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

发布时间：2018-04-13 19:01

  本文选题：法医病理学 + 主动脉夹层　； 参考：《复旦学报(医学版)》2017年S1期

【摘要】：目的探讨主动脉夹层(aortic dissecting,AD)动脉瘤(又称AD)破裂死亡引发医疗纠纷的原因、诊疗过程中存在的医疗过失与患者死亡后果之间的因果关系及参与程度的判定。方法收集本中心2001—2016年受理的34例引发医疗纠纷、经系统的法医病理学检验证实为AD破裂猝死案例,对照法医病理学检验结果审查病历资料,分析诊疗过程中引发医疗纠纷的原因,并结合文献对医疗损害与患者死亡之间的因果关系及参与程度进行分析。结果本组案例中23例医疗纠纷发生于县区级医疗机构,11例发生于地市级医疗机构;34例均伴发其他疾病,其中27例有明确的高血压病史;31例因心包填塞死亡,3例因失血性休克死亡。镜下可见的病理改变有:主动脉中层囊性坏死、冠状动脉粥样硬化、冠状动脉管腔狭窄(Ⅰ~Ⅳ级)等,其中15例可见冠状动脉合并主动脉粥样硬化改变,另有1例合并有肺动脉夹层改变。本组34例入院后均未能对AD给予明确临床诊断及有效治疗,诊疗过程中的误诊、误治与患者死亡之间存在因果关系。结论 AD发病机制复杂,基层医师易误诊、误治。在AD破裂患者猝死引发的医疗纠纷中,误诊、误治行为与患者死亡之间存在间接因果关系。
[Abstract]:Objective to investigate the causes of medical disputes caused by ruptured aneurysms of aortic dissecting aneurysms (ADD), the causality between medical negligence and the death consequences of patients in diagnosis and treatment, and to determine the degree of participation in the diagnosis and treatment of aortic dissecting aneurysms (ADS).Methods 34 cases of medical disputes caused by medical disputes were collected from 2001 to 2016 in our center, which were confirmed by systematic forensic pathological examination as cases of sudden death of AD rupture. The medical records were reviewed in comparison with the results of forensic pathological examination.The causes of medical disputes in the course of diagnosis and treatment were analyzed, and the causality and degree of participation between medical injury and patient death were analyzed in combination with literature.Results in this group, 23 cases of medical disputes occurred in county and district level medical institutions, 11 cases occurred in prefectural and municipal level medical institutions, 34 cases were accompanied by other diseases.Among them 27 cases had a clear history of hypertension 31 cases died of pericardial tamponade and 3 cases died of hemorrhagic shock.The pathological changes were as follows: medial cystic necrosis of aorta, coronary atherosclerosis, stenosis of coronary artery (grade 鈪，

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