52例心脏性死亡相关医疗损害的法医学分析
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摘要
目的综合分析涉及医疗损害的心脏性死亡法医学鉴定案例,探讨其死亡原因、医疗过错及参与程度评定的共性与特点。方法收集2015年1月—2018年4月杭州明皓司法鉴定所萧山分所受理的涉及心脏性死亡的医疗损害案例52例,对案件一般情况、医疗机构、住院情况、死亡原因、医疗过错行为及过错参与程度评定进行回顾性分析。结果 52例中,男女性比例为2.25∶1,年龄以>50~60岁居多。高血压性心脏病及冠心病所引起的心脏性死亡占首位(67.3%),其次为病毒性心肌炎和心肌病(13.5%)。涉及手术的有24例,术后至死亡时长为1 h~118 d,中位数为7 d。医疗损害涉及医疗机构63所,多数医院存在不同程度的医疗过错行为,参与程度多为>20%~30%。结论法医学鉴定有助于确定死亡原因,为医疗损害案件评定提供了科学的依据,有助于医疗部门进一步提高诊疗水平。
Objective To synthetically analyse the medical malpractice cases of cardiac death in forensic identification, and to explore the generality and characteristic of cause of death, medical malpractice and assessment of participation degree. Methods Totally 52 medical malpractice cases of cardiac death examined in the Xiaoshan Branch Office, Hangzhou Minghao Forensic Judical Appraisal Institute, from January2015 to April 2018 were collected. The general information of cases, medical institutions and situations of hospital stay, cause of death, medical malpractice and assessment of participation degree were retrospectively analysed. Results In 52 cases, the male to female ratio was 2.25:1, and most subjects aged>50-60. Cardiac death caused by hypertensive heart disease or coronary heart disease was most common(67.3%), followed by viral myocarditis and cardiomyopathy(13.5%). There were 24 cases involved surgery, and the survival time after surgery was from 1 h to 118 d with a 7 d medium value. There were63 medical institutes involved in these medical malpractices. Medical malpractice presented in most hospitals more or less, and the participation degree was >20%-30%. Conclusion Forensic appraisal contributes to determine causes of death, which not only provides scientific evidence for medical malpractice identification, but also improves diagnosis and treatment levels of medical institutions.
Objective To synthetically analyse the medical malpractice cases of cardiac death in forensic identification, and to explore the generality and characteristic of cause of death, medical malpractice and assessment of participation degree. Methods Totally 52 medical malpractice cases of cardiac death examined in the Xiaoshan Branch Office, Hangzhou Minghao Forensic Judical Appraisal Institute, from January2015 to April 2018 were collected. The general information of cases, medical institutions and situations of hospital stay, cause of death, medical malpractice and assessment of participation degree were retrospectively analysed. Results In 52 cases, the male to female ratio was 2.25:1, and most subjects aged>50-60. Cardiac death caused by hypertensive heart disease or coronary heart disease was most common(67.3%), followed by viral myocarditis and cardiomyopathy(13.5%). There were 24 cases involved surgery, and the survival time after surgery was from 1 h to 118 d with a 7 d medium value. There were63 medical institutes involved in these medical malpractices. Medical malpractice presented in most hospitals more or less, and the participation degree was >20%-30%. Conclusion Forensic appraisal contributes to determine causes of death, which not only provides scientific evidence for medical malpractice identification, but also improves diagnosis and treatment levels of medical institutions.
引文
[1]王雷,郭亚东,陈晓刚,等.心源性猝死的病因、诱因及预防——附178例法医病理学解剖分析[J].华西医学,2007,22(4):790-792.
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[6]张光宇,张晓莹,周玉林.34例主动脉夹层破裂死亡引发医疗纠纷案例的法医学资料分析[J].复旦学报(医学版),2017,44(S1):60-62,74.
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[8]张志威,郑紫雨,李荣,等.73例儿科医疗损害的法医病理学鉴定[J].法医学杂志,2018,34(2):147-149.
[9]彭加茂,金跃明,姜柏生.224起医疗过失行为的原因分析及其防范措施[J].临床误诊误治,2013,26(10):85-87.
[10]邓姣娟,穆娇,刘龙清,等.98例医疗过错鉴定的回顾性分析[J].中国法医学杂志,2015,30(4):401-403.
[11]刘红彬,张晓华,袁会玲.心电图对心源性猝死高危患者的预测价值[J].医学与哲学,2016,37(7B):24-27.
[12]戴瑜珍,喻朝霞,胡小安,等.心源性猝死33例尸检临床病理分析[J].临床与实验病理学杂志,2009,25(2):174-177.
[2]王蕴强,翟晓晨.心源性猝死诸因素及防治研究[J].中国医药科学,2015,5(10):148-150,161.
[3]黄玲,陶桂萍,张婷.心源性死亡的诱发因素分析及干预对策[J].实用临床医药杂志,2013,17(6):42-44,55.
[4]简俊祺,吴玉峰,张建华,等.涉及死亡的医疗损害法医病理学鉴定360例分析[J].中国司法鉴定,2017(3):40-44.
[5]苏勇林,胡玉莲,杨军,等.356例医疗纠纷法医学鉴定回顾性研究[J].华西医学,2009,24(2):288-291.
[6]张光宇,张晓莹,周玉林.34例主动脉夹层破裂死亡引发医疗纠纷案例的法医学资料分析[J].复旦学报(医学版),2017,44(S1):60-62,74.
[7]吕婷婷,张岩,李羽,等.成人Still病29例临床分析[J].中华实用诊断与治疗杂志,2012,26(5):508-509.
[8]张志威,郑紫雨,李荣,等.73例儿科医疗损害的法医病理学鉴定[J].法医学杂志,2018,34(2):147-149.
[9]彭加茂,金跃明,姜柏生.224起医疗过失行为的原因分析及其防范措施[J].临床误诊误治,2013,26(10):85-87.
[10]邓姣娟,穆娇,刘龙清,等.98例医疗过错鉴定的回顾性分析[J].中国法医学杂志,2015,30(4):401-403.
[11]刘红彬,张晓华,袁会玲.心电图对心源性猝死高危患者的预测价值[J].医学与哲学,2016,37(7B):24-27.
[12]戴瑜珍,喻朝霞,胡小安,等.心源性猝死33例尸检临床病理分析[J].临床与实验病理学杂志,2009,25(2):174-177.