羊水栓塞死亡医疗纠纷案件的法医学分析

Forensic Medical Analysis of Medical Disputes Involving Death Caused by Amniotic Fluid Embolism

目的分析引发医疗纠纷的羊水栓塞死亡病例的相关因素,以帮助提高对羊水栓塞诊治能力,减少医疗纠纷。方法对我中心2006～2009年间鉴定的8例医疗纠纷相关羊水栓塞死亡病例的临床资料及过失认定进行回顾性分析。结果(1)医疗因素分析:7例具有使用催产素史;3例发生于产前破膜后,5例发生于产后;具有典型临床症状5例,不典型临床症状3例;早期诊断7例;3例实施子宫次全切除术;发生在二级医院以下6例。(2)法医学鉴定分析:催产素使用不当及观察记录缺陷占87.5%(7/8);7例早期诊断羊水栓塞,但在供氧、解痉和子宫切除方面存在治疗缺陷。结论提高对产前、产后羊水栓塞症状特点的认识和处置能力,强化病历记录规范、完整及充分告知说明,是减少医疗纠纷案件的关键,也是法医学鉴定判断的重要依据。

Objective To analyze factors that cause medical disputes involving death of AFE in order to improve the diagnosis and treatment of AFE and reduce AFE related medical disputes. Methods 8 medical disputes involving death of AFE and examined by our centre from 2006 to 2009 were retrospected. Results 1. Medical factors： 7 cases had history of using alpha oxytocin; 3 cases occurred after rupture of membranes in ante partum and 5 cases in post partum; 6 cases had typical clinical symptom; 7 cases got early diagnosis and 3 cases had subtotal hysterectomies; 6 cases occurred in secondary hospital and below. 2. Forensic medical analysis： 87.5% （7/8）of all 8 cases had defects of improper using of oxytocin and defective observation record; 7 cases had right early diagnosis of AFE, but had medical defects of oxygen supply, spasmolysis and hysterectomy. Conclusion Hospitals ought to increase knowledge and therapeutic ability on AFE, emphasize the integrity and standardization of recording, and improve notification and explanation to patients. All these factors are very important for forensic medical judgment and can help to reduce medical disputes.