541 lines
14 KiB
Plaintext
541 lines
14 KiB
Plaintext
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"DBFieldName":"医护签字时间"
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"DBFieldName":"患者签名时间"
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"DBFieldName":"姓名"
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"DBFieldName":"年龄"
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"DBFieldName":"性别"
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"DBFieldName":"关系"
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},
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"Name":"Number",
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"DBFieldName":"病历号"
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"Name":"DoctorSignature",
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"DBFieldName":"医护人员签字"
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},
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"Name":"PatientSignature",
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"Type":"Binary",
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"DBFieldName":"患者签字"
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},
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"Name":"Agree",
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"DBFieldName":"是否同意"
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"Text":"姓名："
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"Text":"性别："
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"Size":120000,
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"Text":"年龄："
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"Left":0.396875,
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"Name":"宋体",
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"Size":120000,
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"Weight":400,
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"Charset":134
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"Text":"医护人员签名"
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},
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"Name":"StaticBox9",
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"Text":"签名时间"
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"Type":"FieldBox",
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"Name":"FieldBox3",
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"Left":1.79917,
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"Width":1.61396,
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"Font":{
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"Name":"宋体",
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"Weight":400,
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"DataField":"Name"
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"Type":"FieldBox",
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"Name":"FieldBox5",
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"Left":5.21229,
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"Top":1.19063,
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"Width":1.19063,
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"Height":0.608542,
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"Font":{
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"Name":"宋体",
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"Size":120000,
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"Weight":400,
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"Charset":134
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},
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"DataField":"Gender"
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},
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"Type":"FieldBox",
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"Font":{
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"Name":"宋体",
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"DataField":"Age"
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},
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"Type":"FieldBox",
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"Name":"FieldBox10",
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"Font":{
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"DataField":"PatientSignatureTime"
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"Type":"StaticBox",
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"Name":"StaticBox10",
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"Left":3.20146,
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"Top":0.211667,
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"Width":9.07521,
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"Font":{
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"Name":"宋体",
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"Size":142500,
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"Bold":true,
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},
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"TextAlign":"MiddleCenter",
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"Text":"颈动脉血管成型支架植入术知情同意书"
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},
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"Font":{
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"Name":"宋体",
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"Size":120000,
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"Weight":400,
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},
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"Text":"病历号："
|
||
},
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{
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"Type":"FieldBox",
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"Name":"FieldBox11",
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"Left":11.8004,
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"Font":{
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"Name":"宋体",
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"Size":120000,
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"Weight":400,
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"Charset":134
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"DataField":"Number"
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},
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"Type":"StaticBox",
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"Name":"StaticBox12",
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"Left":0.396875,
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"Font":{
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"Name":"宋体",
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"Size":120000,
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"Weight":400,
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"Charset":134
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},
|
||
