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A*******s
发帖数: 9638 | 1 先简单的说一下evidence的分类（详细的请自己google）：
CLASS I
Benefit >>> Risk， Procedure/treatment SHOULD be performed/administered
CLASS II
Benefit > Risk Additional studies with focused objectives needed
IT IS REASONABLE to perform procedure/administer treatment
CLASS III No Benefit/harm
怎样运用EBM，是医疗实践的艺术。
如果一个中老年病人突然大面积中风，用tPA无效，而perfusion CT显示有penumbra，
很多医生会选择endovascular intervention，这个intervention到目前为止顶多是
Class II。
尽管各种治疗手段，病人还是昏迷不醒，并出现脑疝的迹象，有医生会做craniectomy
，这个手术曾经很流行，但几个trials包括HAMLET证明手术与药物治疗没区别，所以现
在也挺多是Class II，仅仅对年纪轻的推荐使用。
同样是Class II的手术，在临床上的应用却大不一样，第一种情况，这个病人如果不采
取措施治疗，终身残废甚至死亡的可能性几乎是100%， 所谓死马当活马医，就是这个
道理，所以我主张让interventional neuroradiologist或neurosurgery做最大努力。
而第二种情况，除非年纪轻，我是不主张做手术的，因为病人无论如何已经瘫痪，即使
九死一生，也毫无生活质量，为什么要冒这个class II的风险呢？
一点感想，纯粹就事论事。 | n*******c
发帖数: 501 | 2 Very well said.
I guess it depends on the treatment goal here.In China it is probably hard
for people to think about quality of life FIRST in that scenario.People tend
to think keeping patient alive first and then how to achieve maximal
functional improvement.
However we know the prognosis well enough to take an "all or none" approach
and prioritize accordingly. And that is where the difference is.
I also don't like using mannitol which is only killing the kidney without
any other help. |
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