Wednesday, 27 September 2023

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验尸官:注射过量麻醉剂“严重疏失” 惟老妇死于自然原因

两年前,一名86岁周姓老妇在新加坡中央医院接受治疗中逝世,护士被指犯下“严重疏忽”注射过量麻醉剂。不过,在昨日的法院审讯中,验尸官马文贝指出,麻醉剂过量并非老妇的直接死因。

有关护士在准备为有关周姓老妇注射局部麻醉药利各卡因(lignocaine)时,对智能静脉注射泵仪器上的毫克和毫升单位混淆,误把频率选项当作剂量选项。

护士也承认她理应在斌率选项上,选择每小时注入4.17毫升,但她却误植为每小时41.7毫克的剂量选项。这导致周姓病患被注入了比原本多10倍的剂量。

护士称,当时她未再向同事再行确认,输入完成后就转头服务其他病患。

验尸官马文贝指出,即便护士对有关仪器不熟悉、且对仪器的使用和掌握很有限,从逻辑角度来看,她很可能犯下疏失,却还是被指派为周姓老妇注射麻醉剂。

“毫无疑问,滥用镇静药物会导致后果。”

不过,根据法医病理学家的调查结果表明,有关周姓病患的死因,乃是由败血症,血液中毒和多器官衰竭引起的。

根据《亚洲新闻台》报导,中央医院国家心脏中心医疗官的证词指出,过量注射利各卡因,可能导致癫痫大作、发病乃至死亡。

非直接导致死因

验尸官认为周女士死于自然原因。其医疗记录表明,她除了患有高脂血症,或血液中胆固醇含量高,以及高血压等疾病外,也已患上绝症。

在周姓老妇被注射过量麻醉剂后,为老妇看诊的王慧善(译音)医生指出,虽然患者精神状态恶化,但利各卡因的毒性对患者死因无关,因为她已患上“危及生命”的脓毒症,肾衰竭和缺血性心脏病的病症。

两年前的5月24日,周女士进行洗肾透析(dialysis)的左臂部位出现感染和出脓,而被送入新加坡中央医院接受治疗。在她的排泄物中发现病原体。

国家心脏中心医生发现,周姓老妇在被诊断出左臂感染六天后出现心跳加速,于是开方为他施以利各卡因,以进行手术治疗。

《海峡时报》报导称,有关护士在5月31日,被指派进行输入麻醉剂,两小时后,肾脏护理中心即收到了出现疏失的通知。

中央医院护理长Tracy Carol Ayre医生,在接受采访时表示,即便上述疏失并未直接构成老妇死因,但对她的离世仍感到遗憾。

她表示,已提醒并强调医护人员,需严格遵守药物和镇静剂管理的复核要求,并确保护士在负责向患者服药时,具备必要的能力和知识。

她说,院方和所有护士分享了上述教训作为警戒,并持续推动患者零伤害的努力。对于疏失职员,已作出适当处分。不过, 新加坡中央医院已证实,有关护士并未被解雇。

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