Doctor LiRuiMan to our correspondent introduce the situation at that time. Interns ROM known feng reporter YangQin perturbation
Wen/reporter ren shan correspondent WenZhiQin
Yesterday morning, guangzhou a woman giving birth appear abruption, because endanger mother-child life, must undertake cesarean delivery operation. However classics doctor, family took turns to persuade, she still resolutely refused to sign, even on the operating table shouts "want oneself life." Finally, the doctor ask for its family agreed after its strong behavior cesarean section.
Reporter learned from the hospital last night, the baby is born, born heavy suffocation symptoms appear a few hours later died. Mother, because they appear heart failure symptoms, still in hospital for rescue. This event to patients with doctors disposition for signing authority surfaced again.
Forced an hour flat-sharing community, pregnant women surgery still shout "want oneself life"
About 6 o 'clock yesterday morning, a 29-year-old parturient women re-gifted into jinan university hospital affiliated first rescues. This woman had previously been guangzhou some hospital diagnosed with "no", and TaiXin suspected placenta low offsets. "Our findings, TaiXin weak and pregnant women nakedness has been in a small amount bleeding, and she is not pain." Nays of gynecology and obstetrics LiRuiMan director doctor said like this, painless bleeding, hint two possible, i.e. low buy placenta and abruption, but b-sonography display maternal does not exist low buy the placenta. The doctor accordingly judgment, she belonged to risk of placental abruption, if not surgical treatment as soon as possible, will cause fetal intrauterine anoxia suffocate death, and trigger maternal massive haemorrhage, cause "a corpse two life" serious consequences.
However, pregnant women to should undertake cesarean section, and excitedly shouted: "I'm going to (themselves) living, don't surgery." The doctor repeated to illustrate the seriousness of the situation, but she would not let go. Meanwhile, the doctor to take measures to alleviate intrauterine fetal distress. Monitoring showed that fetal TaiXin weaker, and maternal bleeding amount of approximately 200 milliliter nakedness, doubt DIC in (DIC), the situation has been very critical. Medical personnel worrying. At 7:30 points, gynecology and obstetrics two director horse, again persuasion, the answer is "no surgery".
At this time, pregnant woman's husband the hospital officials to explain, has informed agreement signed in surgery, but families of persuasion also cannot let pregnant women make a u-turn. Because women are conscious, without her signature, the surgery still cannot carry out. Finally, the hospital is in line with "life first" the principle, decided to exercise the doctor disposition, get to the families of again after confirmation, forced signed for cutting palace surgery.
Morning 8 30 points, pregnant women were sent to the operating room. However even arrived surgery, pregnant women still Shouting "want oneself life."
Children finally died of respiratory failure, later step will endanger the mother
In the operation, the doctor open pregnant celiac found, ascites has become a normal bleeds. And then opens the womb, already a purple-brown quickly remove soak in blood in the fetus, to carry out the sputum aspiration, find baby mouth amniotic fluid is also red. Newborns with heavy suffocation symptoms. "If not undergo surgery, not only the child will die, mother will not shrink from uterine, leading to massive haemorrhage, must cut the uterus, and can cause death." LiRuiMan said, postoperative found that only uterine cavity stockpile clot have 700 milliliter, estimates that pregnant women surgery and cumulative bleeding 1000 ml.
Reporter learns yesterday evening, the children finally died from lung bleeding caused by respiratory failure, and this is abruption trigger DIC consequences. Maternal criterion because blood overmuch, appear heart failure symptoms, still in the hospital for treatment.
This name, maternal shantou is ever before natural labor a girl. According to LiRuiMan introduction, she said, as the postpartum another child is a girl, worry over two years to after cesarean section again to children. After the surgery, doctors drew blood clot look to her, tell her: "your life saved back 1 her answer says," I don't know this circumstance. "
Newslink:
The November 21, 2007, pregnant women in childbirth we were claiming to be the husband's XiaoZhiJun send into Beijing chaoyang hospital jingxi sorting. Facing the dying in pregnant women, XiaoZhiJun refused to in the hospital cesarean section signed, doctors and nurses in saving the helpless, 3 hours, of pregnant women to rescue invalid death.
Hospital for help behavior sparked controversy
Maternal sober families can decide?
Hospitals who saved, but cause "illegal" controversy.
According to the tort liability law "set out in article 55," need surgery, special inspection, special treatment, medical staff shall timely to patients that medical risk, alternative treatment plan, etc., and obtain the written consent; unfavorable to patients that shall be submitted to the patients and close relatives of the instructions, and obtain the written consent." This means that the hospital in preoperative, must first get patients signature agree, the next-best thing, should get the consent of the family members. Three years ago when the Beijing "refuse to sign" incident, maternal death is subject to the terms and conditions, hospital without flatly take surgery measures. But what happened a pregnant woman guangzhou water-and with the above signature surgery events event different nature: pregnant expressly disagree with surgery, family members agree to surgery. But the problem is, in the patient sane, under the situation of families can generation patients making decisions?
Jinan university medical deputy director of the first hospital affiliated CaiZhanYu concedes, when do decide to a big risk, but as medical workers, this is a constrained to do decision. "Theoretically, if ChanFuShu after appear problem, the hospital will face become defendant risks."
But the tort liability law article 56 also stipulated that "for rescue dying patients to emergencies such as, cannot obtain patients or their close relatives of opinion by medical institutions, head of the carrier or authorized approval, can immediately implement relevant medical measure." If not the operation that endanger the patient lives, hospital in line with "life above all" the principle, has the right to take medical treatment measures.
