对《医疗事故分级标准(试行)》中关于视觉功能损伤程度分级的商榷

Deliberation as to the damnific degree classification of visual function in the Classification Standard of Accidents in Medical Treatment

在国家卫生部发布的《医疗事故分级标准 (试行 )》(2 0 0 2年 )中 ,闪光视觉诱发电位P10 0波峰时值被作为客观衡量视觉功能损伤程度的标准。我认为此规定非常不妥 ,建议采用图形视觉诱发电位的P10 0波峰时值为主要观察指标 ,但需要注意峰时值的延长与通常所谓的视力不同。对于PVEP波形不明显或消失者 ,建议用闪光视觉诱发电位判断患者视觉系统是否有功能 ,但不作为判断损伤程度分级标准使用。建议具体鉴定时结合视网膜电图检查项目等结果对视觉功能损伤程度进行综合分析。有条件的地方还可以参考多焦点视网膜电图的检查结果。建议对涉及司法鉴定的检查一定要采用符合国际标准化要求的检查系统 ,检查报告应由具备视觉电生理检查实践经验和相应临床知识的人员出具。

The wave crest P100 of flash visual evoked potential is used as the standard to scale the damnific degree classification of visual function in the 'Classification Standard of Accidents in Medical Treatment'.Author think it's not suitably and suggest to use the wave crest P100 of pattern visual evoked potential as the main observing index,but the defferences of P100's prolong and normal eyesight should be noticed.As to the unconspicuous and disappear of waves in pattern visual evoked potential,flash visual evoked potential is edvised to judge that the visual system's function is normal or not,but not used as the standerd to scale the damnific degree classificarion.It is suggested that the results of electroretinogram,mulfocus electroretinogram better,should be combined in general analysis of autual judgment.the examining system according to the international standard must be used in the examination related to the judgment of justice,and the examination reporting should be offered from the people who have the experiences of actual examination and clinic knowledge.