目的 分析主動脈夾層的臨床及病理特點。 方法 回顧性分析1998年1月－2011年10月26例主動脈夾層致死的臨床及法醫尸檢病理資料，對其發病、死亡經過、診斷、死因進行總結。 結果 26例主動脈夾層平均發病年齡為39.2歲，男女比例為3.3︰1；26例中6例無臨床診斷，17例誤診，3例疑似診斷。26例主動脈夾層中，夾層破裂致心包填塞死亡20例，夾層破裂致失血性休克死亡5例，主動脈夾層未破裂1例系心衰致死；26例按DeBakey分類標準9例為Ⅰ型，14例為Ⅱ型，3例為Ⅲ型。 結論 臨床應警惕主動脈夾層的特殊臨床表現并采取必要的輔助檢查，有助于主動脈夾層的診治和減少醫療糾紛的發生。
Objective To assess the efficacy and safety of gabapentin for restless legs syndrome (RLS). Methods Such databases as PubMed, EMbase, CENTRAL and CBM were searched for collecting the randomized controlled trials (RCTs) on the efficacy and/or tolerability of gabapentin for restless legs syndrome. Methodological quality of the trials was evaluated using the Cochrane risk-of-bias criteria, and meta-analysis was carried out using RevMan 5.1. Results Seven RCTs involving 1 163 patients which met the criteria were included, of which 4 were placebo parallel controlled trials and 3 were placebo cross-over trials. The outcomes of meta-analysis suggested that a) As to the change of RLS severity based on IRLSSG score, gabapentin was superior to placebo in alleviating the severity of RLS (MD= –3.24, 95%CI –4.40 to –2.09, Plt;0.000 01); b) As to the response rate based on investigator-rated CGI-I scale, it was higher in the gabapentin group (77%) compared with that in the placebo group (50%) (RR=1.81, 95%CI 1.54 to 2.11, Plt;0.000 01); c) As to quality of sleep, gabapentin was superior to placebo in reducing sleep disturbance (MD= –11.31, 95%CI –14.46 to –8.16), assuring quality of sleep (MD= 0.27, 95%CI 0.10 to 0.44) and alleviating daytime somnolence (MD= –3.96, 95%CI –6.42 to –1.50); and d) As to the RLS pain score, gabapentin was better in relieving pain compared with placebo (MD= –0.97, 95%CI –1.47 to –0.47). In addition, main side effects were somnolence (3.1% to 26.5%) and dizziness (2.1% to 19.5%), and there was a significant difference between two groups. Conclusion Gabapentin can effectively alleviate RLS patients’ condition, improve quality of sleep, relieve pain and show good tolerability.
【摘要】 目的 從法醫病理學角度分析引起醫療糾紛的孕產婦死亡原因、醫療糾紛發生原因并提出相關防范措施。 方法 對1999年1月-2008年12月間46例引起醫療糾紛的孕產婦死亡案例進行回顧性分析。 結果 孕產婦死亡年齡以30歲以上多見，死亡時妊娠時間以圍產期居多（87.0%）。死亡原因中產科失血性休克死亡21例（45.7%），栓塞類疾病死亡8例（17.4%），感染性疾病死亡5例（10.8%），其他原因死亡12例（26.1%）。46例中屬非醫療過失性醫療糾紛8例（17.4%），醫療過失性糾紛38例（82.6%），醫療過失的原因主要為搶救不及時、處理不當、誤診誤治等。涉及糾紛的醫院以縣區級醫院居多（54.3%）。 結論 通過法醫病理學司法鑒定查明死亡原因，明確醫療責任及醫療糾紛原因，已成為解決孕產婦死亡醫療糾紛的重要手段。【Abstract】 Objective To analyze the causes of maternal death with medical disputes, the causes of medical disputes, and to recommend the related preventions through a forensic pathological angle. Methods We retrospectively analyzed 46 cases of maternal death with medical disputes which were collected by West China Center of Forensic Medicine Service in Sichuan between January 1999 and December 2008. Results Most maternal deaths occurred over 30 years old. They most frequently happened during the peri-natal period (87.0%). The causes of death included obstetric hemorrhagic shock in 21 cases (45.7%), embolism-like diseases in 8 cases (17.4%), infectious diseases in 5 cases (10.8%) and other reasons in 12 cases (26.1%). Among all the 46 cases of medical disputes, 8 (17.4%) were not due to medical malpractices, while the other 38 cases (82.6%) had something to do with such medical malpractices as delayed or inappropriate treatment, misdiagnosis and so on. Most of the malpractices in these cases involved medical institutions at a county level (54.3%). Conclusion Forensic judicatory appraisal is important to resolve medical disputes of maternal death by finding out the cause of death, clarifying the medical responsibility and clearing the cause of medical disputes.
目的 分析心臟手術相關醫療糾紛的臨床及法醫學特點，并就發生原因進行剖析及提出相應防范措施。 方法 對2002年1月－2011年12月四川華西法醫學鑒定中心受理的四川省各級醫療機構發生的17例與心臟手術相關的醫療糾紛法醫學鑒定資料進行回顧性分析。 結果 17例心臟手術相關醫療糾紛中，12例進行了尸體解剖死因鑒定，死亡原因有心臟傳導系統出血，術后感染，低心排量綜合癥、肺動脈高壓、失血性休克致死等。其余5例加上尸體解剖2例在內共7例進行了醫療過錯鑒定，存在的醫療過錯包括術前檢查不完善，告知不充分，手術操作不細致，術后觀察、處理不足，醫療記錄不完整等。 結論 心臟手術相關醫療糾紛與術后并發癥關系密切，醫護人員應重視對心臟術后并發癥的防治。尸體解剖對解決心臟術后死亡引起的醫療糾紛具有重要意義。
目的 分析骨科醫療糾紛的原因及特點，為醫療糾紛的防范提供參考。 方法 收集2010年1月－2011年12月四川華西法醫學鑒定中心涉及四川省各級醫療機構的骨科醫療糾紛鑒定案例55例，進行回顧性分析。 結果 55例骨科醫療糾紛中2010年25例，2011年30例；醫源性醫療糾紛41例（74.5%），非醫源性醫療糾紛14例（25.5%）。醫源性醫療糾紛中醫療機構存在的問題主要以手術操作不當及失誤為主（15例，占27.3%），其次為醫患溝通不到位（8例，占14.5%）。 結論 骨科醫療糾紛防范的關鍵在于醫務人員認真履行其診療義務。