法医学杂志

法医学杂志 ›› 2021, Vol. 37 ›› Issue (1): 49-53.DOI: 10.12116/j.issn.1004-5619.2019.491105

• 案例分析 • 上一篇    下一篇

43例心脏外科手术后死亡医疗纠纷法医学分析

戴运达1 ，陈燕嫦2 ，施蕊娟1 ，郑锦平2 ，马钳钳2 ，刘水平1 ，权力1 ，罗斌1   

  1. 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
  • 收稿日期:2019-11-07 发布日期:2021-02-25 出版日期:2021-02-28
  • 通讯作者: 罗斌，男，主任法医师，博士研究生导师，主要从事法医病理学（心脏性猝死）、法医临床学（医疗损害鉴定）研究；E-mail：1737447635@qq.com
  • 作者简介:戴运达（1994—），男，硕士研究生，主要从事法医病理学（心脏性猝死）研究；E-mail：657395005@qq.com
  • 基金资助:
    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）

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

DAI Yun- da1 , CHEN Yan- chang2 , SHI Rui- juan1 , ZHENG Jin- ping2 , MA Qian- qian2 , LIU Shui- ping1 , QUAN Li1 , LUO Bin1   

  1. 1. Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat- Sen University, Guangzhou 510080, China; 2. Center for Medicolegal Expertise of Sun Yat-Sen University, Guangzhou 510080, China
  • Received:2019-11-07 Online:2021-02-25 Published:2021-02-28

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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。

关键词: 法医病理学, 心脏外科手术, 死亡, 医疗纠纷, 案例分析

Abstract: 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.

Key words: forensic pathology, cardiac surgical procedures, death, medical disputes, cases analysis

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