Zehr K J, Liddicoat J R, Salazar J D, Gillinov A M, Hruban R H, Hutchins G M, Cameron D E
Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Ann Thorac Surg. 1997 Aug;64(2):380-3. doi: 10.1016/S0003-4975(97)00551-1.
This study examined the ability of autopsy to confirm or dispute presumptive cause of death among cardiac surgery patients.
Autopsy reports were compared with mortality conference notes that were dictated prospectively before autopsy results were available. Between January 1985 and December 1995, there were 600 hospital deaths among 13,029 adult cardiac surgery patients (4.6% mortality). Of these 600 deaths, 147 (24.5%) had postmortem examination.
Annual autopsy rate remained constant over the course of the study. Autopsied patients were younger (60.4 +/- 15 versus 66.7 +/- 13 years [mean +/- standard error of the mean]; p < 0.0001), but their race and sex distributions were similar to deceased patients not having autopsy. Autopsy confirmed clinical presumptive cause of death in 52% (76), disputed clinical diagnosis in 9.5% (14), provided definitive diagnosis in the absence of clinical diagnosis in 13.6% (20), and failed to provide definitive diagnosis in 25% (37). One third of autopsies (39%; 57) provided information that was clinically unrecognized and might have altered therapy and outcome if known premortem. As determined by autopsy, common causes of death were cardiac (27%; 39), unknown (25%; 37), sepsis (14%; 21), stroke (8.8%; 13), cholesterol embolism (4.1%; 6), pulmonary embolism (4.1%; 6), and adult respiratory distress syndrome (4.1%; 6).
Autopsy reveals or confirms cause of death in nearly three quarters of cardiac surgical deaths and provides information that differs significantly from premortem clinical impression more than 20% of the time. As such, the autopsy remains important to quality assurance in cardiac surgical care.
本研究探讨了尸检在确认或质疑心脏手术患者推定死因方面的能力。
将尸检报告与在尸检结果出来之前前瞻性记录的死亡病例讨论会记录进行比较。1985年1月至1995年12月期间，13029例成人心脏手术患者中有600例医院死亡（死亡率4.6%）。在这600例死亡病例中，147例（24.5%）进行了尸检。
在研究过程中，年度尸检率保持不变。接受尸检的患者更年轻（60.4±15岁与66.7±13岁[平均值±平均标准误差]；p<0.0001），但他们的种族和性别分布与未接受尸检的死亡患者相似。尸检确认临床推定死因的占52%（76例），质疑临床诊断的占9.5%（14例），在无临床诊断时提供明确诊断的占13.6%（20例），未能提供明确诊断的占25%（37例）。三分之一的尸检（39%；57例）提供了临床上未被认识到的信息，如果生前已知这些信息，可能会改变治疗方法和结果。经尸检确定，常见死因包括心脏相关（27%；39例）、不明原因（25%；37例）、败血症（14%；21例）、中风（8.8%；13例）、胆固醇栓塞（4.1%；6例）、肺栓塞（4.1%；6例）和成人呼吸窘迫综合征（4.1%；6例）。
尸检揭示或确认了近四分之三心脏手术死亡病例的死因，并且在超过20%的情况下提供了与生前临床印象有显著差异的信息。因此，尸检对于心脏手术护理的质量保证仍然很重要。
