泉州市近十年医疗纠纷尸检的回顾性研究及临床思考

摘要

目的 回顾性分析泉州市近十年医疗纠纷死亡的特点,包括就诊医院、死者年龄及死亡原因等分布特点,为医疗纠纷尸检及临床诊疗活动提供经验帮助.方法 通过对泉州市第一医院病理科2008年1月至2017年12月所做的302例尸体解剖病例,从性别、年龄、医疗机构级别、科室、死亡性质等方面进行回顾性统计分析.结果 过去十年共进行尸体解剖302例,其中300例通过病检找到死亡原因,1例吗啡中毒死亡,1例违反中药配伍禁忌导致死亡.尸检例数由2008年共计56例减至2017的15例;十年间三甲医院尸检例数为5例,以外科及妇科、儿科为主;二级以下乡镇卫生院及个体诊所尸检例数共计215例,以内科为主,儿科和妇产科仍是高发科室.结论 因为客观条件的限制及医务工作者自身业务能力所限,基层医疗机构是医疗纠纷高发地.内科、妇产科和儿科为医疗纠纷多发科室.尸检为医学的发展提供了可靠的资料;帮助查明医疗纠纷中死亡病例的死亡原因以解决医疗纠纷;为临床医生的诊疗工作提供非常有价值的参考.由于司法鉴定的逐步推广,临床医生在工作中应加强临床基本能力的训练及与患者及家属的沟通,减少医疗纠纷的发生.%Objective To retrospectively study the characteristics of death in medical disputes in Quanzhou in the past ten years,including hospital,age,and cause of death,so as to provide help for autopsy in medical disputes and clinical diagnosis and treatment.Methods Retrospective statistical analysis was applied to the recent ten-years autopsy cases of medical disputes in Quanzhou from the aspects of gender,age,level of medical institution,department,and nature of death.Results Among the 302 autopsies in the past 10 years,300 were identified the cause of death through examination,1 died from morphine poisoning,and 1 died due to the violation of taboo in compatibility of traditional Chinese Medicine.The number of autopsy cases decreased from 56 in 2008 to 15 in 2017.In the past ten years,the total number of autopsy cases in third-grade class-A hospitals was 5,mainly in surgery,gynecology and pediatrics.A total of 215 autopsies were performed in below Grade Ⅱ township hospitals and private clinics,mainly in internal medicine department,while pediatrics,obstetrics,and gynecology were still high-risk departments.Conclusion Because of the limitation of objective conditions and professional ability of medical workers,primary medical institutions have high incidence of medical disputes.Departments of internal medicine,obstetrics and gynecology,and pediatrics have multiple medical disputes.Autopsy is reliable to identify death causes in medical disputes,helpful to resolve medical disputes,and valuable to provide references for clinicians in their work of diagnosis and treatment.As a result of the gradual popularize of forensic expertise,clinicians should strengthen the basic clinical training and pay attention to their communication with patients and their families,so as to reduce the occurrence of medical disputes.