43例心脏外科手术后死亡医疗纠纷法医学分析  

Forensic Analysis of 43 Medical Disputes Caused by Death after Cardiac Surgery

作　　者：戴运达 陈燕嫦 施蕊娟 郑锦平[2] 马钳钳 刘水平[1] 权力[1] 罗斌[1] DAI Yun-da;CHEN Yan-chang;SHI Rui-juan;ZHENG Jin-ping;MA Qian-qian;LIU Shui-ping;QUAN Li;LUO Bin(Department of Forensic Pathology,Zhongshan School of Medicine,Sun Yat-Sen University,Guangzhou 510080,China;Center for Medicolegal Expertise of Sun Yat-Sen University,Guangzhou 510080,China)

机构地区：[1]中山大学中山医学院法医学系,广东广州510080 [2]中山大学法医鉴定中心,广东广州510080

出　　处：《法医学杂志》2021年第1期49-53,共5页Journal of Forensic Medicine

基　　金：国家自然科学基金资助项目(81671866);广东省自然科学基金自由申请资助项目(2016A030313223,2017A030313469)。

摘　　要：目的探究心脏外科手术后死亡引起医疗纠纷的原因及特点,重点分析心脏外科手术后病理改变及法医学解剖要点,为心脏外科手术临床诊治及司法鉴定提供病理学证据,为此类案件医疗纠纷防范提供参考。方法收集中山大学法医鉴定中心2013—2018年受理的心脏外科手术后死亡引发医疗纠纷的法医病理学案件,从死亡原因、病理诊断、手术情况和医疗过错行为等方面进行回顾性分析。结果43例心脏外科手术后死亡的原因有手术操作异常、低心排血量综合征、术后感染、术后血栓形成、自身其他疾病等。其中无医疗过错的有18例,存在医疗过错的有25例。结论心脏外科手术后死亡引起的医疗纠纷与术者操作技术、术后并发症密切相关。医疗过错的原因既有诊疗技术环节方面的缺陷,也有履行注意义务不足。Objective To explore the causes and characteristics of medical disputes caused by death after cardiac surgery and to analyze the pathological changes after cardiac surgery and the key points of forensic anatomy,thus to provide pathological evidence for clinical diagnosis and treatment of cardiac surgery and judicial appraisal as well as reference for the prevention of medical disputes in such cases.Methods Forensic pathological cases of medical disputes caused by death after cardiac surgery which were accepted by the Center for Medicolegal Expertise of Sun Yat-Sen University from 2013 to 2018 were analyzed retrospectively from aspects such as causes of death,pathological diagnosis,surgery condition,medical misconduct,and so on.Results The causes of death after cardiac surgery of 43 patients were abnormal operation,low cardiac output syndrome,postoperative infection,postoperative thrombosis,and other diseases.Among the 43 cases,there were 18 cases without medical fault while 25 cases had medical fault.Conclusion The medical disputes caused by death after cardiac surgery are closely related to the operative technique and postoperative complications.The causes of medical faults include defects in diagnosis and treatment technique,as well as unfulfillment of duty of care.

关 键 词：法医病理学 心脏外科手术 死亡 医疗纠纷 案例分析 

分 类 号：DF795.1[医药卫生—法医学]