"The current law makes us feel confused: what circumstance, the relative to replace patients signature? And doctors disposition, compared to law gives the patient and family signing authority of right
主治医生李瑞满向本报记者介绍当时的情况。实习生罗知锋 记者杨勤摄
文/记者任珊珊 通讯员温志勤
昨天早晨，广州一名孕妇临产时出现胎盘早剥，因危及母子生命，必须进行剖宫产手术。然而经医生、家人轮番劝说，她仍坚决拒绝签字，甚至在手术台上也大喊"要自己生"。最终，医生征得其家人同意后，强行为其进行剖宫产。
记者昨晚从医院获悉，宝宝一出生就出现重度窒息症状，出生数个小时后不幸死亡。母亲则因出现心衰症状，仍在医院进行抢救。这一事件令病人签字权与医生处置权之争再度浮出水面。
苦劝一小时未果，孕妇手术台上仍喊"要自己生"
昨天早晨6时许，一名29岁的临产孕妇被转送进暨南大学附属第一医院进行抢救。这名孕妇此前被广州某医院诊断为"无胎心"，并怀疑有胎盘低置。"我们检查发现，胎心很微弱，孕妇下体一直在少量流血，而她没有痛感。"该院妇产科李瑞满主任医师说，像这样无痛出血，提示两种可能，即低置胎盘和胎盘早剥，但B超显示产妇不存在低置胎盘。医生据此判断，她属于危险的胎盘早剥，如果不尽快手术，将导致胎儿宫内缺氧窒息死亡，并引发母体大出血，造成"一尸两命"的严重后果。
然而，孕妇一听要进行剖宫产，便情绪激动地大嚷："我就要(自己)生，不要手术。"医生反复向她说明情况的严重性，但她就是不松口。与此同时，医生采取措施以缓解胎儿宫内窘迫。监测显示，胎儿的胎心越来越弱，而产妇下体出血量约达200毫升，怀疑出现弥漫性血管内凝血(DIC)，情况已经十分危急。医护人员焦急万分。7时30分，妇产科两名主任出马，再次进行劝说，答案还是"不做手术"。
此时，孕妇的丈夫经医院有关负责人出面解释后，已在手术知情同意书上签字，但家属的劝说也不能让孕妇回心转意。由于孕妇神志清醒，没有她的签字，手术仍然不能进行。最终，医院本着"生命第一"的原则，决定行使医生处置权，得到家属的再次签字确认后，强行进行剖宫手术。
上午8时30分，孕妇被送进手术室。然而即使到了手术台上，孕妇仍然大喊"要自己生"。
孩子最终死于呼吸衰竭，晚一步将危及母亲
手术中，医生打开孕妇的腹腔发现，腹水已变成不正常的血红色。再打开已呈紫褐色的子宫，迅速取出浸在血水里的胎儿，为其进行吸痰，发现宝宝口中的羊水也是红色的。新生儿有重度窒息症状。"如果不进行手术，不仅孩子必死无疑，母亲也会因子宫不收缩，导致大出血，必须切子宫，并会导致死亡。"李瑞满说，术后发现，仅子宫腔内积存血块就有700毫升，估计孕妇手术前后累计出血达1000毫升。
记者昨天傍晚获悉，孩子最终死于肺出血引发的呼吸衰竭，而这正是胎盘早剥引发DIC的后果。产妇则因失血过多，出现心衰症状，仍在医院进行治疗。
这名产妇是汕头人，之前顺产过一名女孩。据李瑞满介绍，她产后曾表示，以为这一胎是女孩，担心剖宫产后要过两年才能再要孩子。手术结束后，医生把抽出的血块给她看，告诉她："你的命被救回来了１她答称，"我也不知道是这种情况。"
新闻链接：
2007年11月21日，孕妇李丽云因难产被自称是其丈夫的肖志军送进北京朝阳医院京西分院。面对生命垂危的孕妇，肖志军却拒绝在医院剖腹产手术上面签字，医生与护士束手无策，在抢救了3个小时后，孕妇因抢救无效死亡。
医院救命行为引发争议
产妇清醒家属能否决定？
医院救了人，但却引发"违法"争议。
据《侵权责任法》第五十五条规定， "需要实施手术、特殊检查、特殊治疗的，医务人员应当及时向患者说明医疗风险、替代医疗方案等情况，并取得其书面同意；不宜向患者说明的，应当向患者的近亲属说明，并取得其书面同意。"这意味着医院在进行手术前，必须首先得到患者的签字同意，退而求其次，应得到家属的同意。三年前发生的北京"拒签字致产妇死亡"事件，医院受制于该条款，而没有断然采取手术措施。而广州发生的这一孕妇拒签字手术事件与上述事件性质不同：孕妇明确表示不同意手术，家属同意手术。但问题是，在病人神智清醒的情况下，家属能否代病人做决定？
暨南大学附属第一医院医务部副主任蔡湛宇坦言，当时做决定要冒很大风险，但作为医务工作者，这是一个不能不做的决定。"从理论上说，如果产妇术后出现问题，医院将面临成为被告的风险。"
不过《侵权责任法》第五十六条也规定，"因抢救生命垂危的患者等紧急情况，不能取得患者或者其近亲属意见的，经医疗机构负责人或者授权的负责人批准，可以立即实施相应的医疗措施。"如果不手术即危及患者生命，医院本着"生命权高于一切"的原则，有权采取医疗措施。
"现行法律让我们觉得很困惑：什么情况下，亲属才能替代患者签字？和医生的处置权相比，法律赋予病人和家属签字权的权限是否过高？"蔡湛宇认为，如果上述问题得不到合理解释，医生将面临巨大的风险。"我们无从判断在病情紧急的情况下，病人拒绝手术是主动放弃生命，还是有其他的考虑。"
No comments:
Post a Comment