外科手术决策规范化 更多心脏病人可得救
路透社纽约健康消息 一项新的研究发现，许多心脏病患者都没有获得可以挽救他们生命的外科手术治疗。该研究发表在3月1日的《新英格兰医学杂志》上， 提出了关于医学决策如何避免个人主观性的重要议题，强调了制订全国性外科手术决策指导方针的必要性。
研究的带头人，伦敦大学医学院的哈瑞·海明威医生认为，尽管研究是在英国做的，但对美国的医院也一样适用。当前普遍的看法是：是否进行血管再形成术的医学决策过程是最理想的。这项研究结果和在美国进行的一些研究结果，对这种看法进行了挑战。血管再形成术是一种让阻塞的血管重新开通的手术。手术将顶端带有气囊的导管插入动脉里，清除血管里的脂肪粥样斑块。如果病人安排的是药物治疗，那么这部份病人在三年后胸痛复发的机率是接受血管形成术病人的两倍。而这项针对2,500位心脏病人的研究显示，在适合做血管成形术的病人中只有三分之一获得手术治疗。
研究报告指出，只有57%适合做冠状动脉旁路手术的病人做了手术。做了手术的病人与采用药物治疗的病人相比，死亡率、非致命性心脏病发作、以及剧烈胸痛的可能性明显降低。
, http://www.100md.com
该报告是在对这些心脏病人的病史记录以及他们适合做哪种手术的诊断进行了研究后得出来的。一个由九名代表不同学科的专家组成的医疗小组负责判断病人是否适合手术。但来自洛杉矶退伍军人保健系统的保罗西克医生认为，即使是专家小组作出的决定也有差异。 不同的专家小组会做出不一样的结论。
但是总的来说，这项研究肯定了专家小组制定指导方针和适当的标准的作用。经专家小组讨论后得出的适当的标准一般是可靠的，而一个医生作出的决定则可变性较大，而且病人根据这种标准进行治疗后会得到较好的效果。
Heart Surgery Underused, Could Save More Lives
NEW YORK (Reuters Health) - Many heart disease patients are not receiving surgical procedures that could save their lives, a new study reports.
, 百拇医药
The report, published in the March 1st issue of The New England Journal of Medicine highlights the subjective nature of medical decisions and underscores the need for national guidelines that could help physicians decide whether to recommend heart surgery to their patients or treat them with drugs.
While the study was conducted in the UK, the findings also apply to hospitals in the US, Dr. Harry Hemingway, the study‘s lead author, told Reuters Health.
, http://www.100md.com
``Taken along with findings from studies in the US, it challenges the assumption that the current method of making a decision to revascularize a patient is optimal,‘‘ said Hemingway from University College London Medical School. Revascularization refers to procedures designed to re-open blocked blood vessels.
The study of more than 2,500 heart disease patients reveals that just over one third of those eligible for angioplasty had the procedure performed.
, 百拇医药
Angioplasty involves the insertion of a balloon-tipped catheter into an artery to clear fatty plaques. Patients who received drugs in lieu of angioplasty were almost twice as likely to have chest pain nearly 3 years later.
Fifty-seven percent of patients who were eligible for coronary artery bypass surgery (CABG) underwent the procedure. These patients were less likely to die, suffer a nonfatal heart attack and experience severe chest pain than CABG-eligible patients who were treated with drugs, the report indicates.
, http://www.100md.com
The findings are based on medical records of heart disease patients and a determination of whether patients were eligible for the various procedures. Eligibility was judged by a nine-member panel of doctors representing a variety of medical specialties.
In an accompanying editorial, Dr. Paul G. Shekelle from the Greater Los Angeles Veterans Affairs Healthcare System in California noted that even criteria developed by expert panels can also vary from one group to the next.
