有医疗纠纷的31例孕产妇尸体解剖后死因分析  

Analysis of Death Causes in 31 Cases Pregnant Women with Medical Dispute after the Autopsy

作　　者：吴兴龙[1] 黄佳佳[1] 谭娜[1] 郑洪[1] 

机构地区：[1]遵义医学院附属医院病理科,贵州遵义563000

出　　处：《实用妇产科杂志》2014年第11期868-872,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：目的：通过对有医疗纠纷的31例死亡孕产妇尸体解剖（简称尸检）结果的分析,探讨其死亡原因以提高诊治水平,防止或减少医疗纠纷的发生.方法：收集2009～ 2013年遵义医学院附属医院病理科尸检档案中有医疗纠纷的31例孕产妇尸检资料,对孕产妇的死亡原因进行回顾性分析.结果：2009～2013年孕产妇死亡医疗纠纷案例分另为4例、5例、5例、8例、9例.在涉及医疗纠纷的医疗机构中,乡镇医院17例（54.84％）,县级医院11例（35.48％）.孕产妇死亡原因最常见的是产科出血（45.16％）,而导致产科出血的根本原因以宫颈和宫体下段裂伤多见（35.71％）;其次是羊水栓塞（19.35％）;再次是麻醉意外（9.68％）.31例孕产妇死亡病例中,临床死因诊断与尸检结果的符合率35.48％,而产科出血根本原因的临床诊断与尸检结果的符合率仅为21.42％.结论：孕产妇死亡所引发的医疗纠纷呈上升趋势.产科出血是孕产妇最常见的死亡原因,而诊断不明确是引发医疗纠纷的主要因素.应加强产科医师的规范化培训,提高诊断正确率及临床处置能力,减少孕产妇的死亡.Objective ：To explore the causes of maternal deaths by analyzing autopsy results of 31 cases maternal deaths with medical dispute, in order to improve the level of diagnosis and treatment, to prevent or reduce medical disputes. Methods：The autopsy data in 31 cases maternal deaths of medical tangle in the autopsy file of the pathology department of Affiliated Hospital of Zunyi Medical College from 2009 to 2013 were collected ,the causes of maternal deaths and medical disputes were analyzed retrospectively. Results： From 2009 to 2013,the cases of medical tangle of maternal deaths every year were 4 cases,5 cases 5 cases,8 cases and 9 cases, respectively. In medical institutions involved in medical disputes, maternal deaths were 17 cases （54.84%） in township hospitals, 11 cases （35.48%） in county hospitals. The most common cause of maternal deaths was obstetric hemorrhage （45. 16% ）, and the cervical and uterine body segment laceration were the top causes of obstetric hemorrhage （35.71% ）, the second cause was the amniotic fluid embolism（19.35%）, the third one was anesthesia accident （9.68%）. The coincidence rate between the causes of clinical deaths and the autopsy results was 35. 48%, the coincidence rate between the causes of clinical deaths and the autopsy results for obstetric hemorrhage was only 21.42%. Conclusions：There is an upward trend of the medical disputes of maternal deaths. Obstetric hemorrhage is the most common cause of maternal mortality, and the misdiagnosis, missed diagnosis or unclear diagnosis is the major cause of medical disputes, the standardization of the obstetrician training should be strengthened to improve the diagnostic accuracy and reduce maternal mortality.

关 键 词：孕产妇 死亡原因 尸体解剖 误诊 医疗纠纷 

分 类 号：R714.4[医药卫生—妇产科学]