle seizures were the most common type in neonatal asphyxia. EEG was diagnostically available. However, it did not provide critical evidence to predict prognosis of their seizures. Neuroimaging studies were not helpful for the clinical diagnosis. Term infants with seizures who used antiepileptic drugs showed effective responses in managing seizures. There were no sustained seizures in 48 % of all cases who used phenobarbital only. Conclusion:We confirmed neonatal asphyxia is the most important risk factor for term neonatal seizures. Other risk factors are required to be further evaluated. We should identify and establish etiologic risk factors for term neonatal seizures particularly following neonatal asphyxia, and challenge to predict seizure onset and manage presumed seizures in advance.

신생아 가사의 신경학적 예후에 대한 혈중 효소들의 예측도

김기혁,김두산,홍성진,오명호,심재건 건국대학교 의과학연구소 1999 건국의과학학술지 Vol.9 No.-

Perinatal asphyxia is one of the most important factors contributing to neonatal morbidity and mortality. However, no clear-cut parameters exist which enable an early identification of neonates who are at risk to develop brain damage. We measured creatine kinase(CK), CK isoenzyme, AST, ALT, LDH in full term asphyxiated(n=35) and healthy(n=39) newborns at 6-10 hours after birth to establish the values of these enzymes in the retrospective diagnosis of asphyxia and if serum levels of these enzymes correlated with the abnormalities of neurosonography or auditory evoked potential. The asphyxiated newborns had significantly increased serum activities of CK-BB(93.5±160.8 IU/L) and CK-BB%(11.1±12.4%) compare to controls(39.2±37.2 IU/L, 3.9±3.4%). However, there were no significant differences in the enzyme activities between normal and abnormal groups of neurosonography or auditory evoked potential. It is concluded that elevated CK-BB and CK-BB% are reliable indicator of the neonatal asphyxia. But the predictive value of specific enzymes for the development of neurologic disorders is not clear. Prospective long-term follow up studies are necessary to evaluate the predictive value of enzyme activities for the neurologic outcome.

주산기 가사의 저체온 치료

이병섭 ( Byong Sop Lee ) 대한주산의학회 2011 Perinatology Vol.22 No.1

Several well-designed multicenter clinical trials of therapeutic hypothermia, maintaining rectal temperature of 33-34℃ for 72 hours in neonates suffered from perinatal asphyxia, have demonstrated both safety and efficacy of therapeutic hypothermia in improving survival and neurodevelopmental outcomes. However, issues regarding the optimal cooling method, the target temperature and the duration of the hypothermia remain unsettled. To overcome limited efficacy of therapeutic hypothermia in the subgroup of infants with severe hypoxic ischemic encephalopathy, a few promising hypothermia-combined therapies, targeting the several steps in the pathogenesis of hypoxic ischemic encephalopathy, are now under investigation. Further data on the neurodevelopmental outcome of the study population of the finished or ongoing clinical trials, during the childhood period or thereafter, are required to settle therapeutic hypothermia as a standard of care against perinatal asphyxia. Nationwide establishment of efficient patient referral system and intimate communication of cooling protocol between obstetricians and neonatologists will make therapeutic hypothermia in neonates more available in Korea.