利用死後電腦斷層掃描分析心肺復甦術期間胸外按壓所致之併發症

Abstract

心肺復甦術（CPR）是挽救生命不可或缺的救護程序，然而高強度的胸外按壓常對患者胸廓造成不可避免的併發症與法醫的鑑定挑戰。死後電腦斷層掃描（PMCT）憑藉非侵入性與高敏感度，能捕捉傳統解剖難以發現的深層或微細骨折，成為銜接法醫鑑定的重要技術。本研究旨在透過 PMCT 建構心肺復甦術傷勢之空間分佈圖譜，分析個體特徵（年齡、性別、胸廓尺寸及骨質密度）與胸外按壓所致胸廓、臟器損傷之相關性，並比對司法解剖報告評估 PMCT 在醫源性創傷鑑定上的效能。 研究納入 2024 年間 152 例 18 歲以上、生前施予心肺復甦術且無明顯外力創傷之死者影像資料。結果顯示，肋骨骨折（93%）與胸骨骨折（67%）為最典型之傷勢。肋骨骨折具高度空間規律性，集中於胸廓前側第2至7肋；分佈型態顯示外側與後側肋骨傾向以完全骨折樣態出現。分析證實，性別顯著影響肋骨骨折發生率，男性發生完全骨折的風險為女性之2.4倍，而高齡與低骨質密度為預測骨折數量增加的因子。外，胸廓前後徑較小或胸型扁平（高Haller index）將顯著提升胸骨與後側肋骨骨折之風險。在臟器損傷方面，外側肋骨完全骨折被證實是預測血胸、氣胸發生的關鍵指標，男性、低骨質密度與高齡透過介導外側肋骨完全骨折，提高血胸、氣胸的發生率。一致性比對結果顯示，PMCT在偵測氣胸、不完全骨折及深層後側骨折上，具備優於傳統解剖的診斷優勢。 綜上所述，心肺復甦術所致之創傷並非隨機發生，而是由個體特徵與力學傳導共同導致。本研究建立的傷勢圖譜有助於法醫師鑑別急救傷與暴力創傷，排刻板印象，建立客觀且完整的鑑定真相；同時亦為臨床醫療提供併發症預警指標，在追求救治效益與維護生命尊嚴之間提供理性科學依據。

Background and Objective: Cardiopulmonary resuscitation (CPR) is a vital procedure, yet high-intensity chest compressions frequently result in skeletal and visceral injuries. Post-mortem computed tomography (PMCT) has become an essential tool in forensic medicine, offering high sensitivity in detecting subtle fractures that may be overlooked during traditional autopsy. This study aims to establish a spatial injury map of CPR-induced trauma and analyze the correlation between individual characteristics—such as age, sex, bone mineral density (BMD), and thoracic dimensions—and the resulting injuries. Methods: A retrospective analysis was conducted on PMCT data from 152 adult cases (2024) who received CPR without evidence of external trauma. Statistical models,including regression analysis, were used to assess the influence of physiological variables on injury severity. PMCT findings were also compared with forensic autopsy reports to evaluate diagnostic performance. Results: Rib fractures (93%) and sternal fractures (67%) were the most prevalent injuries. Rib fractures showed a distinct spatial distribution, primarily involving the anterior region of the 2nd to 7th ribs. Fracture patterns varied by location: anterior fractures were mostly incomplete, whereas lateral and posterior fractures tended to be complete. Males had a 3.2-fold higher risk for complete rib fractures compared to females. Elder and lower BMD were significant predictors of increased fracture counts. Furthermore, a flat chest morphology (high Haller index) was associated with a significantly higher risk for sternal and posterior rib fractures. Hemothorax and pneumothorax, were strongly correlated with the presence of complete lateral rib fractures. PMCT demonstrated superior diagnostic sensitivity for pneumothorax and incomplete fractures compared to autopsy. Conclusions: CPR-induced injuries are non-random and significantly modulated by individual characteristics. The established injury map assists forensic pathologists in differentiating iatrogenic trauma from external violence. Clinically, these findings identify high-risk populations, providing a scientific basis for monitoring post-resuscitation complications and balancing medical intervention with patient dignity.