Interpretation of drug concentrations in pericardial fluid, cerebrospinal fluid and vitreous humor

本研究选择采集脑脊液、玻璃体液、心包液及血液样本（肺动脉静脉血、心脏血、主动脉血、下腔静脉血、股静脉血），且未观察到明显腐败的涉毒法医尸检病例。虽然血药浓度有很大的部位依赖性，但右心室血药浓度与股静脉血药浓度非常相似。股静脉血与心包液药物浓度的相关性优于血与脑脊液/玻璃体药物浓度的相关性。然而，有些病例显示血液和心包液中药物浓度差异较大。将股静脉血中药物浓度与脑脊液、玻璃体体液和心包液中药物平均浓度以及这三种液体中所有可能对之间的药物平均浓度进行比较。脑脊液/心包液平均药物浓度与股静脉药物浓度之比非常接近1（0.94±0）。20日,n = 16)。为客观判断死后血药浓度是否可用于毒理学评价，我们建立了以下标准：1)当脑脊液/心包液平均药物浓度与血药浓度之比在0.6 ~ 1.4范围内时，死后血药浓度可用于毒理学评价；2)当比值超出范围时，应以脑脊液/心包液平均药物浓度替代死后血药浓度。

Drug-involved forensic autopsy cases in which cerebrospinal fluid, vitreous fluid, pericardial fluid and blood samples (pulmonary arterial and venous blood, cardiac blood, aortic blood, inferior vena caval blood and femoral venous blood) were obtained and in which no obvious putrefaction was observed were selected in this study. Although blood drug concentrations were very site dependent, drug concentrations in blood from the right cardiac chambers were quite similar to those in femoral venous blood. The correlations of drug concentrations between femoral venous blood and pericardial fluid were better than those between blood and cerebrospinal fluid/vitreous humor. However, some cases showed relatively large differences in drug concentrations between blood and pericardial fluid. Drug concentrations in femoral venous blood were compared with concentrations in average drug concentrations in cerebrospinal fluid, vitreous humor and pericardial fluid, and the average concentrations between all possible pairs among these three fluids. The ratios between average cerebrospinal fluid/pericardial fluid drug concentration and femoral venous drug concentration was very close to 1 (O.94±O.20, n=16). We established following criteria for objectively judging whether drug concentrations determined in postmortem blood are usable for toxicologic evaluation : 1) when the ratio of average cerebrospinal fluid/pericardial fluid drug concentration to blood drug concentration is within a range of 0.6-1.4, the postmortem blood drug concentration is usable for toxicologic evaluation ; and 2) when the ratio is outside the range, the average cerebrospinal fluid/pericardial fluid drug concentration should be used as an alternative to drug concentration in postmortem blood.