【摘要】 目的 探讨颅脑损伤(BI)死亡的法医病理学特点,以及继发性脑干损伤、并发症的发生与死亡之间的因果关系。方法 从性别、年龄、致伤方式、损伤类型、生存时间、死亡原因等方面,对四川大学华西法医学鉴定中心1998年1月-2008年12月127例BI死亡尸检案例进行回顾性统计研究分析。结果 127例法医病理学检案中,原发性BI死亡51例(402%),继发性脑干损伤死亡61例(480%),并发症死亡15例(118%),其中伤后12 h内死亡者直接死因均为严重原发性脑损伤,存活12 h～1周者直接死因以继发性脑干损伤居多,生存时间超过1周者约半数死于并发症。结论 在BI案例的死亡原因确定时,应在全面系统的病理学检验基础上,结合案情及临床资料进行综合分析。【Abstract】 Objective To explore the characteristics of forensic pathology in traumatic brain injury and the relationships between secondary brainstem damage, complications and the causes of death. Methods 127 cases were reviewed from gender, age, manner of injury, survival time and the direct causes of death from January 1998 to December 2008. Results Of the 127 cases, the key direct cause of death was secondary brainstem damage, followed by severe primarily brain injury and complications. For those who died within 12 hours after injury, the direct cause was severe primarily brain injury; for those who survived between 12 hours to one week, secondary brainstem damage was in the majority of the causes and for those who survive more than one week time, complication was an important cause. Conclusion In the cases of traumatic brain injury, we should take comprehensive and systematic examination of forensic pathology, and refer to clinical data at the same time to determine the direct cause of death.
【摘要】 目的 探讨新生儿死亡医疗纠纷中临床及法医病理学特点,启示儿科医护人员在防范此类医疗纠纷时应注意的相关问题。方法 对四川大学华西基础医学与法医学院法医病理教研室1998年1月—2007年12月的60例新生儿死亡尸检案例进行回顾性统计分析。结果 60例中除3例非正常死亡外,57例为自然性疾病死亡。其中出生后24 h死亡32例(56.1%),死亡男婴40例(70.2%)。死亡原因主要为胎粪吸入综合征、肺透明膜病、肺出血等窒息性疾病(49.1%)。其中医疗过失性纠纷21例(36.8%),医疗过失的原因主要为观察不仔细、处理不及时、误诊漏诊、产前检查或助产处理不当、告知不足等。涉及纠纷的医院以市级医院居多(58.7%)。结论 医护人员应严格遵守诊疗常规和操作规范,对新生儿加强监护,及时抢救,同时应积极与家属沟通,以减少医疗纠纷的发生。
ObjectiveTo analyze the early outcomes of 203 neonates with low birth weight (<2 500 g) undergoing cardiac surgery, and to analyze the causes of death during hospitalization.MethodsFrom June 2003 to June 2017, medical records of 203 neonates with low birth weight undergoing congenital heart surgery in Guangdong General Hospital were reviewed retrospectively. There were 124 males and 79 females, including 151 premature infants. The average birth weight was 1 719±515 g, the average age at operation was 32.7±20.2 d and the average weight at operation was 1 994±486 g. The causes of death during hospitalization (including neonates given up on treatments) were analyzed.ResultsTotally 103 patients had pneumonia, 98 patients needed mechanical ventilation to support breathing and 26 patients needed emergency operation before operation. All patients undergoing congenital heart surgery were treated with general anesthesia with tracheal intubation, including 107 patients under non cardiopulmonary bypass (CPB) and 96 patients under CPB with a mean CPB time of 96.5±71.7 min and a mean aorta cross-clamp time of 51.8±45.5 min. The average postoperative mechanical ventilation time was 9.1±21.5 d and the average postoperative length of stay was 26.7±19.3 d. The major postoperative complications included pneumonia, anemia, atelectasis, septicemia, intrapleural hemorrhage, diaphragm paralysis and cardiac dysfunction. Twenty-nine patients died during hospitalization and the overall mortality rate was 14.3%. Four patients died in the operation room, 14 patients died 72 hours after operation and 2 patients were given up. The main causes of hospitalized death were low cardiac output syndrome, severe infection, disseminated intravascular coagulation disorder, acute renal failure and pulmonary hypertension crisis.ConclusionOverall, early cardiac surgery for low birth weight neonates is safe and effective. The difficulty of the cardiac surgery is the key to the prognosis. Strengthening perioperative management can improve the quality of operation and reduce the risk of mortality and morbidity during hospitalization.
