ObjectiveTo systematically review the current status of doctor-patient conflicts in China.MethodsWe searched CNKI and CSSCI databases to collect literatures about the doctor-patient conflicts from inception to April 23rd, 2017. The literatures were categorized by the published time, the high-frequency vocabulary, the citation frequency, the researching discipline, the researching facility, the quality of literature, the theme of literature and so on. The current research status of the doctor-patient conflicts was analyzed.ResultsA total of 226 literatures were included, in which 72 defined and classified the doctor-patient conflicts, 122 analyzed the causing reasons of doctor-patient conflicts, and 160 analyzed the governance paths of doctor-patient conflicts. The research disciplinary vision was limited to the policies, regulations and the medical education and so on, and the researches in psychology or economics disciplinary vision were insufficient. The medical and comprehensive universities were the main research units of the studies of the doctor-patient conflicts. The frequency and quality of the researches about doctor-patient conflicts were low.ConclusionThe classified studies of doctor-patient conflicts are insufficient, so the scientific and manageable classified criterions are needed in the further studies. Systematic studies in influential factors of doctor-patient conflicts are insufficient, so the occurring mechanisms of conflicts are needed to be done by systematical researches on patient-centered way. The studies of governance paths of doctor-patient conflicts are insufficient, so the strategies of classified and systematical management which according to the different conflicting forms and entire process of the conflict occurrence should be put forward.
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。
摘要:目的: 探討如何提高早產兒存活率和生存質量。 方法 :對我院新生兒病房收治的228例早產兒的臨床資料進行了回顧分析。 結果 :引起早產的母親因素以胎膜早破、妊娠期膽汁淤積綜合征及妊娠合并高血壓綜合征為早產的重要因素,而引起早產兒常見疾病的是新生兒肺炎,高膽紅素血癥及新生兒窒息等。而呼吸衰竭、新生兒休克、多器官衰竭則是引起早產兒預后不良的重要因素。 結論 :早產原因以母體因素為主,故加強孕期保健,積極防治母親的有關并發癥,同時提高新生兒急救水平,早期干預,以提高早產兒的生存質量。Abstract: Objective: To exploere the ways of promoting the survival rate and the quality of life in premature infants. Methods :The clinical data on 228 cases of premature infants treated by neonatal wards were analyzed retrospectivelly. Results : The important factors of premature are cholestasis of pregnancy syndrome, premature rupture of membbranes, and hypertemsion in prefnancy. The commom diseases in premature infants are neonatal pnecemonia, hyperbilirubinemia and asphxia, the major factors in poor prognasis are caused by neonatal shock, multiple organ failure in premature infants. Conclusion :The main reasons of premature is maternal factors. It is important to strengthen the health care during pregnancy, control the complications of mothers actively, at the same time, improve the level of neonatal first aid, intervent early, so as to imprive the quality of life in preterm infants.
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.
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。