心外科手术后死亡医疗纠纷尸检分析

目的从尸检角度讨论心外科手术后死亡的死因及诊疗缺陷。方法按临床诊断、手术类型、死亡时间、死亡特点、尸检特点、纠纷特点、诊疗缺陷等方面,比较所选案例的临床、尸检资料特点。结果心瓣膜置换手术4例,冠心病冠脉搭桥手术1例,先心病大动脉转位手术1例。心肌梗死2例,心肌广泛损伤1例。心内膜感染2例,多器官功能衰竭1例。家属怀疑诊疗不当6例。诊疗缺陷主要为手术适应证、手术时机,手术器材的选用,手术操作,术后病情观察、处理不及时,对病情严重程度、手术风险及预后的告知不充分。结论尸检不仅能查明死因,还可帮助评价手术质量、术后处理的诊疗质量,对解决纠纷具有重要的辅助作用。

Analysis of autopsy and clinical findings on medical malpractice cases after heart operation

Objective The purpose of this study was to use autopsy to explore cause of death and to identify medical errors after cardiac surgery.Methods Clinical and autopsy findings in 6 cases were analyzed with respect to the clinical diagnosis,operation types,death time and features,and autopsy findings,medico-legal disputes and related medical errors.Results There were total 6 patients.The procedures involve cardiac valve replacement(4),coronary artery bypass(1),and congenital aortic transposition repair(1).Three patients had sudden death one week after surgery and 3 from congestive heart failure.The findings include myocardial infarction(2),massive myocardial injury(1),endocarditis(2),and multi-organ failure(1).The families in all six cases suspected malpractice.The major concerns were operation indication and timing,selection of operation equipment,operative mishandling,inadequate post-operative care and timely therapeutic invention,inadequate informed consent regarding the severity of the disease itself,the risks of heart surgery,and its prognosis after the procedures.Conclusion Autopsy can be used to determine the cause of death,to assess the quality of the operation and post operation management,and to help to resolve malpractice disputes