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骨折术后成植物人,家属索赔1400 万,我们应该借鉴什么?

2015-05-10 张源源 南报网

膝盖骨折住院治疗,手术没多久却昏迷不醒,成了植物人。家属觉得蹊跷,从病历中找出问题后,起诉医院索赔1400万。家住浦口的徐女士今年60多岁,2011年时不慎跌倒,膝盖受了伤,医院检查发现,徐女士膝盖粉碎性骨折,需要手术治疗。手术前,徐女士告诉医生她有严重的高血压。手术中,医生使用了止血带,并同时给徐女士注射了一种名为“氟比洛芬酯”的药物。注射该药没多久,徐女士就感到胸闷,后来心跳加快,出现了昏迷。

膝盖骨折住院治疗,手术没多久却昏迷不醒,成了植物人。家属觉得蹊跷,从病历中找出问题后,起诉医院索赔1400万。

家住浦口的徐女士今年60多岁,2011年时不慎跌倒,膝盖受了伤,医院检查发现,徐女士膝盖粉碎性骨折,需要手术治疗。手术前,徐女士告诉医生她有严重的高血压

手术中,医生使用了止血带,并同时给徐女士注射了一种名为“氟比洛芬酯”的药物。注射该药没多久,徐女士就感到胸闷,后来心跳加快,出现了昏迷。医生虽然立刻对徐女士进行抢救,但徐女士还是成了植物人。

徐女士的儿子也是医生,他在查看母亲的手术病历后,发现手术过程中使用的“氟比洛芬酯”本不应用于像母亲这样有严重高血压的人,他认为母亲变成植物人是医院用错了药,遂向法院起诉,向医院提出了包括医疗费、护理费、精神损失费等各种赔偿400多万元,而在后期治疗费方面,更是提出了高达1000多万元的赔偿要求。

为查明真相,双方委托南京市和江苏省医学会对此事进行了鉴定,2家鉴定机构认为医院实施的抢救并未违规,但是用“氟比洛芬酯”违反该药使用禁忌症,在病历记录上也存在过错。

最终,医学会认定医院的过错行为与徐女士成植物人这一损害后果之间有因果关系。同时,鉴定还认为,徐女士构成一级伤残,需终生营养和护理。

浦口法院审理后认为,医院诊疗中对徐女士未遵循安全有效的原则,违禁使用“氟比洛芬酯”。徐女士手术后成为植物人,不排除与医院违禁使用“氟比洛芬酯”的关联性。法院根据徐女士家人提供的票据,以及相关的法规核算后,认定医院赔偿她医疗费、住院期间护理费等共100多万元。

一审判决后,医院和徐女士家人都不服,提出上诉。不久前,市中级法院二审后作出裁定,医院承担85%的赔偿责任,共计120多万元。法院认为家属提出的后续1000多万元治疗费用尚未实际发生,应在医疗费实际发生后另行索赔。


提醒:
不管最后结果如何,但这个案例值得我们每位医生重视。临床医生不仅仅是看病,还要全面掌握多方面知识,包括药物知识,甚至科研性知识,尤其是科研,不仅能让临床医生知其然,更知其所以然,大大减少犯错的可能,同时增加对疾病深层次地认识。否则,仅仅一心“扑”在临床上,难免不犯错

这个案例表面是临床用药常识,实则背后反应对疾病的全面了解,以及临床知识的更新。氟比洛芬酯是较常用的镇痛药物,但是即便如此,对其禁忌症仍然要了解。尤其是对药物的药理学机制的理解。

小知识:氟比洛芬酯

为氟比洛芬的前体药物。用于手术后及各种癌症的镇痛。氟比洛芬酯注射液是一种非甾体类靶向镇痛药,通过在脊髓和外周抑制环氧化酶(COX)减少前列腺素的合成,降低手术创伤引起的痛觉过敏状态。脂微球制剂药效更强,起效更迅速,持续时间更长,且不易引起胃黏膜损伤等不良反应。其用于术后镇痛,优点在于没有中枢抑制作用,不影响处于麻醉状态患者的苏醒,可在术后立即使用。

【性 状】本品为白色乳液,略带粘性,有特异性气味。
【适 应 症】术后及癌症的镇痛。
【用法用量】成人每次静脉给予氟比洛芬酯50mg,尽可能缓慢给药(1分钟以上),根据需要使用镇痛泵,必要时可重复应用.并根据年龄,症状适当增减用量.一般情况下,本品应在不能口服药物或口服药物效果不理想时应用.

