人工血管置換手術後出血死亡判賠【寰宇醫事裁判】 試閱
Bleeding Death after Prosthetic Blood Vessel Replacement Surgery and Being Awarded Compensation
原告A於2019年3月1日在被告Y經營醫院接受腹部主動脈人工血管置換手術。同日下午14時手術結束，16時A之收縮壓低於監測值，而醫師指示繼續輸液；16時30分，A之血壓仍低於監測值，A開始出現譫妄並主訴腹痛、腹脹等，護理師調整儀器位置後血壓讀數回升，因此判斷之前讀數不正確；17時11分醫師巡房，A之血壓仍低於正常值，故決定輸血輸液，嗣後進行開腹止血；惟A經急救仍死亡。法院認為16時時A的各項監測數值，都尚未達到醫療常規所定內出血的合理懷疑標準，且腹痛腹脹乃開腹手術常見副作用，醫師指示繼續輸液並作觀察，尚無過失。惟16時30分A之血壓在持續輸液後依然低於監測值，且A出現譫妄等症狀而符合出血性休克的具體標準，而多數患者在失血量超過30%以上才會出現血壓下降；縱然A的心率與呼吸頻率尚未達到出血性休克之標準，然而對老年人出血而言，其心率與呼吸頻率變化不大。因此法院認為16時30分，A已有出血性休克之病徵而醫師未及時處置，與死亡結果有因果關係並具過失。
On March 1, 2019, the plaintiff A underwent an abdominal aortic prosthetic blood vessel replace-ment surgery at a hospital operated by the defendant Y. The surgery was completed at 2:00 p.m. on the same day. At 4:00 p.m., A’s systolic blood pressure was lower than the monitored valued and the surgeon instructed to continue the infusion. At 4:30 p.m., A’s systolic blood pressure was still lower than the monitored value and he began to delirium and complained of abdominal pain and bloating. After the nurse adjusted the position of the equipment, the blood pressure reading went down. The surgeon judged that the previous reading was incorrect. At 5:11 a.m., A’s blood pressure was still below the normal value while the physician makes the round, so he decided to give blood and fluids and then opened the abdomen to stop the bleeding. However, A still died after emergency treatment. The court held that A’s various monitoring values at 4:00 hat not yet reached the standard of reason-able suspicion of internal bleeding as stipulated in the medical standard and that abdominal pain and distension were common side effects of open abdomen surgery. Therefore, the physician was not negligent when instructing to continue to give fluids and conduct observation. Nevertheless, at 4:30 p.m., A’s blood pressure was still lower than the monitoring value after the continuous infusion and A showed delirium and other symptoms that met the specific criteria for hemorrhagic shock, while most patients would only experience a drop in blood pressure when the blood loss exceeded 30%. Even though A’s heart rate and the respiratory rate didn’t meet the criteria for hemorrhagic shock, they didn’t change much in respect of the elderly people, to which A belonged. Therefore, the court held the physician didn’t treated A in time at 4:30 a.m. and was negligent when he had symptoms of hemorrhagic shock. The negligence was related to the outcome of A’s death causally.
098-106
