Xie Zhi-Gang, Zheng Jie
Department of Pathology, Health Science Center, Peking University, Beijing 100191, China.
Zhonghua Bing Li Xue Za Zhi. 2009 Jun;38(6):370-5.
To study the characteristics of autopsies in medical dispute cases, with respect to class of hospitals, clinical units concerned, age of deceased and cause of death.
Two hundred and seventy-five autopsies performed on medical dispute cases during the period from January 1, 2002 to September 30, 2008 at the Department of Pathology, Health Science Center, Peking University, China were retrospectively reviewed.
During the period of study, the number of autopsies performed on medical dispute cases gradually increased. Medical dispute cases happened more often in surgical, obstetric and gynecology departments of grade II and III hospitals, as well as emergency departments of grade I hospitals. Perinatal death in infants of less than 1 year old more frequently caused medical dispute than death occurring in other age groups. According to the International Classification of Diseases (ICD10), disorders of the circulatory system, perinatal illnesses, external injury or iatrogenic conditions represented the major categories of cause of death. In general, the vast majority was due to natural causes and only 13.5% were related to iatrogenic reasons or medical negligence. Pathologic diagnosis of sudden coronary death, myocardial infarction and viral myocarditis should only be made with strict diagnostic criteria.
Autopsies for medical dispute cases can help to delineate the cause of death and provide evidence for further clarification. Meticulous autopsy techniques, application of strict diagnostic criteria and detailed analysis of cause of death are key steps in achieving a high quality service in this area.
研究医疗纠纷案件尸检在医院级别、相关临床科室、死者年龄及死因方面的特点。
回顾性分析2002年1月1日至2008年9月30日期间北京大学医学部病理学系对275例医疗纠纷案件所做的尸检。
在研究期间，医疗纠纷案件的尸检数量逐渐增加。医疗纠纷案件较多发生在二级和三级医院的外科、妇产科以及一级医院的急诊科。1岁以下婴儿的围产期死亡比其他年龄组的死亡更常引发医疗纠纷。根据国际疾病分类（ICD10），循环系统疾病、围产期疾病、外伤或医源性疾病是主要死因类别。总体而言，绝大多数是自然原因导致，仅有13.5%与医源性原因或医疗过失有关。对于心源性猝死、心肌梗死和病毒性心肌炎的病理诊断应严格遵循诊断标准。
医疗纠纷案件的尸检有助于明确死因并为进一步厘清情况提供证据。细致的尸检技术、严格诊断标准的应用以及死因的详细分析是在该领域提供高质量服务的关键步骤。
