昆明地区医疗争议死亡事件的流行病学和法医学鉴定研究

目的回顾性分析研究昆明地区涉及医疗争议死亡事件的流行病学特点,探讨医疗争议死亡事件的法医学鉴定问题,为有效预防医疗纠纷、医疗争议死亡事件的法医学鉴定和相关立法提供重要的实践和理论依据。方法收集昆明医学院司法鉴定中心1998年至2003年间受理的昆明地区涉及医疗争议的死亡事件160例(包括医疗纠纷和非法行医死亡案件)的法医病理鉴定资料进行统计学分析研究,应用法医病理学死因分析理论,对医疗争议死亡事件的司法鉴定问题进行探讨。结果昆明地区医疗争议死亡事件呈逐年上升趋势,其中以育龄妇女发生死亡所占比率最高;其次是5岁以下小儿发生死亡;分娩中或分娩后胎儿迅速死亡居第三位;在后两者中男性死亡发生率高于女性。在非法行医死亡案件中,医疗过错参与死因构成的比率为88.89%。结论昆明地区医疗争议死亡事件的临床诊断符合率和医疗过错发生率与国内外相关报道基本一致。法医学鉴定采用"六等九级法"对医疗争议死亡事件中医疗过错对死亡发生的作用及其参与度进行分析和评价,具有较强的可操作性和实用性。     

52例心脏性死亡相关医疗损害的法医学分析

目的综合分析涉及医疗损害的心脏性死亡法医学鉴定案例,探讨其死亡原因、医疗过错及参与程度评定的共性与特点。方法收集2015年1月—2018年4月杭州明皓司法鉴定所萧山分所受理的涉及心脏性死亡的医疗损害案例52例,对案件一般情况、医疗机构、住院情况、死亡原因、医疗过错行为及过错参与程度评定进行回顾性分析。结果 52例中,男女性比例为2.25∶1,年龄以50~60岁居多。高血压性心脏病及冠心病所引起的心脏性死亡占首位(67.3%),其次为病毒性心肌炎和心肌病(13.5%)。涉及手术的有24例,术后至死亡时长为1 h~118 d,中位数为7 d。医疗损害涉及医疗机构63所,多数医院存在不同程度的医疗过错行为,参与程度多为20%~30%。结论法医学鉴定有助于确定死亡原因,为医疗损害案件评定提供了科学的依据,有助于医疗部门进一步提高诊疗水平。     

致死性心脏压塞38例法医病理学分析

目的探讨致死性心脏压塞的法医病理学特点和鉴定要点。方法对成都中医药大学附属医院病理科2005~2015年完成的38例心脏压塞致死案例进行回顾分析。结果致死性心脏压塞好发于男性(71.1%),平均年龄44岁;直接死因血性积液34例,非血性4例;根本死因以疾病多见(73.7%),主要为夹层动脉瘤、冠心病、恶性肿瘤;发病12小时内死亡占75%;涉及医疗行为30例(78.9%),26例无医疗过错(86.7%);疾病致死案件涉及伤病关系15例(39.5%)。结论掌握致死性心脏压塞的法医病理学特点和鉴定路径是准确完成该类案件法医学鉴定的基本要求。     

中毒死亡案件的法医学分析

目的分析中毒性死亡案件和与中毒死亡有关的医疗纠纷案件的法医学特点,探讨此类案件的防护重点和鉴定要点。方法对四川大学法医学院1985～2004年106例中毒死亡尸体剖验病理材料进行回顾性统计分析。结果性别:男性61例,女性45例,男女比例1.36:1;年龄:以21～40岁年龄组(60.38%)为主;死亡方式:意外死亡最多见(52.83%),其次为自杀(33.02%)和他杀(14.15%);死亡原因:CO中毒、有机磷类中毒、毒鼠强及药物中毒多见(72.64%);医疗纠纷:发生医疗不当12例(11.32%),7例为医源性中毒性医疗纠纷,5例为中毒后在医院抢救中发生的医疗纠纷,主要发生于乡镇医院和县级医院(83.33%)。结论加强毒物的管理、提高安全意识、加强法制教育、增加生产安全等是减少中毒性死亡的重要手段。提高城乡医疗水平,加强中毒急诊抢救临床技能是防止中毒性医疗纠纷的关键。     

