我国医疗机构抗结核药物性肝损伤所致医疗纠纷的特点及改善策略  

Characteristics and improvement strategies of medical disputes caused by anti-tuberculosis drug-induced liver injury in Chinese medical institutions

作　　者：杨烁[1] 林平[1] 韩爽[1] 张威[1] 甄健存[1] 陈伟[2] 刘诗卉[2] YANG Shuo;LIN Ping;HAN Shuang;ZHANG Wei;ZHEN Jian-cun;CHEN Wei;LIU Shi-hui(Department of Pharmacy,Beijing Jishuitan Hospital,Beijing 100035,China;Office of Doctor-Patient Relations Coordination,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院药剂科,北京100035 [2]北京积水潭医院医患关系协调办公室,北京100035

出　　处：《中国医院药学杂志》2023年第10期1150-1153,共4页Chinese Journal of Hospital Pharmacy

基　　金：北京市属医院科研培育计划项目(编号:PG2020010)。

摘　　要：目的:分析与抗结核药物性肝损伤(anti-tuberculosis drug-induced liver injury,ATB-DILI)相关医疗纠纷的规律及特点,为合理用药提供参考。方法:检索“中国裁判文书网”从建库到2021年12月31日与ATB-DILI相关的医疗损害责任纠纷的裁判文书,建立数据库,回顾性分析纠纷的分布特点,用药错误原因等相关内容。结果:共检索到判决书2970篇,纳入ATB-DILI相关有责案件34例。2017—2020年的判决案例数是2013—2016年的1.6倍。男性多于女性,有基础肝病的患者数量约占总患者数量的38.24%。25例(73.53%)患者死亡或进行了肝移植,6例(17.65%)患者发生肝衰竭。有肝脏基础疾病的患者发生死亡或肝移植的比例为84.61%,稍高于无肝脏基础疾病的患者的66.67%。从开始使用抗结核药至发现肝损伤的时间(潜伏期)最短为1 d,最长为182 d,中位时间为34 d,26例(76.47%)潜伏期≤60 d。引发纠纷的前3条错误原因分别为不良反应的识别或处理不当,告知不足及用药前对肝病重视不足。结论:医师应该加强对抗结核药物性肝损伤的重视程度,正确识别和处理抗结核药物性肝损伤,充分履行告知义务,减少ATB-DILI对患者造成的生命安全威胁及用药纠纷。OBJECTIVE To analyze the characteristics of medical disputes related to anti-tuberculosis drug-induced liver injury(ATB-DILI),so as to provide reference for clinical rational drug use.METHODS By searching“China Judgements Online”related to medical disputes with ATB-DILI from the establishment of the database to December 31,2021,we established a database and retrospectively analyzed the distribution characteristics of disputes,causes of medication errors and other related contents.RESULTS A total of 2970judgments were retrieved,including 34 ATB-DILI related liability cases.The number of cases adjudicated in2017—2020 was 1.6 times than that in2013—2016.There were more males than females,and the number of patients with liver diseases accounted for about 38.24%of the total number.Twenty-five patients(73.53%)died or underwent liver transplantation,and 6 patients(17.65%)developed liver failure.The rate of death or liver transplantation in patients with the history of liver disease was 84.61%,which was slightly higher than66.67%in patients without the history of liver disease.The shortest time from the start of antituberculous drugs to the detection of liver injury was 1 day,the longest was 182 days,and the median time was 34 days.The incubation period of 26 cases(76.47%)was less than60 days.The top three wrong causes of disputes were improper identification or treatment of adverse reactions,insufficient notification,and insufficient attention to liver disease before medication.CONCLUSION Physicians should strengthen the importance of anti tuberculosis drug induced liver injury,correctly identify and handle anti tuberculosis drug induced liver injury,fully fulfill their obligation to inform,and reduce the life safety threat and medication disputes caused by ATB-DILI to patients.

关 键 词：医疗纠纷 抗结核药物性肝损伤 中国裁判文书网 

分 类 号：R978.3[医药卫生—药品]