Still, he concludes, the study supports the usefulness of guidelines or ‘‘appropriateness criteria.‘‘ ``There is demonstrably less variability in the development of appropriateness criteria than in the judgments of individual physicians, and patients have better outcomes when they are treated according to such criteria,‘‘ Shekelle writes., 百拇医药
研究的带头人，伦敦大学医学院的哈瑞·海明威医生认为，尽管研究是在英国做的，但对美国的医院也一样适用。当前普遍的看法是：是否进行血管再形成术的医学决策过程是最理想的。这项研究结果和在美国进行的一些研究结果，对这种看法进行了挑战。血管再形成术是一种让阻塞的血管重新开通的手术。手术将顶端带有气囊的导管插入动脉里，清除血管里的脂肪粥样斑块。如果病人安排的是药物治疗，那么这部份病人在三年后胸痛复发的机率是接受血管形成术病人的两倍。而这项针对2,500位心脏病人的研究显示，在适合做血管成形术的病人中只有三分之一获得手术治疗。
研究报告指出，只有57%适合做冠状动脉旁路手术的病人做了手术。做了手术的病人与采用药物治疗的病人相比，死亡率、非致命性心脏病发作、以及剧烈胸痛的可能性明显降低。
, http://www.100md.com
该报告是在对这些心脏病人的病史记录以及他们适合做哪种手术的诊断进行了研究后得出来的。一个由九名代表不同学科的专家组成的医疗小组负责判断病人是否适合手术。但来自洛杉矶退伍军人保健系统的保罗西克医生认为，即使是专家小组作出的决定也有差异。 不同的专家小组会做出不一样的结论。
但是总的来说，这项研究肯定了专家小组制定指导方针和适当的标准的作用。经专家小组讨论后得出的适当的标准一般是可靠的，而一个医生作出的决定则可变性较大，而且病人根据这种标准进行治疗后会得到较好的效果。
Heart Surgery Underused, Could Save More Lives
NEW YORK (Reuters Health) - Many heart disease patients are not receiving surgical procedures that could save their lives, a new study reports.
, 百拇医药
The report, published in the March 1st issue of The New England Journal of Medicine highlights the subjective nature of medical decisions and underscores the need for national guidelines that could help physicians decide whether to recommend heart surgery to their patients or treat them with drugs.
While the study was conducted in the UK, the findings also apply to hospitals in the US, Dr. Harry Hemingway, the study‘s lead author, told Reuters Health.
, http://www.100md.com
``Taken along with findings from studies in the US, it challenges the assumption that the current method of making a decision to revascularize a patient is optimal,‘‘ said Hemingway from University College London Medical School. Revascularization refers to procedures designed to re-open blocked blood vessels.
The study of more than 2,500 heart disease patients reveals that just over one third of those eligible for angioplasty had the procedure performed.
, 百拇医药
Angioplasty involves the insertion of a balloon-tipped catheter into an artery to clear fatty plaques. Patients who received drugs in lieu of angioplasty were almost twice as likely to have chest pain nearly 3 years later.
Fifty-seven percent of patients who were eligible for coronary artery bypass surgery (CABG) underwent the procedure. These patients were less likely to die, suffer a nonfatal heart attack and experience severe chest pain than CABG-eligible patients who were treated with drugs, the report indicates.
, http://www.100md.com
The findings are based on medical records of heart disease patients and a determination of whether patients were eligible for the various procedures. Eligibility was judged by a nine-member panel of doctors representing a variety of medical specialties.
In an accompanying editorial, Dr. Paul G. Shekelle from the Greater Los Angeles Veterans Affairs Healthcare System in California noted that even criteria developed by expert panels can also vary from one group to the next.
Still, he concludes, the study supports the usefulness of guidelines or ‘‘appropriateness criteria.‘‘ ``There is demonstrably less variability in the development of appropriateness criteria than in the judgments of individual physicians, and patients have better outcomes when they are treated according to such criteria,‘‘ Shekelle writes., 百拇医药
参见：首页 > 医疗版 > 疾病专题 > 骨科 > 慢性非化脓性关节炎或关节病 > 大骨节病（外科）