本文選題：法醫(yī)病理學(xué) + 主動脈夾層　； 參考：《復(fù)旦學(xué)報(醫(yī)學(xué)版)》2017年S1期

【摘要】：目的探討主動脈夾層(aortic dissecting,AD)動脈瘤(又稱AD)破裂死亡引發(fā)醫(yī)療糾紛的原因、診療過程中存在的醫(yī)療過失與患者死亡后果之間的因果關(guān)系及參與程度的判定。方法收集本中心2001—2016年受理的34例引發(fā)醫(yī)療糾紛、經(jīng)系統(tǒng)的法醫(yī)病理學(xué)檢驗證實為AD破裂猝死案例,對照法醫(yī)病理學(xué)檢驗結(jié)果審查病歷資料,分析診療過程中引發(fā)醫(yī)療糾紛的原因,并結(jié)合文獻對醫(yī)療損害與患者死亡之間的因果關(guān)系及參與程度進行分析。結(jié)果本組案例中23例醫(yī)療糾紛發(fā)生于縣區(qū)級醫(yī)療機構(gòu),11例發(fā)生于地市級醫(yī)療機構(gòu);34例均伴發(fā)其他疾病,其中27例有明確的高血壓病史;31例因心包填塞死亡,3例因失血性休克死亡。鏡下可見的病理改變有:主動脈中層囊性壞死、冠狀動脈粥樣硬化、冠狀動脈管腔狹窄(Ⅰ~Ⅳ級)等,其中15例可見冠狀動脈合并主動脈粥樣硬化改變,另有1例合并有肺動脈夾層改變。本組34例入院后均未能對AD給予明確臨床診斷及有效治療,診療過程中的誤診、誤治與患者死亡之間存在因果關(guān)系。結(jié)論 AD發(fā)病機制復(fù)雜,基層醫(yī)師易誤診、誤治。在AD破裂患者猝死引發(fā)的醫(yī)療糾紛中,誤診、誤治行為與患者死亡之間存在間接因果關(guān)系。
[Abstract]:Objective to investigate the causes of medical disputes caused by ruptured aneurysms of aortic dissecting aneurysms (ADD), the causality between medical negligence and the death consequences of patients in diagnosis and treatment, and to determine the degree of participation in the diagnosis and treatment of aortic dissecting aneurysms (ADS).Methods 34 cases of medical disputes caused by medical disputes were collected from 2001 to 2016 in our center, which were confirmed by systematic forensic pathological examination as cases of sudden death of AD rupture. The medical records were reviewed in comparison with the results of forensic pathological examination.The causes of medical disputes in the course of diagnosis and treatment were analyzed, and the causality and degree of participation between medical injury and patient death were analyzed in combination with literature.Results in this group, 23 cases of medical disputes occurred in county and district level medical institutions, 11 cases occurred in prefectural and municipal level medical institutions, 34 cases were accompanied by other diseases.Among them 27 cases had a clear history of hypertension 31 cases died of pericardial tamponade and 3 cases died of hemorrhagic shock.The pathological changes were as follows: medial cystic necrosis of aorta, coronary atherosclerosis, stenosis of coronary artery (grade 鈪，

本文編號：1745791