脑血管畸形死亡案例的法医病理学分析

Forensic Pathological Analysis of Death from Cerebrovascular Malformation

目的 探讨脑血管畸形死亡案例的医疗纠纷鉴定、伤病关系分析和法医病理学特点,以期为规避脑血管畸形死亡医疗纠纷风险和为脑血管畸形伤病关系分析鉴定提供参考。方法 收集整理2006年1月-2014年12月四川华西法医学鉴定中心病理检案中33例脑血管畸形死亡案例的案情、临床病历及法医病理解剖资料,进行回顾性分析。结果 33例脑血管畸形死亡案例平均年龄37.4岁;男女比例23∶10;发病0-1 h死亡者19例（57.6%）;病理分型以混合型为主,有17例（51.5%）。33例中涉及医疗纠纷者7例（21.1%）,经鉴定存在医疗过错4例,无明显过错3例;涉及伤病关系者11例（33.3%）,经鉴定损伤为死亡诱因9例,损伤与死亡无关1例,损伤为死因1例。结论 全面系统的法医病理解剖检验对明确死亡原因、正确处理医疗纠纷和伤病关系起着重要作用。

Objective To provide references in the forensic identification of injury and cerebrovascular malformation involved death cases,and to reduce the relevant medical dispute by exploring the forensic pathological features,identification of medical dispute as well as relationship between injury and disease.Methods We collected33 cases of cerebrovascular malformation from January 2006 to December 2014 in West China Center of Forensic Medicine,including details of cases,clinical medical record and forensic pathology examination,and then the cases were retrospectively analyzed.Results In the 33 cases,the average age of the individuals was 37.4 years old,and the male/female ratio was 23/10.Nineteen patients（57.6%） died within 1 hour.Seventeen patients with mixed pathological type of cerebrovascular malformation dominated（51.5%）.Medical dispute happened in 7 cases（21.1%）,4 of which were identified to be led by medical fault and 3 with no medical fault.Relationship between injury and disease was analyzed in11 cases（33.3%）,in which injury was identified to take full responsibility in 1 case,inductive cause of death in 9 cases,and no relationship between injury and death in 1 case.Conclusion Comprehensive and systematic investigation of forensic pathology plays an important role in the proper settlement of medical disputes as well as the identification of cause of death and relationship between injury and disease.