法医学杂志

法医学杂志 ›› 2024, Vol. 40 ›› Issue (1): 43-49.DOI: 10.12116/j.issn.1004-5619.2022.220302

• 案例分析 • 上一篇    下一篇

25例新生儿分娩性臂丛神经损伤医疗损害法医学鉴定评价

俞勇1(), 王英杰1, 贾云飞1, 黄宝静1, 何颂跃1, 刘川川2()   

  1. 1.北京法源司法科学证据鉴定中心，北京 100062
    2.重庆市公安局大渡口区分局刑事侦查支队，重庆 400084
  • 收稿日期:2022-03-10 发布日期:2024-03-19 出版日期:2024-02-25
  • 通讯作者: 刘川川
  • 作者简介:俞勇（1983—），男，主检法医师，主要从事法医临床学、法医病理学鉴定；E-mail：156630761@qq.com

Forensic Identification and Evaluation of 25 Obstetric Brachial Plexus Palsy Medical Damage Cases

Yong YU1(), Ying-jie WANG1, Yun-fei JIA1, Bao-jing HUANG1, Song-yue HE1, Chuan-chuan LIU2()   

  1. 1.Beijing Fayuan Judicial Science Evidence Appraisal Center, Beijing 100062, China
    2.Criminal Investigation Detachment of Dadukou District Branch of Chongqing Public Security Bureau, Chongqing 400084, China
  • Received:2022-03-10 Online:2024-03-19 Published:2024-02-25
  • Contact: Chuan-chuan LIU

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摘要：

目的 分析新生儿分娩性臂丛神经损伤的高危因素，探讨在医疗损害法医学鉴定中如何评价过错诊疗行为与新生儿分娩性臂丛神经损伤之间的关系。 方法 对北京法源司法科学证据鉴定中心2017—2021年25例新生儿分娩性臂丛神经损伤医疗损害责任纠纷相关案例进行回顾性分析，总结医院在胎儿体质量评估、分娩方式选择、产程观察与肩难产处置等方面存在的不足之处及其与患儿损害后果之间的关系。 结果 过错医疗行为评定为主要原因2例，同等原因10例，次要原因8例，轻微原因1例，无因果关系1例，未明确原因力3例。 结论 新生儿分娩性臂丛神经损伤医疗损害法医学鉴定过程中，从产前评估、分娩方式告知、规范使用缩宫素、肩难产操作规范性等环节，客观分析医疗行为是否履行诊疗义务，同时需充分考量不同危险因素的客观风险性和损伤预防的困难性，综合评价过错医疗行为在损害结果中的原因力大小。

关键词: 法医学, 分娩性臂丛神经损伤, 医疗损害, 案例分析

Abstract:

Objective To analyze the high risk factors of obstetric brachial plexus palsy （OBPP）, and to explore how to evaluate the relationship between fault medical behavior and OBPP in the process of medical damage forensic identification. Methods A retrospective analysis was carried out on 25 cases of medical damage liability disputes related to OBPP from 2017 to 2021 in Beijing Fayuan Judicial Science Evidence Appraisal Center. The shortcomings of hospitals in birth weight assessment, delivery mode selection, labor process observation and shoulder dystocia management, and the causal relationship between them and the damage consequences of the children were summarized. Results Fault medical behavior was assessed as the primary cause in 2 cases, equal cause in 10 cases， secondary cause in 8 cases, minor cause in 1 case, no causal relationship in 1 case, and unclear causal force in 3 cases. Conclusion In the process of forensic identification of OBPP, whether medical behaviors fulfill diagnosis and treatment obligations should be objectively analyzed from the aspects of prenatal evaluation, delivery mode notification, standardized use of oxytocin, standard operation of shoulder dystocia, etc. Meanwhile, it is necessary to fully consider the objective risk of different risk factors and the difficulty of injury prevention, and comprehensively evaluate the causal force of fault medical behavior in the damage consequences.

Key words: forensic medicine, obstetric brachial plexus palsy, medical damage, cases analysis

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