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。
Objective To establish a personalized Stanford type B aortic dissection numerical simulation model, and using computational fluid dynamics (CFD) numerical simulation to obtain the hemodynamic behavior and law of the type B aortic dissection at different stages of development. Methods Based on the theory of three-dimensional model reconstruction, we used CT images of a patient with type B aortic dissection in the Xiamen Cardiovascular Hospital of Xiamen University, relevant medical image processing software to reconstruct a personalized aortic three-dimensional model, and CFD to reconstruct the model which was simulated in fluid mechanics. Results The three-dimensional reconstruction model could intuitively observe the changing trend of the false cavity at different stages of the dissection development. Through fluid mechanics simulation, the blood flow rate, pressure, wall shear stress, vascular wall Von Mises stress and other parameters at different stages of the dissection development were obtained. Conclusion The hemodynamic behavior and law of relevant parameters in the development stage of aortic dissection are analyzed. The combination of the values of relevant parameters and clinical medical detection and diagnosis can well predict the development of the disease, and finally provide more theories and methods for the scientific diagnosis of aortic dissection.
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。
Objective To analyze the risk factors for ventilator-associated pneumonia( VAP) in adult patients undergoing cardiac surgery with cardiopulmonary bypass ( CPB) . Methods A total of 127 consecutive adult patients who received postoperative ventilation for more than 48 hours between January 2002 and June 2008 in the cardiac surgical intensive care unit( CSICU) were included in this study. The patients were assigned into a VAPgroup( n =64) and a control group( n = 63) . Pre-, intra-, and postoperative factors were collected and analyzed between two groups, and the multivariate analysis( logistic regression)were used to identify the risk factors of VAP. Results The overall incidence of VAP was 5.1%. The mortality of VAP was 28. 1% . Compared to the control group, the patients in the VAP group had longer duration of cardiopulmonary bypass time, ventilation time, more blood products usage and the duration of stay in CSICU( P lt; 0. 001) , higher morbidity of low cardiac output syndrome and tracheotomy( P lt; 0. 01) and higher rate of aortic surgery and mortality( P lt; 0. 05) . The preoperative left ventricular ejection fraction ( LVEF) and postoperative oxygenation index( PaO2 /FiO2 ) were lower in the VAP group than those of the control group( P lt; 0. 001) . Five variables were found to be significantly related to the development of VAP by multivariate analysis: CPB time gt; 120 min( OR = 6. 352, P = 0. 000) ; PaO2 /FiO2 lt; 300 mm Hg( OR =3. 642, P = 0. 017) , transfusion of blood products ≥1500 mL( OR = 5. 083, P = 0. 039) , ventilation time≥5 days( OR = 9. 074, P = 0. 047) and tracheotomy( OR = 19. 899, P = 0. 021) . A total of 102 pathogens were obtained by sputum culture in 64 VAP patients. There were 62( 60. 8% ) cases of gram negative bacilli, 19 cases( 18. 6% ) of gram positive cocci and 21( 20. 6% ) cases of eumycetes. Conclusion This study shows that the cardiopulmonary bypass time, ventilation time, hypoxemia, blood products transfusion and tracheotomy are risk factors most likely associated with VAP development.