解剖尸体后,终于找到死亡原因了……

2017-06-13 李金山 “医学界”微信号

一个医生的解剖日志:尸体会说话。

无论是刑事案件还是医疗纠纷等导致的非正常死亡,都会使法医病理学产生社会需求,检验的主要对象是尸体,目的是查明死亡原因和方式等问题,澄清死亡是否涉及法律问题。

这里介绍一起因“诊疗行为导致”死亡的案例。

简要案情

患者男性,45岁,主诉咳嗽、发烧两天,到当地社区医疗机构诊治,诊断:上呼吸道感染,医疗机构给予头孢类抗生素静脉点滴,但未给予其它检查。门诊静点过程顺利,离院步行回家,途中约20分钟左右,突然倒地人事不省,院前急救人员赶到现场,判断患者死亡。后逝者家属辩称医疗机构在静点前未做药物过敏试验导致逝者过敏死亡,医院应承担死亡全部责任。

医院方辩称静点前虽未做皮试但给予肌肉注射试敏后静点,静点过程中未发现药物过敏症状,认为逝者因其它意外情况死亡。双方争执不断升级,尸体停留医院近40小时,后由相关部门强制冷冻。经三方协议委托某司法鉴定机构进行尸检。

记得当时是冬天,地点是某殡仪馆解剖室,早七点左右将尸体自冷冻箱取出自然解冻,到晚六点左右开始解剖,偌大个殡仪馆只有几名法医和三名家属参加检验过程,院方未派员参加,北风呼啸拍打着解剖室的窗棂,这种格子的设计不知是否要安慰放在这里的亡灵,但我的感觉应该是考虑到安全问题。



尸表勘验可见双上臂有明显腐败静脉网(图一),下肢量少较轻。



寻找臀部肌注试敏部位(图二,三)。



打开胸腔后可见左胸腔内可见2500毫升血液及少量凝血块(图四),寻找出血源,可见胸主动脉有一梭形肿物并破裂(图五),当时即考虑为胸主动脉夹层动脉瘤破裂



系统解剖后,心包积液,其它器官未发现存在改变,尤其喉头未见水肿(图六)。后经病理诊断肿物为主动脉夹层动脉瘤

近年来大量数据表明,医疗纠纷数量呈现逐年上升的趋势,医患之间的纠纷已经严重影响到社会的稳定与发展,其主要原因是医疗损害鉴定制度尚不完善,不能很好的解决医患矛盾,进而导致医患之间产生信任危机,虽然《中华人民共和国侵权责任法》于2010年7月1起施行,并且对医疗损害责任进行专章规定,但并没有使紧张的医患关系得到舒缓,在医院内经常出现暴力事件就是有力证明。

正如这位逝者家属所说“好好的一个人到你们医院只是打个静点,人就没了,医院是在杀人”。好好的一个人去医院,然后就如何如何了,这话听的太多了,我想做为医生这不是我一个人的感受,医生们都想搞清楚死亡真相,但实践中可以看到,医患双方对尸体检验在医疗纠纷中的法律意义在认识上存在不足,抛开患方不说,有些医生更相信自己的诊断和推断,经常会出现患方不愿尸检,医生也不喜欢尸检的现象。

我国医患纠纷发生死亡后果的尸检率是很低的,一方面原因来自于患方,这主要来自于陈旧的传统观念,往往以人死后要保以全尸,家属常常采取拒绝和不合作的态度,事实上这种做法对当事人维权是十分不利的。

另一方面原因是医疗机构不主动提出尸检,患者死亡后,由于家属一度处于极度悲痛之中,加上医疗机构及医务人员的法律意识淡薄,往往不能及时提出尸检请求,使尸检错过最佳检验时间。

很多患者死亡后没做尸检,这对以后的鉴定会带来很大麻烦,往往难以确定死亡的真正原因,所以在诊疗过程中出现死亡后果,患者家属又对诊疗过程存在异议,本人更希望对于非正常死亡的进行解剖勘验,但我国到目前为止还没有规定出强制性解剖的范围,更谈不上从立法上限制和规范,司法实践中尸检的随意性比较大。

很多例子可以看到在有条件可以进行系统解剖的,可双方当事人认为死亡原因明确而放弃尸检草草了事,真正的结果其实是死因不明。当然这种现象不仅仅发生在医疗纠纷中,包括意外事故、猝死、自杀死亡尸体等情况。

本案例说明死亡原因不是靠推测就能得出结论,尽管存在“阴性解剖”,但尸检应该是确定死亡原因和方式的金标准。

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    2017-06-16 医张生

    什么都立法,为什么这样的事件不立法?为什么,草民没有能力,大咖呢。胡咧咧的大咖

    0

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    2017-06-14 1511e81efbm

    凡是纠纷的国家应该强制尸解不就行了吗?