"Text":"患者因患于收住入院。经行全脑血管造影术检查发现："
|
||
},
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"Type":"FieldBox",
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"Name":"FieldBox12",
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"Left":10.795,
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"Border":{
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"Styles":"[DrawBottom]"
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},
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"Font":{
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"Name":"宋体",
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"Size":120000,
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"Weight":400,
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"Charset":134
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},
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"DataField":"Name"
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},
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"Type":"StaticBox",
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"Name":"StaticBox15",
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"Left":0.396875,
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"Top":2.80458,
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"Width":14.896,
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"Height":0.899583,
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"Font":{
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"Name":"宋体",
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"Weight":400,
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"Charset":134
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},
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"WordWrap":true,
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||
"Text":"为进一步治疗，降低或解除再发严重脑卒中事件，需行。介入手术相关并发症及可能出现的危险如下："
|
||
},
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"Type":"StaticBox",
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"Name":"StaticBox16",
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"Left":0.396875,
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"Width":15.3194,
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"Height":16.9863,
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"Font":{
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"Name":"宋体",
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"Charset":134
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},
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"WordWrap":true,
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||
"Text":"1）麻醉意外及药物不良反应（如造影剂过敏、肝肾功能损害等）：\r\n2)术中血管斑块脱落、移位，或脑血管严重痉挛、血管内膜损伤，致急性脑血栓形成或动脉夹层，引起邻近血管闭塞或远端其他部位脑梗死，引起头晕、行走不稳，言语、吞咽、视觉功能障碍、肢体瘫痪，甚至昏迷、植物人状态或死亡等，必要时可能需急诊予以动脉溶栓及支架取栓等抢救治疗措施；\r\n3）球囊、支架、导管等介入器材刺激颅内动脉血管，致血管损伤破裂、颅内大出血，引起言语、吞咽功能障碍、瘫痪，甚至昏迷、植物人状态或死亡等；\r\n4)因球囊或支架刺激颈动脉窦，引起血压下降、心率减慢或休克、心跳、呼吸骤停等反应，加重病情，甚至危及生命；\r\n5）重度狭窄解除后可能继发脑高灌注综合征，导致躁动、癫痫发作、严重脑水肿、脑出血、脑疝等；\r\n6）因患者严重动脉硬化、血管迂曲，以及严重狭窄等病变原因，可能使导管、导丝、支架等不能到达病变部位，致手术不能继续进行，须及时终止介入手术，改用内科药物继续治疗；\r\n7)心跳、呼吸骤停，或发生其他意外，危及生命；\r\n8）股动脉穿刺部位血肿、感染；\r\n9)术中可能发生其他未能预估到的特殊病情变化或急性不良反应，手术医师有权根据实际情况，按照相关医疗原则及有利于患者健康、减轻病情危害性的原则，酌情调整手术治疗方案，并及时告知患者家属；\r\n10）支架植入术后血管再狭窄可能，需术后定期复查及长期服用抗栓、调脂药物治疗，必要时需再次行血管成型支架置入术；\r\n11)手术不成功及其它情况（如血管严重迂曲、痉挛，病人不能耐受，其他脏器功能发生严重不良反应等)，致手术不能继续进行，须及时终止介入手术，改用内科药物继续治疗。注意：若因上述原因导致手术不成功者，患方仍需承担所耗材料及手术相关费用；\r\n12）患者原有基础疾患（如：心、肺、肝、肾等重要脏器疾患）在术中发生合并症，出现相应功能障碍，加重病情等；\r\n13）本次手术仅只能解决部分严重血管病变风险，如患者高龄，身体机能自然退化，其他部位亦有动脉粥样硬化斑块形成等原因，术后亦有可能在其他动脉血管发生狭窄病变，并在其供血区域发生闭塞、梗死可能，需长期控制危险因素、内科药物治疗；\r\n14）以上情况我们将充分考虑，认真准备，针对具体病情积极采取防治措施，尽力防止出现严重并发症，降低手术风险。但因目前医疗发展水平及医疗条件有限，一些病情不能完全靠手术治疗来解决；术中亦可能发生一些非人为因素所能控制的不良情况，引起病情不能\r\n缓解或病情加重，希望患者及其家属能充分理解。\r\n以上情况我们将充分考虑，认真准备，针对具体病情积极采取防治措施，尽力防止出现严重并发症，降低手术风险。但因目前医疗技术发展水平有限，以及患者病情个体差异等情况，有可能在采取了积极防治措施的基础上仍发生不同程度的并发症或手术意外风险，希望患者及其家属能充分理解。"
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},
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"WordWrap":true,
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"Text":"医师已对病情及上述情况作了详细介绍和解释，患者（或家属代表)已详细阅读了上述内容，对病情及术中、术后可能出现的问题（危险）均已了解清楚和理解，经慎重考虑，决定"
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"Weight":400,
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},
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"WordWrap":true,
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"Text":"做此手术治疗。"
|
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},
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"Left":3.99521,
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"Styles":"[DrawBottom]"
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"DataField":"Agree"
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"Left":0.396875,
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"Size":120000,
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"Charset":134
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},
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"Text":"如果患者无法签署知情同意书,请其授权的亲属在此签名:"
|
||
},
|
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{
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"Type":"StaticBox",
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"Left":0.343958,
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"Weight":400,
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"Charset":134
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},
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"WordWrap":true,
|
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"Text":"患者/患者授权亲属签名"
|
||
},
|
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{
|
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"Type":"PictureBox",
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"Name":"PictureBox1",
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"Left":2.80458,
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"Top":26.4848,
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},
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"Size":120000,
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"Weight":400,
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"Charset":134
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},
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"Text":"与患者关系"
|
||
},
|
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{
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"Type":"FieldBox",
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"Name":"FieldBox16",
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"Left":7.69938,
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"Charset":134
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},
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"WordWrap":true,
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"Text":"医护人员陈述：\r\n我已经将患者目前的病情危重、溶栓治疗可能出现的并发症和风险以及医护人员在患者病情危重时进行的救治措施向患者家属或患者的法定监护人、授权委托人详细告知。"
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