妇产科医疗纠纷司法鉴定82例分析

目的研究妇产科医疗纠纷鉴定案件的一般规律及其医疗过失的特点．为法医学鉴定提供理论支持。方法对2002--2008年在华西法医学鉴定中心鉴定的82例妇产科医疗纠纷医疗过失案例进行回顾性分析。结果妇产科医疗纠纷司法鉴定案例逐年增多;发生纠纷的医院以市（区）级与县级医院为多见,发生纠纷的案件中又以分娩和手术者为多见;医疗过失的主要原因为医疗技术缺陷与医疗管理缺陷。结论法医学鉴定时应参照临床医疗规范,考察医师义务履行情况,重点观察有无医疗技术缺陷或管理缺陷。     

32例脊柱手术术后医疗过错鉴定分析

<正>1案例资料1.1一般资料我中心2011~2013年受理的脊柱及脊髓损伤医疗过错鉴定案件32例。涉及人数27人(男性19人,女性8人),年龄范围18~87岁,主要集中在35~60岁(约占78%);涉及医院32家,见表1。1.2鉴定依据依据司法部《司法鉴定程序通则》(中华人民共和国司法部第107令)及《北京司法鉴定行业协会关     

医疗纠纷中死亡争议案件尸检价值的评估

目的探讨尸体检验对死亡争议事件的医疗鉴定、赔偿处理上的价值,以妥善处理医疗纠纷中医患双方的矛盾。方法对温州市4个市、区、县2002—2004年的182例死亡争议事件进行回顾性分析,就尸检率,临床、尸检诊断,尸检对医疗鉴定及争议事件处理上的作用,及其在不同级别医院的具体情况等进行了统计处理。结果182例其中尸检46例,尸检率25.27%。二级以上医疗机构死亡争议事件112例,尸检率19.64%。临床死因诊断与尸检死因诊断不符合率37%,以循环系统、呼吸系统为多。46例尸检中,医疗鉴定32例(69.5%),经济赔偿29例(63%)。未尸检136例,医疗鉴定20例(14.7%),经济赔偿121例(88.9%),两者差异显著,有统计学意义(P<0.05)。结论尸体检验对死亡争议案件的医疗鉴定与处理具有重要意义,尤其在死因鉴定方面具有不可替代性。     

18例输卵管妊娠相关医疗损害法医学鉴定分析

目的 分析输卵管妊娠误诊后发生医疗损害的案例,探讨发生医疗损害的原因,过错行为与损害后果的因果关系以及原因力大小,为此类案件的法医学鉴定提供评价思路。方法 收集18例输卵管妊娠相关医疗损害的法医学鉴定案件,从患者年龄、孕产史、生育需求、危险因素、诊疗情况、医疗过错、损害后果、原因力大小等方面进行回顾性分析。结果 18例均为输卵管妊娠,其中17例医疗行为存在过错,导致14例患侧输卵管切除,2例失血性休克死亡,1例宫内胎儿停止发育并患侧输卵管切除。另1例虽有输卵管切除的损害后果,但医疗行为无过错。结论 正确的诊断有助于制定合理的治疗方案,防止病情进展,减少严重不良后果和医患纠纷的发生。科学、合理地分析医疗过错行为与损害后果之间的因果关系及原因力大小,对此类医患纠纷的顺利解决有重要意义。     

医疗纠纷的法医学鉴定

目的研究医疗纠纷法医学鉴定的特点,并讨论医疗纠纷法医学鉴定的重点及难点。方法将医疗缺陷分为责任性缺陷、技术性缺陷、管理性缺陷、学科性缺陷和其他缺陷,对36件案例分别进行分类并进行统计。其中把18例由医疗事故鉴定委员会鉴定的结论与我室的鉴定结果进行比较分析,其他18例另行统计。结果36例案件中存在医疗缺陷的占86.11%,其中技术性缺陷66.67%,责任性缺陷和管理性缺陷均占25%。18例由医疗事故鉴定委员会鉴定的结论与我室的鉴定结果进行比较,医疗缺陷的认定两者有明显差异(P<0.05),对于医疗缺陷已对患者造成不良影响的认定,两者具有显著性差异(P<0.01)。结论法医进行医疗纠纷的鉴定,对医疗纠纷诉讼案件的处理起着积极的作用。目前,医疗纠纷的法医学鉴定仍存在许多问题需要进一步讨论。     