    0

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    2017-06-14 人间可客

    学习了谢谢分享。

    0

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    2017-06-14 Chongyang Zhang

    签到学习了很多人

    0

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    2017-06-14 戒馋,懒,贪

    超赞的文章

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1903518, encodeId=d15e190351804, content=<a href='/topic/show?id=c8aa6335ed5' target=_blank style='color:#2F92EE;'>#死亡原因#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63357, encryptionId=c8aa6335ed5, topicName=死亡原因)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=570c172, createdName=tigerlr98, createdTime=Mon Sep 04 17:13:00 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211455, encodeId=ca342114553d, content=什么都立法,为什么这样的事件不立法?为什么,草民没有能力,大咖呢。胡咧咧的大咖, beContent=null, objectType=article, channel=null, level=null, likeNumber=133, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=01bb1684217, createdName=医张生, createdTime=Fri Jun 16 09:25:53 CST 2017, time=2017-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210781, encodeId=3051210e81d9, content=凡是纠纷的国家应该强制尸解不就行了吗?, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=56c82033600, createdName=1511e81efbm, createdTime=Wed Jun 14 20:15:33 CST 2017, time=2017-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210525, encodeId=a9842105257e, content=学习了谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuEJWOf8El7MfqtlSpy4eWtPl5cxmNJ4ezwbFf5vtCeh53ITyabFpFIJfKTPlzdh6ibOibVONwHUbm9/0, createdBy=a4351715107, createdName=人间可客, createdTime=Wed Jun 14 07:49:06 CST 2017, time=2017-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210513, encodeId=1f42210513fc, content=签到学习了很多人, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/A3E53E62691178E2F18D7B999FD22131/100, createdBy=f44d2003846, createdName=Chongyang Zhang, createdTime=Wed Jun 14 07:21:31 CST 2017, time=2017-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210427, encodeId=4b1721042e45, content=超赞的文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Wed Jun 14 05:39:22 CST 2017, time=2017-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210377, encodeId=1ab22103e773, content=很有意义, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6lR0HdZibhWZ8X1yLOVj8WPicl2Fu38UJyue9g5yUbZYs8LBhr8juq58bkLYbZ7ic8fmlEUHXgAic73qLqVNnkXwrj/0, createdBy=8ebc2052195, createdName=大家, createdTime=Tue Jun 13 23:57:46 CST 2017, time=2017-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210368, encodeId=56ae210368e2, content=文章写的真好 真像及时雨!, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2d941739100, createdName=1df05b80m14(暂无匿称), createdTime=Tue Jun 13 23:22:58 CST 2017, time=2017-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210348, encodeId=9770210348a5, content=尸检,确实是很多时候有必要的存在, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160911/IMG57D51CE461BD24798.jpg, createdBy=91d61672802, createdName=西风染林, createdTime=Tue Jun 13 22:19:39 CST 2017, time=2017-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210316, encodeId=f23b21031617, content=哈哈哈哈哈哈哈哈哈哈,不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/06/13/0111a89d3ce54851592678534e7b21fe.jpg, createdBy=5cb91710235, createdName=菊花小王子, createdTime=Tue Jun 13 20:07:06 CST 2017, time=2017-06-13, status=1, ipAttribution=)]
    2017-06-13 大家

