剖宫产术后神经损伤相关医疗纠纷的研究(1)
[摘要] 目的 探讨剖宫产术后神经损伤的病因、治疗、结局等，为临床预防、诊断及治疗提供指导。方法 本研究选取2000～2016年国内文献报导剖宫产术后神经损伤案例及本鉴定中心相关医疗纠纷鉴定案例共92例。对剖宫产术后神经损害的病因、年龄、产次、是否行激素冲击治疗、是否进行司法鉴定分别进行分组及组间差异的统计学分析。结果 神经损伤在年龄、产次分组间无统计学意义(P>0.05)，未经激素冲击治疗组恢复率40.6%(神经损伤后遗症轻微)，而经激素冲击治疗组恢复率上升至73.3%；损伤后遗症明显分组的司法鉴定率为67.5%，明显高于后遗症轻微分组的26.7%司法鉴定率；治疗、司法鉴定率差异具有统计学意义(P<0.05)。结论 剖宫产术后神经损伤与年龄、产次因素无关，应用激素冲击疗法对剖宫产术后神经损伤的治疗具有显著效果，从而在一定程度上降低医疗纠纷司法鉴定的比率。
[关键词]剖宫产；神经损伤；医疗纠纷；司法鉴定
[中圖分类号] R89 [文献标识码] A [文章编号] 2095-0616(2017)12-248-03
Study on medical tangle related to nerve injury caused by cesarean section
ZHANG Guangxia HE Ying HAN Lei
Shandong Dashun Judicial Authentication Institute， Ji'nan 250014， China
[Abstract] Objective To investigate the pathogeny， treatment and outcome of nerve injury after cesarean section， and to provide guidance for clinical prevention， diagnosis and treatment. Methods In this study， 92 nerve injury cases from Literature report and the cases in our Forensic Center between 2000 and 2016 were selecterd. Statistical analysis of age， parity， the treatment of hormone shock therapy and judicial expertise ratio was carried on. Results The difference in age and parity had no statistical significance(P>0.05). The recovery ratio was 40.6% in hormone therapy group， while without hormone therapy the recovery ratio increased to 73.3%. The judicial expertise ratio in sequelae of nerve injury mild group was 67.5%， which significantly higher than the 26.7% rate of nerve injury obvious group. The difference in judicial expertise ratio and therapy had statistically significance(P<0.05). Conclusion The nerve injury after cesarean section is not related to the age and the parity， and the application of hormone shock therapy has a significant effect on the treatment of nerve injury after cesarean section，then effect the judicial expertise ratio.
[Key words] Cesarean section； Nerve injury； Medical tangle； Judicial expertise
随着医学助产技术尤其是剖宫产技术的进展，采用剖宫产手术分娩的比例逐渐增加。剖宫产术致神经损伤虽不是剖宫产术常见并发症，但其发生后较易产生严重不良后果(如截瘫等)[1]，对孕产妇及其家庭均有较为严重的影响，且较易发生医疗纠纷进而产生较大的社会影响而受到国内外学者的关注，多有剖宫产术后截瘫致医疗纠纷的相关案例报导[2]。本研究对剖宫产术后神经损伤产生的相关高危因素、病因、治疗、结局等进行分析、研究，探讨剖宫产术后截瘫的预防、诊断及治疗方案，指导临床应用，以期降低相关医疗纠纷产生的比例。
1 资料与方法
1.1 一般资料
分析本鉴定中心剖宫产术后神经损伤医疗纠纷鉴定案例及国内文献报导案例，本研究选取2000～2016年年国内文献报导剖宫产术后神经损伤案例及本鉴定中心2009～2016年年剖宫产术后神经损伤医疗纠纷法医临床鉴定案例，从中筛选符合剖宫产手术指征、孕前无神经损害、术后神经损害诊断明确并有完整治疗及术后随访记录的案例，共计92例(本研究进行时间2017年1～3月)。按神经损伤的结局分为神经损伤轻微(神经损伤后期基本无后遗症状或遗有部分感觉障碍无肢体运动障碍)、神经损伤明显(神经损伤后期遗有部分感觉及肢体运动障碍、截瘫或双下肢感觉、运动功能丧失)两类。, 百拇医药(张光霞?何英?韩蕾)
[关键词]剖宫产；神经损伤；医疗纠纷；司法鉴定
[中圖分类号] R89 [文献标识码] A [文章编号] 2095-0616(2017)12-248-03
Study on medical tangle related to nerve injury caused by cesarean section
ZHANG Guangxia HE Ying HAN Lei
Shandong Dashun Judicial Authentication Institute， Ji'nan 250014， China
[Abstract] Objective To investigate the pathogeny， treatment and outcome of nerve injury after cesarean section， and to provide guidance for clinical prevention， diagnosis and treatment. Methods In this study， 92 nerve injury cases from Literature report and the cases in our Forensic Center between 2000 and 2016 were selecterd. Statistical analysis of age， parity， the treatment of hormone shock therapy and judicial expertise ratio was carried on. Results The difference in age and parity had no statistical significance(P>0.05). The recovery ratio was 40.6% in hormone therapy group， while without hormone therapy the recovery ratio increased to 73.3%. The judicial expertise ratio in sequelae of nerve injury mild group was 67.5%， which significantly higher than the 26.7% rate of nerve injury obvious group. The difference in judicial expertise ratio and therapy had statistically significance(P<0.05). Conclusion The nerve injury after cesarean section is not related to the age and the parity， and the application of hormone shock therapy has a significant effect on the treatment of nerve injury after cesarean section，then effect the judicial expertise ratio.
[Key words] Cesarean section； Nerve injury； Medical tangle； Judicial expertise
随着医学助产技术尤其是剖宫产技术的进展，采用剖宫产手术分娩的比例逐渐增加。剖宫产术致神经损伤虽不是剖宫产术常见并发症，但其发生后较易产生严重不良后果(如截瘫等)[1]，对孕产妇及其家庭均有较为严重的影响，且较易发生医疗纠纷进而产生较大的社会影响而受到国内外学者的关注，多有剖宫产术后截瘫致医疗纠纷的相关案例报导[2]。本研究对剖宫产术后神经损伤产生的相关高危因素、病因、治疗、结局等进行分析、研究，探讨剖宫产术后截瘫的预防、诊断及治疗方案，指导临床应用，以期降低相关医疗纠纷产生的比例。
1 资料与方法
1.1 一般资料
分析本鉴定中心剖宫产术后神经损伤医疗纠纷鉴定案例及国内文献报导案例，本研究选取2000～2016年年国内文献报导剖宫产术后神经损伤案例及本鉴定中心2009～2016年年剖宫产术后神经损伤医疗纠纷法医临床鉴定案例，从中筛选符合剖宫产手术指征、孕前无神经损害、术后神经损害诊断明确并有完整治疗及术后随访记录的案例，共计92例(本研究进行时间2017年1～3月)。按神经损伤的结局分为神经损伤轻微(神经损伤后期基本无后遗症状或遗有部分感觉障碍无肢体运动障碍)、神经损伤明显(神经损伤后期遗有部分感觉及肢体运动障碍、截瘫或双下肢感觉、运动功能丧失)两类。, 百拇医药(张光霞?何英?韩蕾)