围产期脑损伤医疗过失分析17例

笔者选择17例围产期脑损伤医疗过失鉴定的案例,通过对案例的分析,探讨此类医疗损害案件法医学鉴定常见问题及注意事项。1案例资料1.1案例来源及分析项目17例围产期发生患儿脑损伤医疗过失的鉴定案例,为本中心2008年7月至2010年5月期间受理的案件。     

Examination reports on survived strangulation cases

Clinical-forensic examination of strangulation victims is an increasing part of the routine of many forensic pathology institutes. The cases examined between 2004 and 2008 at the Institute of Legal Medicine of the Hanover Medical School were retrospectively analysed. In total, the study material comprised 218 victims (175 females and 43 males). In 80.7 %, the clinical-forensic examination was performed within 24 hours after the incident. In the overwhelming number of cases, the alleged perpetrator was no stranger. 128 victims (58.7 %) had strangulation marks, 32 victims (14.7 %) ligature marks and 65 victims (29.8 %) nail marks. Four victims showed injuries of the laryngeal and pharyngeal structures (reddening, hematomas, swelling and in one case a fracture of the cricoid cartilage on both sides). Extensive petechiae were predominantly seen in the conjunctivae, the buccal mucosa and the skin of the face in cases where the victims suffered a loss of consciousness. 87 cases (39.9% were classified as potentially life-threatening and 30 cases (13.8 %) as acute life-threatening events. This classification is of legal relevance for the penalty. In addition, 60 victims experienced sexual violence. These results suggest that early clinical-forensic examination is crucial for documenting forensic evidence in support of police investigations and may deliver significant details relevant in court.     

道路交通事故中涉案者交通行为方式的法医学鉴定

目的回顾道路交通事故中需要进行涉案者交通方式鉴定的案例。探讨此类案例鉴定的思路和技术方法。方法收集28例近年本单位进行的道路交通事故涉案者交通行为方式鉴定案例,统计涉案者一般情况、损伤程度与交通行为方式的关系,交通事故发生的时间和地点、交通事故中车辆碰撞类型、采用的技术方法等,进行统计学处理。结果本组资料共28起道路交通事故案件,涉案人员共57人,男性50人．女性7人。交通事故发生时间夜间为19例（67．86％）,白天为9例（32．14％）。道路类型中,城市市区道路10例（35．7％）,城市郊区道路1例（3．6％）,省级道路10例（35．7％）,高速公路7例（25％）。酒后驾车9例（32．1％）。交通事故类型中,电动自行车与机动车事故5例（17．8％）,机动车与自行车事故1例（3．6％）,机动车单方事故7例（25．0％）;机动车与机动车事故11例（39．3％）,机动车与行人事故4例（14．3％）。涉案人员死亡27人,损伤29人,无明显伤害1人。损伤存活者中轻微伤10例（34．5％）,轻伤8例（27．6％）,重伤1l例（37．9％）。涉案者交通行为方式鉴定种类中,汽车驾驶人和乘车人认定16例（57．1％）,摩托车驾驶人和乘车人认定1例（3．6％）,电动自行车驾驶人和乘车人认定5例（17．8％）,自行车推行和骑行状态认定1例（3．6％）,摩托车推行和骑行状态认定1例（3．6％）,行人横过公路方向4例（14.3％）。涉案者交通行为方式鉴定采用的技术手段和方法．包括法医学活体损伤检验、法医学尸表检验、涉案肇事车车辆痕迹检验、DNA检验鉴定、现场人体模拟实验等。结论根据人体（活体或尸体）的体表损伤形态特征、痕迹分布,分析其致伤物和致伤方式,结合车辆痕迹检验结果,得出确认符合某种交通行为方式或者不符合某种交通行为方式的判断,结合案件的相关情况分析重建交通事故过程．是进行涉案者交通行为方式鉴定的基本思路。     

Cause of death and drug use pattern in deceased drug addicts in Sweden, 2002-2003