    很有意义

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1903518, encodeId=d15e190351804, content=<a href='/topic/show?id=c8aa6335ed5' target=_blank style='color:#2F92EE;'>#死亡原因#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63357, encryptionId=c8aa6335ed5, topicName=死亡原因)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=570c172, createdName=tigerlr98, createdTime=Mon Sep 04 17:13:00 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211455, encodeId=ca342114553d, content=什么都立法,为什么这样的事件不立法?为什么,草民没有能力,大咖呢。胡咧咧的大咖, beContent=null, objectType=article, channel=null, level=null, likeNumber=133, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=01bb1684217, createdName=医张生, createdTime=Fri Jun 16 09:25:53 CST 2017, time=2017-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210781, encodeId=3051210e81d9, content=凡是纠纷的国家应该强制尸解不就行了吗?, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=56c82033600, createdName=1511e81efbm, createdTime=Wed Jun 14 20:15:33 CST 2017, time=2017-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210525, encodeId=a9842105257e, content=学习了谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuEJWOf8El7MfqtlSpy4eWtPl5cxmNJ4ezwbFf5vtCeh53ITyabFpFIJfKTPlzdh6ibOibVONwHUbm9/0, createdBy=a4351715107, createdName=人间可客, createdTime=Wed Jun 14 07:49:06 CST 2017, time=2017-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210513, encodeId=1f42210513fc, content=签到学习了很多人, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/A3E53E62691178E2F18D7B999FD22131/100, createdBy=f44d2003846, createdName=Chongyang Zhang, createdTime=Wed Jun 14 07:21:31 CST 2017, time=2017-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210427, encodeId=4b1721042e45, content=超赞的文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Wed Jun 14 05:39:22 CST 2017, time=2017-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210377, encodeId=1ab22103e773, content=很有意义, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6lR0HdZibhWZ8X1yLOVj8WPicl2Fu38UJyue9g5yUbZYs8LBhr8juq58bkLYbZ7ic8fmlEUHXgAic73qLqVNnkXwrj/0, createdBy=8ebc2052195, createdName=大家, createdTime=Tue Jun 13 23:57:46 CST 2017, time=2017-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210368, encodeId=56ae210368e2, content=文章写的真好 真像及时雨!, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2d941739100, createdName=1df05b80m14(暂无匿称), createdTime=Tue Jun 13 23:22:58 CST 2017, time=2017-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210348, encodeId=9770210348a5, content=尸检,确实是很多时候有必要的存在, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160911/IMG57D51CE461BD24798.jpg, createdBy=91d61672802, createdName=西风染林, createdTime=Tue Jun 13 22:19:39 CST 2017, time=2017-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210316, encodeId=f23b21031617, content=哈哈哈哈哈哈哈哈哈哈,不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/06/13/0111a89d3ce54851592678534e7b21fe.jpg, createdBy=5cb91710235, createdName=菊花小王子, createdTime=Tue Jun 13 20:07:06 CST 2017, time=2017-06-13, status=1, ipAttribution=)]
    2017-06-13 1df05b80m14(暂无匿称)

    文章写的真好 真像及时雨!

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1903518, encodeId=d15e190351804, content=<a href='/topic/show?id=c8aa6335ed5' target=_blank style='color:#2F92EE;'>#死亡原因#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63357, encryptionId=c8aa6335ed5, topicName=死亡原因)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=570c172, createdName=tigerlr98, createdTime=Mon Sep 04 17:13:00 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211455, encodeId=ca342114553d, content=什么都立法,为什么这样的事件不立法?为什么,草民没有能力,大咖呢。胡咧咧的大咖, beContent=null, objectType=article, channel=null, level=null, likeNumber=133, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=01bb1684217, createdName=医张生, createdTime=Fri Jun 16 09:25:53 CST 2017, time=2017-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210781, encodeId=3051210e81d9, content=凡是纠纷的国家应该强制尸解不就行了吗?, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=56c82033600, createdName=1511e81efbm, createdTime=Wed Jun 14 20:15:33 CST 2017, time=2017-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210525, encodeId=a9842105257e, content=学习了谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuEJWOf8El7MfqtlSpy4eWtPl5cxmNJ4ezwbFf5vtCeh53ITyabFpFIJfKTPlzdh6ibOibVONwHUbm9/0, createdBy=a4351715107, createdName=人间可客, createdTime=Wed Jun 14 07:49:06 CST 2017, time=2017-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210513, encodeId=1f42210513fc, content=签到学习了很多人, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/A3E53E62691178E2F18D7B999FD22131/100, createdBy=f44d2003846, createdName=Chongyang Zhang, createdTime=Wed Jun 14 07:21:31 CST 2017, time=2017-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210427, encodeId=4b1721042e45, content=超赞的文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Wed Jun 14 05:39:22 CST 2017, time=2017-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210377, encodeId=1ab22103e773, content=很有意义, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6lR0HdZibhWZ8X1yLOVj8WPicl2Fu38UJyue9g5yUbZYs8LBhr8juq58bkLYbZ7ic8fmlEUHXgAic73qLqVNnkXwrj/0, createdBy=8ebc2052195, createdName=大家, createdTime=Tue Jun 13 23:57:46 CST 2017, time=2017-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210368, encodeId=56ae210368e2, content=文章写的真好 真像及时雨!, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2d941739100, createdName=1df05b80m14(暂无匿称), createdTime=Tue Jun 13 23:22:58 CST 2017, time=2017-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210348, encodeId=9770210348a5, content=尸检,确实是很多时候有必要的存在, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160911/IMG57D51CE461BD24798.jpg, createdBy=91d61672802, createdName=西风染林, createdTime=Tue Jun 13 22:19:39 CST 2017, time=2017-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210316, encodeId=f23b21031617, content=哈哈哈哈哈哈哈哈哈哈,不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/06/13/0111a89d3ce54851592678534e7b21fe.jpg, createdBy=5cb91710235, createdName=菊花小王子, createdTime=Tue Jun 13 20:07:06 CST 2017, time=2017-06-13, status=1, ipAttribution=)]
    2017-06-13 西风染林

    尸检,确实是很多时候有必要的存在

    0

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    2017-06-13 菊花小王子

    哈哈哈哈哈哈哈哈哈哈,不错

    0