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Hu Mou's (pseudonym) family could not imagine that the liver replacement surgery not only did not make him recover physically, but also caused mental illness due to complications, and finally Hu chose to jump down from the hospital and end his life.
Hu Mou was diagnosed with primary liver cancer 6 years ago, and after many surgeries, liver cancer recurred again, and liver replacement became the last hope.
After matching the liver source, he was admitted to a hospital in Shanghai and underwent liver replacement surgery. Who knew that two days later, Hu mou was transferred to the isolation room and had obvious symptoms of mental disorders such as "persecution" and "fear". That night, he removed the tube from his body and fell through the window of the ward and died.
Afterwards, Hu's family believed that the hospital misjudged the patient's early postoperative mental disorder, had medical faults such as improper monitoring measures and duration, and ineffective treatment measures, and demanded compensation of more than 430,000 yuan.
The hospital said that the medical behavior has entrusted the Shanghai Medical Association to conduct a medical damage appraisal. According to the appraisal conclusion, the defendant hospital was not at fault for the patient's diagnosis and treatment process, so the hospital did not agree to bear the corresponding compensation liability.
According to the results of the medical damage appraisal, it is clear that the case is not a medical damage to the patient's person. There is a shortage of insufficient number of accompanying personnel in the medical activities of the surgical hospital, but there is no causal relationship with the result of personal injury caused by the death of patient Hu Mou. And the analysis believes that according to Hu's condition, the doctor chose classic in situ liver transplantation, which has indications for transplant surgery.
On the first day after the liver transplantation, the patient appeared restless, mentally unstable and other states, and the doctor gave restraint band restraint and olanzapine sedation treatment, which was in line with the diagnosis and treatment routine. At the same time, mental complications are one of the common complications after liver transplantation, and individual differences are large. The informed consent form for preoperative surgery informs you that mental system complications such as delirium, depression, and anxiety may occur after surgery, and the patient signs and agrees to postoperative surgery.
After the appearance of psychiatric symptoms, the doctor has done the corresponding symptomatic treatment, and it has a curative effect. Hu's fall from the building is an irresistible and unpredictable situation, and there is no causal relationship with the medical prescription diagnosis and treatment. Due to the limitation of existing medical resources, the number of accompanying personnel (non-nursing medical staff) in the medical isolation ward is insufficient, and the emergency of the patient's mental state cannot be detected in time.
The patient's donor liver is distributed after matching the organs through the Chinese organ allocation and the shared computer system, and the donor liver management complies with the management regulations. The doctor who provided the liver source did not have direct medical behavior with the patient, and the related cost issues were not within the scope of medical technology identification. The patient then died unexpectedly due to psychiatric symptoms after liver transplantation, and there was no causal relationship with the liver donor of the doctor.
After trial, the court held that the informed consent for surgery had informed that there might be mental system complications such as delirium, depression, and anxiety after the operation, and the family had agreed to sign it. Moreover, postoperative jumping off a building is an irresistible and unpredictable situation, and there is no causal relationship with the diagnosis and treatment of the doctor. At the same time, the hospital lacked the shortage of escorts in medical activities, which then led to medical disputes, and finally the court ordered the hospital to compensate 20,000 yuan and pay 3,500 yuan in appraisal fees.
Why does delirium occur after liver transplantation?
Postoperative delirium (POD) is a postoperative complication that occurs after undergoing surgery and occurs mostly in older patients. It is not a mental illness, it is usually the result of a physiological abnormality, it is a reversible change in mental state, usually accompanied by inattention, cognitive confusion, non-answering, and even hallucinations. Patients' symptoms are usually worse at night than during the day, some call it "sunset syndrome." In addition to occurring in patients after major surgery, it is also more common in patients admitted to the ICU
, hence the term " ICU syndrome " .
What are the manifestations of postoperative delirium?
Disorientation disorders. That is, the people, times and places around them are confused, they don't know where they are, and they don't know the people around them.
Mood changes and sleep is reversed. It is manifested as one will be awake, one will be sleepy, one will be excited, one will be sluggish.
Delusional (always think someone is going to hurt him)
Hallucinations or illusions, especially visions are more common.
Studies have shown that patients undergoing major surgery (such as abdominal and cardiac surgery) are more likely to develop delirium, which is more common in men over the age of 65 years old, and the factors causing postoperative delirium cover preoperative, intraoperative and postoperative three aspects, mainly including:
1. Advanced age
2. Preoperative psychological stress
3. Combined internal medicine diseases (cerebrovascular disease, diabetes, etc.)
4. Surgery (including type of surgery, timing, bleeding)
5. Effects of alcohol and drugs
6. Postoperative pain
7. Postoperative metabolic and electrolyte abnormalities
8. Postoperative admission to the ICU caused by white night biological clock imbalance
How to deal with postoperative delirium?
1. Postoperative delirium should first be distinguished from true neurological diseases, and blood tests and brain-related examinations should be done to rule out other organic lesions of the brain.
2. Because postoperative delirium is mostly caused by physiological problems, the physiological causes of postoperative delirium should be found, and the cause treatment should be carried out, such as pain relief and correction of electrolyte disorders.
3. Carry out symptomatic treatment to avoid secondary injuries caused by delirium, such as the patient's possible forced out of bed and falling, pulling out the infusion or bow | the flow tube causing bleeding. At this time, the patient can be given appropriate therapeutic drugs to calm the patient to sleep, and if necessary, the patient can be briefly restrained.
4. Actively prevent the high risk factors of delirium, encourage family members to accompany and give psychological support. The ICU gives the patient the brightness of the light and the sound of the machine - an environment that conforms to the rhythm of the white night biological clock, and can hang a clock and calendar around it to tell the patient at regular intervals to increase the sense of spatial-temporal orientation.
Source of information for this article: Health Community