心源性猝死医疗纠纷鉴定78例分析  

Retrospective Analysis:The Medical Dispute Appraisal of 78 Cases of Sudden Cardiac Death

作　　者：张平 徐辉 高觉 蒋士浩[4] 张志湘[5] 施晓玲 ZHANG Ping;XU Hui;GAO Jue;JIANG Shihao;ZHANG Zhixiang;SHI Xiaoling(Suzhou Tongji Forensic Science Institute,Suzhou 215004,China;Suzhou Medical Association,Suzhou 215006,China;Changzhou Medical Association,Changzhou 213001,China;Jiangsu Medical Association,Nanjing 210008,China;Institute of Forensic Science,Soochow University,Suzhou 215021,China)

机构地区：[1]苏州同济司法鉴定所,江苏苏州215004 [2]苏州市医学会,江苏苏州215006 [3]常州市医学会,江苏常州213001 [4]江苏省医学会,江苏南京210008 [5]苏州大学司法鉴定中心,江苏苏州215021

出　　处：《中国司法鉴定》2023年第5期57-63,共7页Chinese Journal of Forensic Sciences

摘　　要：目的探讨心源性猝死(sudden cardiac death,SCD)引起的医疗纠纷的特点、原因和鉴定路径。方法对78例SCD的鉴定案例进行回顾性分析。结果SCD患者男性明显多于女性;多发年龄段为40~59岁;急性冠脉综合征37例,主动脉夹层24例,心肌炎10例,心脏传导系统疾病1例,瓣膜病2例,先天性心脏病2例,其他2例;医疗过错主要责任科室:心血管内科48例,急诊科15例,普外科7例,骨科3例,呼吸科3例,内分泌科2例。上述医疗纠纷案例,6例诊疗不存在过错,15例诊疗虽有过错,但与患者死亡无因果关系,32例诊疗过错与患者死亡的因果关系为轻微,18例的因果关系为次要,仅有3例因果关系为主要,完全因果关系的为0。结论SCD医疗纠纷的发生受到医患多方因素影响,鉴定过程中应综合考虑疾病的高风险性、诊疗过错程度以及患方的依从性。其中,SCD起病急、病情变化极快,临床表现不典型,抢救成功率低等特点是导致医疗过错与患者死亡之间原因力大小比例普遍较低的主要原因。Objective To explore the characteristics,causes and appraisal approach of sudden cardiac death induced medial disputes.Methods 78 cases of sudden cardiac death were analyzed retrospectively.Results The incidence of sudden cardiac death in male was higher than that in female,and mainly happened in the rang of 40-59 years old.37 cases had acute coronary syndrome,24 cases had aortic dissection,10 cases had myocarditis,1 case had heart conduction system disease,2 cases had valvular disease,2 cases had congenital heart defect,and 2 had other situations.The departments primarily responsible for medical errors were counted as follows:cardiovascular department(48 cases),emergency department(15 cases),general surgery department(7 cases),orthopedics department(3 cases),respiratory department(3 cases)and endocrinology department(2 cases).In the cases mentioned above,6 cases had no fault in diagnosis and treatment,15 cases had faults in diagnosis and treatment,but had no cause-and-effect relationship with the patient's death.32 cases had weak cause-and-effect relationship between the faults in diagnosis and treatment and the patient's death.In 18 cases,the faults in diagnosis and treatment were of secondary responsibility for the death of patients.In 3 cases,the faults in diagnosis and treatment were of primary responsibility for the death of patients.No case was completely responsible for the death of patients.Conclusion The occurrence of medical disputes about sudden cardiac death is affected by many factors.Consequently,the high risk of disease,the degree of diagnosis and treatment fault,and the compliance of patients should be considered in the forensic appraisal of medical malpractice.Sudden cardiac death is characterized by acute onset,rapid change of condition,atypical clinical manifestations and low rescue success rate,which are the main reasons for the low proportion of the causal force between medical errors and patients’death.

关 键 词：法医病理学 心源性猝死 医疗纠纷 司法鉴定 

分 类 号：DF795.4[医药卫生—法医学]