【不良反应】
1、严重不良反应:罕见休克、急性肾衰、肾病综合症、胃肠道出血、伴意识障碍的抽搐。
2、在氟比洛芬的其他制剂的研究中还观察到以下严重不良反应:罕见再生障碍性贫血、中毒性表皮坏死症(Lyell综合症)、剥脱性皮炎。
3、一般的不良反应:
(1)注射部位:偶见注射部位疼痛及皮下出血;
(2)消化系统:有时出现恶心、呕吐,转氨酶升高,偶见腹泻,罕见胃肠出血;
(3)精神和神经系统:有时出现发热,偶见头痛、倦怠、嗜睡、畏寒;
(4)循环系统:偶见血压上升、心悸;
(5)皮肤:偶见瘙痒、皮疹等过敏反应;
(6)血液系统:罕见血小板减少,血小板功能低下。

【禁 忌】
1.消化道溃疡患者;
2.严重的肝、肾及血液系统功能障碍患者;
3.严重的心衰、高血压患者;
4.对本制剂成分有过敏史的患者;
5.阿司匹林哮喘,或有既往史的患者;
6.正在使用依洛沙星、洛美沙星、诺氟沙星的患者。

【注意事项】
1.下述患者慎用本药
(1)有消化道溃疡既往史的患者;
(2)有出血倾向、血液系统异常或有既往史的患者;
(3)心、肝、肾功能不全或有既往史的患者及高血压患者;
(4)有过敏史的患者;
(5)有支气管哮喘的患者。
2.尽量避免与其他的非甾体抗炎药合用。
3.不能用于发热患者的解热和腰痛症患者的镇痛。
4.本品的给药途径为静脉注射,不可以肌肉注射。
5.不能经口服药的患者如能口服药物时,应停止静脉给药,改为口服给药。
6.本品应避免长期使用,在不得已需长期使用时,要定期监测血尿常规和肝功能,及时发现异常情况,给予减量或停药。
7.在用药过程中要密切注意患者的情况,及时发现不良反应,并作适当的处理。

【孕妇及哺乳期妇女用药】1.妊娠妇女应用的安全性尚未确立,妊娠或可能妊娠的妇女必须在治疗的有益性大于危险性时才能应用;2.尽量不在妊娠末期应用(动物试验中发现在妊娠末期的大鼠用药后可导致分娩延迟及胎儿的动脉导管收缩),3.应用本品过程中避免哺乳(可能会转移到母乳中)。

【儿童用药】儿童使用的安全性尚未确定,因此儿童不宜使用。

【老年用药】要特别当心老年患者出现不良反应,要从小剂量开始慎重给药。

【药物相互作用】
1. 禁止与洛美沙星,诺氟沙星,伊诺沙星合用,合用有导致抽搐的可能.
2. 慎与双香豆素类抗凝剂,甲氨蝶呤,锂剂,噻嗪类利尿剂,髓袢利尿剂,新喹诺酮类抗生素,肾上腺皮质类激素合用.

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    2017-01-02 许阳阳

    借鉴啥

    0

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    2016-01-27 doctording1

    引以为鉴哈

    0

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    2016-01-26 doctording1

    学习了…

    0

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    2015-08-16 xjy02
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    2015-09-09 Bobby7868

    引以为戒啊

    0

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    2015-05-24 发哥

    可怕

    0

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    2015-05-22 匿名用户

    哎,太可怕了

    0

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    2015-05-13 huaxipanxing

    看看

    0

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    2015-05-10 1381516dc4m

    要注意禁忌症

    0

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