背景:一氧化二氮(N2O)是一种用于药物镇痛的气体,抗焦虑和健忘症的性质。如果充分施用,它是一种被认为是安全的药物。在文学中,与N2O相关的意外死亡很少见。它们主要与出于娱乐和自发目的吸入该物质有关;很少报告由于麻醉中不正确的医用气体管理而死亡。急性N2O中毒死亡的诊断很复杂,通常是排除诊断:宏观和微观的死后体征完全是非特异性的。此外,间接数据并不总是支持性的,甚至可能令人困惑,主要是在医院内死亡。
方法:我们描述了在医院环境中因急性一氧化二氮中毒而死亡的特殊情况,一名72岁的白人男性。由于医疗气体(O2和N2O)的供应管线的不正确组装,在微创血管手术中发生了中毒。死因的确定是通过对间接数据的分析得出的,宏观和微观的自体发现,以及基于寻找抗E-选择素抗体的免疫组织化学研究,P-选择素,和HIF1-α。
结论:虽然不是N2O窒息的病因,后一种分子是缺氧损伤的有效和早期标记。因此,与所有其他发现一致,这可能是法医病理学家在怀疑N2O中毒的情况下确定死亡原因的有效支持。
BACKGROUND: Nitrous oxide (N2O) is a gas used in medicine for its analgesic, anxiolytic and amnesic properties. It is a drug considered safe if adequately administered. In the literature, accidental N2O-related deaths are rare. They are mostly related to inhalation of this substance for recreational and autoerotic purposes; rarely are reported deaths due to incorrect administration of medical gas in anesthesia. The diagnosis of death from acute N2O intoxication is complex and is generally an exclusion diagnosis: the macroscopic and microscopic post-mortem signs are entirely nonspecific. Furthermore, the circumstantial data are not always supportive and can even be confusing, mainly if the death occurred inside a hospital.
METHODS: We describe a particular
case of death from acute nitrous oxide poisoning in a hospital environment, of a Caucasian male of 72-years-old. The intoxication occurred during a minimally invasive vascular surgery due to an incorrect assembly of the supply lines of medical gases (O2 and N2O). The identification of the cause of death resulted from the analysis of circumstantial data, macroscopic and microscopic autoptic findings, and immunohistochemical investigations based on the search for antibodies anti E-selectin, P-selectin, and HIF 1-α.
CONCLUSIONS: Although not pathognomonic of asphyxiation by N2O, the latter molecules are a valid and early marker of hypoxic insult. Therefore, in concert with all other findings, it may constitute valid support for the forensic pathologist to ascertain the cause of death in
case of suspected intoxication by N2O.