[1]万辉赵胜兵彭骏曹廷龙柏愚.内镜逆行胰胆管造影术医疗纠纷案件中医疗过错因素与原因力的关系研究[J].中国卫生质量管理,2023,30(05):45-50.[doi:10.13912/j.cnki.chqm.2023.30.5.10 ]
　WAN Hui,ZHAO Shengbing,PENG Jun.The Relationship between Medical Fault Factors and Causative Potency in Medical Disputes of ERCP[J].Chinese Health Quality Management,2023,30(05):45-50.[doi:10.13912/j.cnki.chqm.2023.30.5.10 ]

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内镜逆行胰胆管造影术医疗纠纷案件中医疗过错因素与原因力的关系研究

《中国卫生质量管理》[ISSN:1006-7515/CN:CN 61-1283/R] 卷: 第30卷期数: 2023年05期页码: 45-50 栏目: 医疗质量出版日期: 2023-05-15

Title:: The Relationship between Medical Fault Factors and Causative Potency in Medical Disputes of ERCP

作者:: 万辉赵胜兵彭骏曹廷龙柏愚; 海军军医大学

Author(s):: WAN Hui; ZHAO Shengbing; PENG Jun; Naval Military Medical University

关键词:: 内镜逆行胰胆管造影术; 医疗纠纷; 医疗过错; 原因力; 医疗质量

Keywords:: ERCP; Medical Dispute; Medical Fault; Causative Potency; Medical Quality

分类号:: R197.3

DOI:: 10.13912/j.cnki.chqm.2023.30.5.10

文献标志码:: A

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。

Abstract:: ObjectiveTo 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.MethodsThe 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.ResultsA 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.

参考文献/References:

［1］李跃华,龚建平.ERCP在胆胰系统疾病的诊治应用现状及研究进展［J］.临床医学进展,2021,11(7):3123-3130. ［2］李莉,谭跃,黎振林,等.ERCP术后近期并发症及防治［J］.基层医学论坛,2012,16(19):2457-2461. ［3］中华人民共和国全国人民代表大会.中华人民共和国民法典［EB/OL］.（2021-05-28）［2022-09-26］.http://www.npc.gov.cn. ［4］冯龙,王典,于晓军,等.医疗损害因果关系及其原因力的定性定量分析［J］.中国司法鉴定,2013(3):95-98. ［5］医法汇.2021年全国医疗损害责任纠纷案件大数据报告［EB/OL］.（2022-02-07）［2022-09-26］. https://baijiahao.baidu.com. ［6］李鹏,王拥军,王文海.ERCP诊治指南(2018版)［J］.中国实用内科杂志,2018, 38(11):1041-1072. ［7］中华医学会.临床技术操作规范普通外科分册［M］.北京:人民军医出版社,2002:202-204. ［8］最高人民法院.关于审理医疗损害责任纠纷案件适用法律若干问题的解释［EB/OL］.（2020-12-23）［2022-09-26］.https://www.court.gov.cn/fabu-xiangqing-73512.html. ［9］柏愚,李德锋,王树玲,等.经内镜逆行胰胆管造影术围手术期用药专家共识意见［J］.临床肝胆病杂志,2018,34(12):2555-2562. ［10］刘宇,柏涌海,王沛,等.上海某三甲医院医疗纠纷影响因素研究［J］.中国卫生质量管理,2019,26(3):75-78. ［11］毛艳霞. 诊疗规范在医疗损害责任纠纷中的应用［D］.重庆：西南政法大学,2014. ［12］王瑞涛,冀依帆,田胜男,等.从案例谈医师注意义务［J］. 中国卫生人才,2022(9):37-40. ［13］马佛涵.医疗技术过失认定探讨［D］.昆明：云南财经大学, 2022. ［14］曾文博,周惠黠,邓虹.基于Logistic回归分析探讨医疗损害因素对原因力判定的影响［J］.中国司法鉴定,2022(2):46-50. ［15］曾文博. 临床视域下医疗过错与医疗损害原因力研究［D］.昆明：昆明医科大学,2021. ［16］应娇茜,张燕,王晨曦,等.会诊制度落实难点分析与管理策略［J］.中国卫生质量管理,2021,28(2):6-8. ［17］李霞,应娇茜,邹鎔,等.疑难病例讨论制度落实难点分析与思考［J］.中国卫生质量管理,2022,29(4):36-38.

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更新日期/Last Update: 2023-05-15