Compared with their contemporaries, individuals abusing illicit drugs suffer a higher risk of premature death. In Sweden, a simple protocol for registration of fatalities among abusers of alcohol, pharmaceuticals, illicit drugs, or other substances, has been used by the forensic pathologists since 2001. This routine was introduced to allow for an evaluation of the cause and manner of death, and patterns of abuse among different groups of abusers. We explored the data on drug abusers (i.e. abusers of illicit drugs) subjected to a forensic autopsy 2002-2003. The Swedish forensic pathologists examined 10,273 dead victims during the study period and 7% (743/10,273) of the cases were classified as drug abusers. Toxicological analyses were carried out in 99% (736/743) and illicit drugs were detected in 70% (514/736) of these. On average, 3.8 substances (legal or illegal) were found per case. The most common substances were ethanol and morphine, detected in 43 and 35% of the cases, respectively. When exploring the importance of the different substances for the cause of death, we found that the detection of some substances, such as fentanyl and morphine, strongly indicated a poisoning, whereas certain other substances, such as benzodiazepines more often were incidental findings. In total, 50% (372/743) died of poisoning, whereas only 22% (161/743) died of natural causes. Death was considered to be directly or indirectly due to drug abuse in 47% (346/743), whereas evidence of drug abuse was an incidental finding in 21% (153/743) or based on case history alone in 33% (244/743). We believe that this strategy to prospectively categorize deaths among drug addicts constitutes a simple means of standardizing the surveillance of the death toll among drug addicts that could allow for comparisons over time and between countries.     

Forensic odontologists successfully identify tsunami victims in Phuket, Thailand

More than a year has elapsed since the seaquake in South-East Asia in December 2004, and more than 92% of the non-Thai victims have been identified. About 80% of the non-Thai victims were identified by dental information. This high success rate of dental identification in Thailand was a matter of surprise for many forensic experts. Identification based on dental information is a highly efficient, reliable and rapid procedure. The conclusions drawn from the identification of tsunami victims in Thailand were recently discussed at the 17th Meeting of the Standing Committee on Disaster Victim Identification of Interpol in Lyon, and may be used to formulate new guidelines for the identification of victims.     

产前畸形筛查医疗损害责任之司法鉴定20例分析

目的：研究产前畸形筛查医疗损害责任司法鉴定案件的一般规律及其医疗损害责任司法鉴定的特点,为法医学鉴定提供理论支持。方法：对20例产前畸形筛查医疗损害责任司法鉴定案例进行回顾性分析。结果：产前畸形筛查医疗损害责任司法鉴定案例逐年增多;发生纠纷的医疗机构以市（区）级为多见,发生纠纷的案件中以手足畸形和先心病多见;医疗损害责任司法鉴定的主要原因为医疗技术缺陷与医疗管理缺陷。     

Examination results and autopsy findings in assaults on elderly people

As the percentage of elderly people in the population grows, violence against persons of advanced age constitutes an increasing social problem. The findings of the clinical forensic examinations (CE group) and autopsies performed on elderly violence victims (> or = 60 years) between 1999 and 2008 at the Institute of Legal Medicine of the Hanover Medical School were retrospectively analysed. In all, the study material comprised 55 victims of the CE group (35 females and 20 males, median age 73.5 years) and 55 autopsies (33 females and 22 males, median age 72.7 years). In most of the autopsy cases, the suspect was a family member or partner. In contrast, the alleged perpetrator was a stranger in most cases of the CE group. Blunt force injuries were most often found in the CE group victims (63.6%). Altogether, 38.2% (CE group) and 20.0% (autopsy cases) of the violent assaults were associated with robbery. In the majority of the CE cases, the victims suffered potentially or acute life-threatening injuries. In summary, the analysis shows that elderly people frequently become victims of robbery and blunt force injury. In most homicides of old people, the perpetrator is familiar to the victim. In surviving elderly violence victims, the assault is more likely to be reported to the police if the suspect is a stranger.     

Sudden epilepsy deaths and the forensic pathologist

Sudden unexpected deaths in epileptic persons are not rare events, most commonly encountered by the forensic pathologist rather than the clinician. Such deaths may represent 1-1.5% of all "natural" deaths certified by the medical examiner or coroner. The typical victim is a black male about 30 years of age who tends to abuse alcohol, with a history of generalized epilepsy for more than 1 year and likely for more than 10 years. There are a lack of obvious anatomic causes for the death at autopsy, but 60-70% of cases will have a lesion in the brain (most commonly old trauma) to explain the epilepsy. Most victims have no blood levels of anticonvulsant medications at the time of death. We have evolved a form for use by medical examiner/coroner's investigators at the scene to collect relevant information which will be of assistance to the pathologist in interpreting the case. Estimated prevalence of sudden epilepsy death, mechanisms, and other features of such cases are reviewed briefly.