目的 对医疗损害责任纠纷案的法庭审理进行分析,探究医疗损害责任纠纷案件的处理现状,对此过程中医疗机构应当关注的问题进行分析总结,以期为医院应对医疗损害鉴定工作和法官审理医疗损害责任纠纷案提供参考。方法 对广州市三所综合医院2015—2021年共93例医疗损害责任纠纷案的判决书进行描述性分析。结果 93例案例中79例进行了医疗损害鉴定。79例进行医疗损害鉴定的案例中,71例鉴定结论被法院采信,采信率达90%。有29例案件鉴定人出庭（占比36.7%）,其中有25例鉴定意见被法院采信,采信率为86.2%,仅有7例案例当事人申请了专家辅助证人出庭。医方大多数最终承担次要及以下责任,占比为73.4%。鉴定结论为责任范围的,法院最后判决偏向于取最高值和中间值（43例出具责任范围的案例中,14例为最高值,13例为中间值）。结论 医疗机构要充分加强对医疗事故技术鉴定和医疗损害鉴定的认识,高度重视医疗损害鉴定工作,尤其加强尸体解剖告知及病历书写管理,充分利用好鉴定人和专家辅助证人出庭两种手段。

Objective To analyze the court trial of medical damage liability disputes,to explore the current situation of medical damage liability disputes,to analyze and summarize the problems encountered in dealing with medical damage disputes,so as to provide some references for hospitals to deal with medical damage disputes．Methods Descriptive statistical analysis performed on the written judgment of 93 cases of medical damage liability disputes in three large comprehensive hospitals in Yuexiu District,Guangzhou from 2015 to 2021．Results In 93 cases,79 cases had expertise of medical malpractice．In 79 expertise,71 of them were adopted,and the acceptance rate was 90%．Among the 29 cases in which the appraisers appeared in court,25 expert opinions were accepted by the court,the acceptance rate was 86.2%．In only 7 cases,the parties applied for expert witnesses to appear in court．In most cases,hospitals ultimately took secondary and lower responsibilities,accounting for 73.4%．If the appraisal conclusion falls within the scope of responsibility,the court's final judgment tends to take the highest and middle values．Conclusions Medical institutions should fully strengthen their understanding of technical identification of medical accidents and medical malpractice identification．Attach great importance to the identification of medical malpractice,especially strengthen the management of autopsy notification and medical record writing,make full use of two methods：appraisers and experts witnesses appearing in court．

目的 分析药源性双硫仑样反应医疗损害责任纠纷的规律及特点,为规避用药风险、促进合理用药提供参考。方法 以“双硫仑”为关键词,检索中国裁判文书网,时间截至2025年3月25日,将通过筛选的裁判文书基本情况、双硫仑样反应药物关联情况、症状表现、转归、赔偿情况等信息提取录入Excel表,建立评价数据库。结果 共检索得裁判文书81份,纳入裁判文书18例,涉及医疗机构为三级医院3例、二级医院5例、卫生院/卫生室7例、民营医院2例、诊所1例;性别构成中,男15例,女3例;怀疑引起双硫仑样反应的药物有头孢哌酮、头孢呋辛、替硝唑、头孢噻肟、甲硝唑、左氧氟沙星、头孢曲松钠、头孢替安和头孢米诺;患者饮酒和用药间隔多为1~3 d;症状表现有呼吸困难/呼吸骤停、昏迷/意识丧失/休克、面色紫绀/局部发紫/指甲发紫、抽搐/发抖、出汗、不能说话/说话不清楚等;转归结果中,15例结局为死亡,1例为神经症,1例为一级伤残（植物人）,1例为二级伤残（缺氧缺血性脑病后遗四肢功能障碍）;7例患者死亡案例因未尸检影响了结果鉴定;判决情况中,1例和解,1例未公布三审判决结果,余16例医疗机构承担了10%~70%的医疗赔偿责任,赔偿金额43 092.4~1 616 354元;医方存在的过失主要有未认真采集饮酒史、违反诊疗常规用药、违反合理注意义务、未履行知情告知义务等。结论 药源性双硫仑样反应危害大,误诊率高,发病急骤凶险,基层医疗机构对其鉴别和处置能力亟需提高;应重视饮酒史的采集和记录;合理合规处方抗生素;加强对患者的高度注意义务、知情告知义务等履行;医院药学人员应积极参与安全用药工作,做好用药教育。

