475 lines
12 KiB
Plaintext
475 lines
12 KiB
Plaintext
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"DBFieldName":"患者签字"
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"Text":"急性缺血性卒中血管内治疗知情同意书"
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"Text":"一、术前诊断:"
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"Text":"二、拟施行手术及麻醉：\r\n需要在局麻和/或静脉麻醉和/或全麻麻醉下进行经股动脉全脑血管造影术+经动脉血流重建(动脉内溶栓/碎栓/机械取栓/血管成形术）\r\n三、手术可能获益:血管再通,拯救濒死脑组织、减少梗死面积,改善神经功能\r\n四、实行该手术存在的风险及可能发生的意外和并发症\r\n1.此手术可能发生的风险、并发症和意外\r\n⑴血管部分或全部再通,但症状无改善,甚至加重:\r\n⑵血管无法再通,或再通后再次闭塞,症状无改善或恶化,新发梗死，危及生命；\r\n⑶颅内出血或再灌注损伤，导致偏瘫、失语、癫痫甚至昏迷等症状,必要时转为开颅手术,甚至危及生命；\r\n⑷术中出现颅内外血管痉挛、夹层造成动脉闭塞甚至脑梗死或是动脉破裂,出现相关症状，甚至危及生命\r\n⑸小栓子脱落向远端血管逃逸导致再次梗塞,使已经恢复的神经功能再次缺损;\r\n⑹血气栓、异物、动脉粥样硬化斑块等栓塞以及脑血栓形成造成脑梗死;\r\n⑺导管、导丝、支架打折、打结甚至断裂,滞留体内难以取出,并造成脑梗死；\r\n⑻药物过敏,发生溶血、发热、皮参、哮喘甚至过敏性休克；\r\n⑼穿刺部位血肿、硬结、感染、腹膜后出血、假性动脉瘤及股动脉业住甚至危及生命;\r\n⑽动脉血管严重硬化、迂曲、血管开口狭窄明显,造影导管、微导管、支架无法到位,手术无法完成，患方仍需承担相应费用；\r\n⑾术中心脑血管疾病急性发作,导致呼吸循环衰竭；\r\n⑿造影发现远端分支血管闭塞、微导管及支架无法到位和开通血管,症状无法改善;\r\n⒀溶栓及抗凝药物导致其他部位出血,危及生命;\r\n⒁DSA机器故障,检查或治疗不能如期进行或完成\r\n⒂其他无法预料的情况。\r\n2.手术麻醉存在的风险(详见《麻醉同意书》)。\r\n3.拒绝手术可能导致的严重后果:病情持续加重、危及患者生命、失去手术最佳治疗时机、引起各种严重的并发症、多脏器器官功能损害等。\r\n4.部分手术麻醉费用及材料费为自费或部分自费。\r\n5.任何所用药物都可能产生不良反应,包括轻度恶心、皮疹等症状,直至严重的过敏性休克,甚至危及生命。\r\n6.对于患有高血压、心脏病、糖尿病、肝肾功能不全、静脉血栓等疾病,或者有吸烟、酗酒史的患者,以上这些风险可能会加大,或者在术中或术后出现相关的病情加重或心脑血管意外,甚至死亡。\r\n7.如患者术后不遵医嘱或不配合治疗,可能影响手术效果。\r\n8.其他难以预料的,危及患者生命等意外情况。\r\n五、替代治疗方案告知\r\n保守治疗或单纯静脉溶栓治疗：症状无改善甚至持续恶化。\r\n我们对以上各项均已了解清楚,同意接受手术治疗,愿意承担因此而带来的各种风险。\r\n并同意:\r\n1.手术中发现的情况可能与术前估计有差异,在手术操作中医师可以根据患者的病情征得法定代理人签字同意后,对预定的操作作出调整。\r\n2.授权医师对于操作切除的病变器官、组织或者标本进行处置，包括病理学检查、细胞学检查和医疗废物处理等。"
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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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"Text":"医护人员陈述：\r\n我已经将患者目前的病情危重、血管内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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