分娩性臂丛神经损伤原因及因果关系分析

›› 2004 ›› Issue (02): 12-14+5.

分娩性臂丛神经损伤原因及因果关系分析

范利华,刘瑞珏

司法部司法鉴定科学技术研究所,司法部司法鉴定科学技术研究所上海200063 ,上海200063

Analysis of Cause and Effect for Obstetric Brachial Plexus Palsy

FAN Li -hua,LIU Rui-jue(Institute of Forensic Sciences,Ministry of Justice,Shanghai 200063)

摘要/Abstract

摘要： 目的分析分娩性臂丛神经损伤的原因,探讨此类损伤与医疗过程的因果关系及医疗参与程度。方法回顾性分析15例不能恢复的分娩性臂丛神经损伤案例中出生体重、产程时间、催产素使用、手术助产、有无肩难产及接产医院类型等因素对新生儿臂丛神经损伤产生的影响,并比较了15例不能恢复的分娩性臂丛神经损伤案例中有肩难产和无肩难产两种情况在孕周、新生儿出生体重、产程时间、催产素使用、手术助产、接生医院各因素的差异。结果本组资料中胎儿巨大(60%)、肩难产(53.3%)、催产素使用不当(40%)、手术助产(27%),是发生分娩性臂丛神经损伤的危险因素。其中无肩难产与有肩难产两组比较,有肩难产组的第二产程延长的比例高,两组有显著差异;而在出生体重、孕周、催产素使用方面两组无明显差异。结论分娩性臂丛神经损伤的发生是多因素的,至今为止,临床产科对分娩性臂丛神经损伤发生的危险因素在围产期的预测率仍较低。考虑到此因素,在法医鉴定中对此类多因一果案件的鉴定应综合分析各种因素,确定这些危险因素与医疗过程的关系,与新生儿臂丛神经损伤是否存在因果关系,以及医疗不当的参与程度。

关键词: 臂丛神经损伤, 肩难产, 产伤

Abstract: Objective To analyse risk factors associated with obstetricbrachial plexus injury and relationship between obstetric injury permanentbrachial plexus palsy and medicinal manage.Methods We performed aretrospective 15 case analysis from permanent brachial plexus palsy inforensic identification. Results Risk factors for permanent brachial injurywere fetal macrosomia, improper use of oxytocin, instrumental vaginaldelivery and shoulder dystocia. Conclusions Cause of obstetric brachialplexus palsy is multifactor. To date, no specific pattern of perinatal eventsappears to be reliably predictive for this injury. Different factors should betaken into account in forensic identifying causation of medical procedureswith brachial plexus injury and the degree involved medicine .

Key words: brachial palsy, shoulder dystocia, obstetric injury, foren-sic identification

范利华;刘瑞珏. 分娩性臂丛神经损伤原因及因果关系分析[J]. , 2004(02): 12-14+5.

FAN Li -hua;LIU Rui-jue(Institute of Forensic Sciences;Ministry of Justice;Shanghai 000). Analysis of Cause and Effect for Obstetric Brachial Plexus Palsy[J]. , 2004(02): 12-14+5.