      Objective  To analyze the regularity and characteristics of the medical damage liability dispute with drug-induced disulfiram-like reaction, to avoid the risk of medication and provide reference for clinical rational drug use. Methods  China Judgements Online had been searched using the keywords of “disulfiram” from inception to March 25,2025. The evaluation table database was established with the excel table to conduct statistical analysis on the basic information of judgements, drug association, clinical performance,outcome of disease and the compensation. Results A total of 81 cases of judgements documents were retrieved,and 18 cases were enrolled. There were 3 tertiary hospitals, 5 second-class hospitals, 7 health-centers, 2 private hospitals,1 clinic among the medical establishments. Fifteen cases were male and 3 cases were female. The drugs suspected causing disulfiram-like reaction were cefoperazone, cefuroxime, tinidazole, cefotaxime, metronidazole, levofloxacin, ceftriaxone, cefotiam, cefminox. The interval between drinking and medication was usually 1-3 days. The symptoms were as follows：dyspnea/respiratory arrest, coma/loss of consciousness/shock, cyanosis /purple nails, convulsion/trembling, sweatiness, inability to speak/lack of clarity, etc. Fifteen cases ended in death, 1 was neurosis, 1 was first-degree disability (vegetative state), 1 was secondary disability (limb dysfunction after hypoxic encephalopathy). The identification of 7 cases of death was affected by the lack of autopsy. One case was settled and the outcome of the third trial was not announced in another case. The remaining 16 medical institutions took 10%-70% of the medical compensation liability, with the compensation amount ranging from 43 092. 4 yuan to 1 615 354 yuan. The main faults of the medical institutions were undetailed drinking history, irregular medication, breaches of duty of reasonable care, failure to fulfill the obligation of informed notification,etc. Conclusions Drug-induced disulfiram-like reaction has the characteristics of graveness of harm and rapid progress. Primary medical institutions need to improve their identification and disposal capacity urgently. Attention should be paid to collecting and recording of drinking history. Antibiotics should be used in a reasonable and compliant manner. Obligation of high attention to patients, information and other obligations should be fulfilled. Hospital pharmacy staff should ensure drug use safety through participating in drug education actively.

       目的   对医疗损害责任纠纷案的法庭审理进行分析，探究医疗损害责任纠纷案件的处理现状，对此过程中医疗机构应当关注的问题进行分析总结，以期为医院应对医疗损害鉴定工作和法官审理医疗损害责任纠纷案提供参考。方法   对广州市三所综合医院2015—2021年共93例医疗损害责任纠纷案的判决书进行描述性分析。结果  93例案例中79例进行了医疗损害鉴定。79例进行医疗损害鉴定的案例中，71例鉴定结论被法院采信，采信率达90%。有29例案件鉴定人出庭（占比36.7%），其中有25例鉴定意见被法院采信，采信率为86.2%，仅有7例案例当事人申请了专家辅助证人出庭。医方大多数最终承担次要及以下责任占比为73.4%。鉴定结论为责任范围的，法院最后判决偏向于取最高值和中间值（43例出具责任范围的案例中，14例为最高值，13例为中间值）。结论   医疗机构要充分加强对医疗事故技术鉴定和医疗损害鉴定的认识，高度重视医疗损害鉴定工作，尤其加强尸体解剖告知及病历书写管理，充分利用好鉴定人和专家辅助证人出庭两种手段。

      Objective  To analyze the court trial of medical damage liability disputes，to explore the current situation of medical damage liability disputes，to analyze and summarize the problems encountered in dealing with medical damage disputes，so as to provide some references for hospitals to deal with medical damage disputes．Methods  Descriptive statistical analysis performed on the written judgment of 93 cases of medical damage liability disputes in three large comprehensive hospitals in Yuexiu District，Guangzhou from 2015 to 2021．Results  In 93 cases，79 cases had expertise of medical malpractice．In 79 expertise，71 of them were adopted，and the acceptance rate was 90%．Among the 29 cases in which the appraisers appeared in court，25 expert opinions were accepted by the court，the acceptance rate was 86.2%．In only 7 cases，the parties applied for expert witnesses to appear in court．In most cases，hospitals ultimately took secondary and lower responsibilities，accounting for 73.4%．If the appraisal conclusion falls within the scope of responsibility，the court’s final judgment tends to take the highest and middle values．Conclusions  Medical institutions should fully strengthen their understanding of technical identification of medical accidents and medical malpractice identification．Attach great importance to the identification of medical malpractice，especially strengthen the management of autopsy notification and medical record writing，make full use of two methods：appraisers and experts witnesses appearing in court．