73例儿科医疗损害的法医病理学鉴定

摘要

目的 通过对73例儿科医疗损害的法医病理学鉴定案例进行分析,探讨法医病理学在解决儿科医疗损害等问题上的重要性.方法 收集南京医科大学司法鉴定所2002年1月-2016年8月受理的、死亡年龄在28 d～10岁的儿科医疗损害病理检验案例73例,对死亡原因及与涉案医疗机构的关系进行回顾性分析.结果 73例中,男女性比例1.70:1,年龄在28 d～1岁的居多,为26例(35.62％),其次是>1～3岁,为21例(28.77％).通过尸体检验确定死亡原因的71例中,死亡原因以疾病为主,其中呼吸系统疾病占首位,为33例(46.48％),其次是心血管系统疾病,为12例(16.90％).医疗损害涉及医疗机构共75所,三级医疗机构32所(42.67％),其次为二级以下(不包括二级)医疗机构23所(30.67％).临床诊断与法医病理学诊断相符及基本相符的有38例(52.05％),未明确或者误诊的35例(47.95％).结论 法医学尸体解剖及病理学鉴定有助于确定死亡原因,不仅为儿科医疗损害提供了科学的依据,并且丰富和发展了临床医学知识,可在一定程度上提高诊疗水平.%Objective To analyse 73 medical malpractice cases of pediatrics for discussing the importance of forensic pathology in solving the issues such as medical malpractice of pediatrics. Methods From January 2002 to August 2016, 73 medical malpractice cases of pediatrics with age of death between 28 days old and 10 years old were collected from Institute of Judical Expertise of Nanjing Medical University. The relationship between causes of death and related medical institutions was retrospectively analysed. Results In 73 cases, the male to female ratio was 1.70:1, and ages of 28 days old to 1 year old were com-mon (26 cases, 35.62％), followed by ages between 1 year old and 3 years old (21 cases, 28.77％). In 71 cases which had been determined the cause of death by postmortem examination, the main cause of death was disease, especially respiratory diseases (33 cases, 46.48％), followed by cardiovascular diseases (12 cases, 16.90％). In 75 medical institutes which involved with these medical malpractices, most were tertiary medical institutes (32, 42.67％), followed by the sub-secondary (excluding the secondary) medi-cal institutions (23, 30.67％). The clinical diagnosis of 38 cases (52.05％) completely or mostly corre-sponded with the pathological findings. There were 35 cases (47.95％) undefined or misdiagnosed cases. Conclusion Autopsy and forensic pathological examination contribute to determine causes of death, which not only provide scientific evidence for medical malpractice of pediatrics, but also enrich and develop clinical medical knowledge, and thus improve diagnosis and treatment level in a certain extent.