涉及死亡的医疗损害法医病理学鉴定360例分析  

Forensic Examination of Fatally Medical Malpractice: an Analysis of 360 Cases

作　　者：简俊祺 吴玉峰 张建华[2] 陈忆九[2] 

机构地区：[1]苏州大学医学部法医学系,江苏苏州215123 [2]司法部司法鉴定科学技术研究所上海市法医学重点实验室上海市司法鉴定专业技术服务平台,上海200063 [3]诸暨市公安局刑事科学技术室,浙江诸暨311800

出　　处：《中国司法鉴定》2017年第3期40-44,共5页Chinese Journal of Forensic Sciences

基　　金：中央级科研院所研究专项(GY2017G-4);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(16DZ2290900)

摘　　要：目的研究涉及死亡医疗损害法医学鉴定的案例特点,总结医疗损害死亡原因鉴定、医疗过错因果关系及参与度评定的鉴定思路和方法。方法收集司法部司法鉴定科学技术研究所2008—2016年受理的360例涉及死亡的医疗纠纷案例,从被鉴定人一般信息、科室分布、死亡原因分布、因果关系及参与度评定等方面进行总结分析。结果涉及死亡医疗纠纷案件呈逐年增多趋势,涉及临床科室以外科居多,其次为内科、儿科、妇产科;尸检率为45.2%,以疾病和自身因素为主要死因占比较大;多数医院都存在一定程度的医疗过错行为,且与患者死亡相关,医方承担次要责任占主要比例。结论涉及死亡医疗损害的法医学鉴定的首要任务是明确死因,系统尸体解剖仍为死亡原因鉴定的金标准,结合明确死亡原因的因果关系及参与度评定更加科学客观。Objective To explore the characteristics of cases of fatally medical malpractice in forensic examination; to review ideas and methods involving determination of cause of death, the causality between death and medical errors and evaluation of their contribution to the death. Method In this study, 360 cases of fatally medical disputes examined by our institute from 2008 to 2016 were collected. A comprehensive analysis on these cases were performed based on the victim＇s personal information, the distribution of hospital departments and causes of death, and the correlation between medical behaviors with death and their contribution to death. Results There was an annual growing trend in the number of cases involving medical disputes, especially surgery, followed by internal medicine, paediatrics, obstetrics and gynecology. In these cases, the autopsy rate was 45.2%, and the main causes of death included fatal diseases and other self-factors. Medical errors presented in most hospitals, and they were related to victim＇s death more or less. The result that hospitals undertook secondary responsibility accounted for a larger proportion. Conclusion Determination of cause of death is of great importance in the forensic examination of cases of fatally medical malpractice, and systematic autopsy remains the gold standard for it. Combined with the definite cause of death would provide more objective estimation on whether medical behaviors are related to victim＇s death and their contribution to the death.

关 键 词：法医病理学 医疗纠纷 死因分析 死因构成 因果关系 

分 类 号：D919.4[医药卫生—法医学]