Twenty-one patients(male 18 cases,femal 3 cases)died of primary liver cancer after operation are reviewed.The liver tumors were located in the right lobe(13 cases),left lobe(3 cases),middle position of liver(4 cases)and hepatic hilum(1 cases).The average diameter of the tumors were 9.0cm.All the patients had suffered from liver cirrhosis and were operated on (most of them partial hepatectomy).The times of death were about 7 days,7-14 days later after operation.The data suggest that causes of death were different from the different stage after operation.The relations between partial hepatectomy and hepatic failure,and the liver cirrhosis and liver regeneration are discussed.
目的 分析心脏手术相关医疗纠纷的临床及法医学特点，并就发生原因进行剖析及提出相应防范措施。 方法 对2002年1月－2011年12月四川华西法医学鉴定中心受理的四川省各级医疗机构发生的17例与心脏手术相关的医疗纠纷法医学鉴定资料进行回顾性分析。 结果 17例心脏手术相关医疗纠纷中，12例进行了尸体解剖死因鉴定，死亡原因有心脏传导系统出血，术后感染，低心排量综合症、肺动脉高压、失血性休克致死等。其余5例加上尸体解剖2例在内共7例进行了医疗过错鉴定，存在的医疗过错包括术前检查不完善，告知不充分，手术操作不细致，术后观察、处理不足，医疗记录不完整等。 结论 心脏手术相关医疗纠纷与术后并发症关系密切，医护人员应重视对心脏术后并发症的防治。尸体解剖对解决心脏术后死亡引起的医疗纠纷具有重要意义。
ObjectiveTo analyze the cause of death in low-risk cardiac surgery patients during postoperative period and discuss the prevention and treatment methods to increase the survival rate.MethodsWe retrospectively analyzed the clinical data of 132 patients dead after cardiac surgery from January 2014 to December 2018, among whom 35 patients had a EuroSCORE Ⅱ score <4% (low-risk cardiac surgery patients), including 20 males and 15 females aged 62.7±13.4 years. The cause of death in these low-risk patients was analyzed.ResultsThe main causes of death were cardiogenic and brain-derived causes (60.0%), and infections and ogran failure (45.7%). Pulmonary infection and low cardiac output after surgery were the main causes of death. Cerebral infarction, malignant arrhythmia and multiple organ failure were the common causes of death. There were 4 deaths (11.4%) caused by accidents, including gastrointestinal bleeding caused by esophageal ultrasound probe, cough and asphyxia caused by drinking water, postoperative paralytic ileus and multiple perioperative allergic reactions caused by allergic constitution.ConclusionPostoperative treatment and prevention for low-risk cardiac surgery patients should be focused on postoperative infection, and cardiac and brain function protection. Changes in various organ functions need to be closely monitored for preventing organ failure, accidents should be strictly controlled, and more details of intraoperative and postoperative treatment still need to be further improved.
【摘要】 目的 探讨颅脑损伤(BI)死亡的法医病理学特点,以及继发性脑干损伤、并发症的发生与死亡之间的因果关系。方法 从性别、年龄、致伤方式、损伤类型、生存时间、死亡原因等方面,对四川大学华西法医学鉴定中心1998年1月-2008年12月127例BI死亡尸检案例进行回顾性统计研究分析。结果 127例法医病理学检案中,原发性BI死亡51例(402%),继发性脑干损伤死亡61例(480%),并发症死亡15例(118%),其中伤后12 h内死亡者直接死因均为严重原发性脑损伤,存活12 h～1周者直接死因以继发性脑干损伤居多,生存时间超过1周者约半数死于并发症。结论 在BI案例的死亡原因确定时,应在全面系统的病理学检验基础上,结合案情及临床资料进行综合分析。【Abstract】 Objective To explore the characteristics of forensic pathology in traumatic brain injury and the relationships between secondary brainstem damage, complications and the causes of death. Methods 127 cases were reviewed from gender, age, manner of injury, survival time and the direct causes of death from January 1998 to December 2008. Results Of the 127 cases, the key direct cause of death was secondary brainstem damage, followed by severe primarily brain injury and complications. For those who died within 12 hours after injury, the direct cause was severe primarily brain injury; for those who survived between 12 hours to one week, secondary brainstem damage was in the majority of the causes and for those who survive more than one week time, complication was an important cause. Conclusion In the cases of traumatic brain injury, we should take comprehensive and systematic examination of forensic pathology, and refer to clinical data at the same time to determine the direct cause of death.