摘要
目的分析心脏相关医疗纠纷鉴定的临床及法医学特点,剖析纠纷原因并提出鉴定建议。方法对2011年1月-2019年8月苏州大学司法鉴定中心受理的省内外各级医疗机构发生的29例与心脏疾病相关死亡的医疗纠纷鉴定案例进行回顾性分析。结果29例心脏相关疾病死亡案件中,10例与心脏手术相关(6例为微创手术,4例为心脏外科手术);另19例为心内科疾病死亡患者,包括感染性心内膜炎、急性心肌炎、急性心肌梗死、不明原因心源性猝死等。本组案例中,9例进行了尸体解剖死因鉴定,死亡原因有心脏传导系统病变、冠心病急性发作、冠心病合并急性心肌炎、急性暴发性心肌炎、心瓣膜病致急性心功能衰竭、主动脉夹层等;其余20例未行尸体解剖,医、患双方同意根据提供的病历等资料推断其死亡原因,认定的死因包括急性心肌梗死、急性心肌炎、心脏术后并发症(感染、主动脉夹层破裂)、不明原因心源性猝死等。上述医疗纠纷鉴定案例,除2例医方不存在医疗过错外,其余医方均存在不同程度的医疗过错,主要包括术前检查不完善、告知不充分、手术操作有误、术后观察及处理不足、医疗记录不完整等。医疗过错与患者损害后果之间因果关系认定中,除1例无因果关系外,其余均存在因果关系,根据原因力大小分为无因果关系、轻微作用、次要作用、同等作用、主要作用、完全作用。结论心脏相关医疗纠纷中,与手术有关的案件主要与术后并发症关系密切,而内科案件多数为急症病人。死因推断虽然有助于部分医疗纠纷案件的处理,但仍建议尸体解剖明确死亡原因,有助于更客观、科学地开展鉴定工作。
Objective Analyze the clinical features,causes of cardiac-related medical disputes,and provide preventive measures.Methods We retrospectively analyzed the data of 29 cases of cardiac-related medical disputes collected in Institute of forensic science,Soochow University from Jan 2011 to Aug 2019.Results Among the 29 cases of heart disease-related medical disputes,autopsies were performed on 9 of the 29 patients to figure out the causes of death.In the remaining 20 cases,no autopsy was performed.The patient’s family members and doctors all agreed to infer the cause of death based on the medical records provided.The inferential cause of death includes acute myocardial infarction,acute myocarditis,postoperative complications of the heart(infection,rupture of aortic dissection,etc.),and sudden cardiac death of unknown cause.With the exception of two cases in which there is no medical fault,all the other hospitals have different degrees of medical fault,including incomplete preoperative examination,inadequate notification, incomplete operation, and inadequate post-operative observation and treatment, incomplete medical records, et al. The cause and effect between the medical fault and the patient's damage result is determined. There is one case without causality, and the rest all have causality. According to the size of responsibility, they are divided into slight, minor, equal, major, and complete. Conclusion In cardiac-related medical disputes, surgical cases are mainly related to postoperative complications, while medical cases are mostly in acute patients. Medical personnel should strengthen legal awareness and strengthen doctor-patient communication. Although the inference of death cause is helpful to deal with some medical disputes, autopsy is still recommended to clarify the cause of death in order to carry out identification work more objectively and scientifically.
作者
杨丽
张志湘
王亚辉
陈溪萍
陶陆阳
YANG Li;ZHANG Zhixiang;WANG Yahui;CHEN Xiping;TAO Luyang(Institute of Forensic Science,Department of Forensic Medicine,Soochow University,Suzhou 215000,China;Shanghai Key Laboratory of Forensic Medicine,Shanghai Forensic Service Platform,Key Lab of Forensic Science,Ministrg of Justice,Academy of Forensic Science,Shanghai 200063,China)
出处
《中国司法鉴定》
2020年第4期39-44,共6页
Chinese Journal of Forensic Sciences
基金
上海市法医学重点实验室资助项目(17DZ2273200)
上海市司法鉴定专业技术服务平台资助项目(19DZ2292700)。
关键词
心脏疾病
医疗纠纷
死亡原因
法医学鉴定
cardi-related disease
medical disputes
cause of death
forensic identification
