摘要
目的探讨内镜逆行胰胆管造影术(ERCP)医疗纠纷案件中医疗过错与原因力之间的关系,为预防相关医疗纠纷发生提供参考。方法收集截至2022年6月30日中国裁判文书网公布的ERCP医疗纠纷案件,分析案件的医疗损害和医疗过错特征以及不同原因力组之间医疗过错特点。结果共纳入152例ERCP医疗纠纷案件。ERCP医疗损害中,手术并发症发生频次由高到低依次为胰腺炎、穿孔、感染和出血,围手术期并发症发生频次由高到低依次为中枢神经系统病变、脏器功能衰竭、猝死、急性心梗、异物残留和其他。ERCP医疗过错多见于“未尽注意义务或延误治疗”“术前评估不全面”“未尽告知义务”。较高原因力案件中,“违反诊疗规范”和“术中未尽谨慎注意义务”占比较高,“术前评估不全面”“术前检查准备不充分”“术后治疗处置不到位”“手术风险告知不充分”占比较低。结论医务人员应严格遵循诊疗规范,加强术前评估,充分履行注意义务和告知义务,重视围手术期诊疗监护;管理部门应强化医疗核心制度管理和医疗安全培训,提高医务人员风险防范能力。
Objective To explore the relationship between medical fault and causative potency in medical dispute cases involving Endoscopic Retrograde Cholangiopancr Patography(ERCP),and to provide reference for the prevention of related medical disputes.Methods The medical dispute cases of ERCP published by China Judgment Documents Network up to June 30,2022 were collected,and the characteristics of medical damage and medical fault as well as the characteristics of medical fault among different causative potencies were analyzed.Results A total of 152 cases of ERCP medical disputes were included.In ERCP medical injury,surgical complications from high to low frequency were pancreatitis,perforation,infection and bleeding,and the perioperative complications from high to low frequency were central nervous system disease,organ failure,sudden death,acute myocardial infarction,foreign body residual and others.The most common medical errors in ERCP were"not fulfilling the duty of care or delaying treatment","incomplete preoperative assessment"and"not fulfilling the duty of notification".Among the cases with high causative potency,"violation of diagnosis and treatment norms"and"failure to fulfill the duty of care and care during surgery"accounted for a relatively high proportion,while"incomplete preoperative assessment","inadequate preparation for preoperative examination","inadequate postoperative treatment and disposal"and"inadequate notification of surgical risk"accounted for a relatively low proportion.Conclusion Medical staff should strictly follow the diagnosis and treatment standards,strengthen preoperative evaluation,fully fulfill the duty of care and notification,and pay attention to perioperative diagnosis and care.Management departments should strengthen core medical system management and medical safety training to improve the risk prevention ability of medical personnel.
作者
万辉
赵胜兵
彭骏
曹廷龙
柏愚
WAN Hui;ZHAO Shengbing;PENG Jun(Naval Military Medical University,Shanghai,200433,China)
出处
《中国卫生质量管理》
2023年第5期45-50,共6页
Chinese Health Quality Management
基金
海军军医大学第一附属医院“234学科攀峰计划”研究项目(编号:2019YXK004)。
