精神疾病患者致命性窒息：法医证据的系统综述
Fatal Choking in Patients with Psychiatric Disorders: A Systematic Review of Forensic Evidence.
文献信息
| PMID | 42793759 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Lucia Candela |
| 作者单位 | Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy. |
| 期刊 | Diagnostics (Basel, Switzerland) |
| SCI 分区 | Q1 |
| IF | 3.6 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 致命性窒息是一种可预防的机械性窒息原因，由于行为异常、神经系统合并症和药物相关吞咽障碍，其在精神疾病患者中发生更为频繁。本综述旨在强调导致致命性窒息的临床和法医因素，以及多学科方法在其调查中的重要性。方法：按照PRISMA指南进行系统综述，检索PubMed、Scopus和Web of Science。共选择并分析了25项描述成人精神疾病患者致命性窒息并包含法医学调查的研究。结果：精神分裂症是最常报告的精神疾病，其次是双相情感障碍、抑郁症和痴呆。抗精神病药、抗抑郁药、抗焦虑药和其他精神药物反复与吞咽困难和气道保护性反射减弱相关。食团是主要的阻塞物，但也记录了几种不寻常的异物。虚拟解剖、尸检、组织学和毒理学调查始终被证明对于确认气道阻塞、重建死亡机制以及识别 contributing 临床和药理学因素至关重要。结论：精神疾病患者的致命性窒息是一个多因素事件，需要早期风险评估、预防策略和全面的法医评估，以提高患者安全并确保准确确定死因。
英文摘要
Background: Fatal choking is a preventable cause of mechanical asphyxia that occurs more frequently among individuals with psychiatric disorders due to behavioural abnormalities, neurological comorbidities, and medication-related swallowing impairment. This review aims to highlight the clinical and forensic factors contributing to fatal choking and the importance of a multidisciplinary approach to its investigation. Methods: A systematic review was conducted according to PRISMA guidelines by searching PubMed, Scopus, and Web of Science. In total, 25 studies describing fatal choking in adults with psychiatric disorders and including medico-legal investigations were selected and analyzed. Results: Schizophrenia was the most frequently reported psychiatric condition, followed by bipolar disorder, depression, and dementia. Antipsychotics, antidepressants, anxiolytics, and other psychotropic drugs were recurrently associated with dysphagia and reduced airway protective reflexes. Food boluses represented the predominant obstructive material, although several unusual foreign bodies were documented. Virtopsy, autopsy, histological, and toxicological investigations consistently proved essential for confirming airway obstruction, reconstructing the mechanism of death, and identifying contributing clinical and pharmacological factors. Conclusions: Fatal choking in psychiatric patients is a multifactorial event requiring early risk assessment, preventive strategies, and comprehensive forensic evaluation to improve patient safety and ensure accurate determination of the cause of death.