PiCCO监测在危重患者容量管理中的应用

目的探讨PiCCO监测在危重患者容量管理中的应用价值。方法采用前瞻性临床观察研究方法,将入住重症医学科的32例危重患者随机分成两组。试验组16例患者接受脉搏指示连续心排血量（PiCCO）监测,以GEDVI、EVLWI作为容量管理的指导指标;对照组16例患者以中心静脉压（CVP）作为容量管理的指导指标,对比两组患者治疗1d、2d和3d的急性生理学与慢性健康状况评分系统Ⅱ（APACHE11）评分、机械通气时间、住ICU天数、3d液体总入量、住院病死率等数据。结果①试验组2d、3d时APACHEⅡ评分、HR均较1d时显著下降（P〈0．05）,MAP均显著升高（P〈0．05）;②机械通气时间、住ICU天数试验组均短于对照组（P〈0．05）;③试验组与对照组3d液体总人量、住院病死率比较,差异无统计学意义（P〉0．05）。结论与用CVP指导相比,用PiCCO监测指标指导危重患者的容量管理显示,2d、3d时危重患者病情均较1d改善,PiCCO监测指标能指导临床对血容量状态作出准确判断和指导恰当的补液,使危重患者获益。     

脉搏指示连续心排血量监测技术在重度心力衰竭治疗中的应用研究

目的探讨脉搏指示连续心排血量监测(Pi CCO)技术在重度心力衰竭患者治疗中的应用效果。方法将60例重度心力衰竭患者按随机数字法分为治疗组与对照组,各30例。治疗组采用Pi CCO技术监测血流动力学指标:心脏指数(CI)、胸腔内血容积指数(ITBVI)、血管外肺水指数(EVLWI)、系统血管阻力指数(SVRI)等指导液体管理及血管活性药物应用;对照组根据中心静脉压(CVP)变化指导治疗。比较两组患者机械通气时间、ICU住院时间、治疗后28 d病死率的不同;观察治疗组治疗前后CI、ITBVI、EVLWI、SVRI的变化;观察治疗组死亡与存活患者治疗前及治疗3 d后EVLWI的变化。结果治疗组机械通气时间、ICU住院时间、治疗后28 d病死率均低于对照组(P<0.05);治疗组治疗后ITBVI、EVLWI、SVRI恢复正常,与治疗前比较差异有统计学意义(P<0.05),CI改善与治疗前比较,差异有统计学意义(P<0.05);治疗组患者死亡7例,存活23例;治疗组存活与死亡患者治疗前EVLWI水平比较,差异无统计学意义(P>0.05);存活患者治疗3天后EVLWI水平明显低于治疗前,且明显低于死亡患者(P<0.05)。结论利用Pi CCO监测指标指导重度心力衰竭治疗,可改善患者心功能,减少机械通气时间及ICU住院时间,降低病死率;动态观察EVLWI可评估患者预后。     

PiCCO监测在危重烧伤患者早期液体复苏中的应用效果

目的探析PiCCO监测在危重烧伤患者早期液体复苏中的使用效果。方法选取2013年4月至2016年6月郑州市第一人民医院收治的危重烧伤患者80例作为观察对象,随机分为研究组和对照组,各40例。对照组给予常规监测,研究组实施PiCCO监测,比较复苏前后两组的HR、APACHEⅡ评分、CVP、MAP、EVLWI、ITBVI及GEDVI。结果复苏后,研究组的HR、APACHEⅡ评分低于对照组,差异有统计学意义(P<0.05)。复苏后,研究组的CVP与MAP明显高于对照组,差异有统计学意义(P<0.05)。研究组复苏后的EVLWI、ITBVI及GEDVI高于复苏前,差异有统计学意义(P<0.05)。结论 PiCCO监测对危重烧伤患者早期液体复苏具有积极的临床指导价值,可有效改善患者预后,值得推广。     

PICCO主导下多指标监测在严重烧伤患者休克期治疗中的应用

目的探讨脉搏轮廓温度稀释连续心排血量(PICCO)主导下多指标监测在严重烧伤患者休克期治疗中的应用效果。方法选择2012年1月至2016年12月郑州市第一人民医院收治的112例严重烧伤住院患者为研究对象。其中2012年1月至2013年12月入院的56例患者为对照组,接受常规监测方法指导液体管理;2014年10月至2016年12月入院的56例患者为观察组,接受PICCO主导下的多指标监测方法指导液体管理。记录两组患者入院后24、72 h及7 d时平均动脉压(MAP)、中心静脉压(CVP)、心率(HR)水平,比较两组患者急性生理学与慢性健康状况系统Ⅱ(APACHEⅡ)评分、入住ICU天数及入院72 h、30 d死亡率等;比较观察组患者治疗前后全身血管阻力指数(SVRI)、全心舒张末期容积指数(GEDVI)、心指数(CI)、血管外肺水指数(EVLWI)水平。结果治疗24、72 h及7 d后,观察组患者APACHEⅡ、HR、MAP、CVP水平高于对照组,输液量少于对照组,胸腔积液及肾功能不全发生率低于对照组,差异有统计学意义(P均<0.05);观察组患者入住ICU天数及呼吸机使用天数少于对照组,入院72 h、30 d内死亡率均低于对照组,差异有统计学意义(P均<0.05)。应用PICCO后,观察组患者CI、SVRI、GEDVI、EVLWI等各指标水平均优于治疗前,差异有统计学意义(P<0.05)。结论 PICCO主导下的多指标监测能直接、准确地提供严重烧伤患者血流动力学的重要信息,对严重烧伤患者输液管理有重要的指导意义,可改善患者预后。     

两种容量管理对老年急性心源性肺水肿机械通气患者的影响

目的 分析两种不同容量管理方法在老年急性心源性肺水肿机械通气患者中的应用效果。方法 将50例老年急性心源性肺水肿患者随机分为对照组和观察组,每组25例,对照组采用中心静脉压（CVP）进行容量管理,观察组根据脉搏指数连续心输出量监测（PICCO）、胸内血容量（ITBV）、血管外肺水（EVLW）数据进行容量管理,评价两种容量管理方式的应用效果。结果 两组患者治疗后24 h、48 h的平均动脉压（MAP）、CVP水平均较治疗前下降,且治疗后48 h的MAP、CVP水平均低于治疗后24 h(P均<0.05);组间对比,观察组和对照组患者CVP、MAP变化趋势不同,观察组CVP、MAP下降较对照组更快（P<0.05）;治疗后36 h,观察组患者心排血指数（CI）水平较治疗前提高,舒张末总容量指数（GEDVI）、胸内血容量指数（ITBVI）、血管外肺水指数（EVLWI）水平均较治疗前下降（P均<0.05）;观察组平均住院时间为（15.13±4.12） d,短于对照组的（19.12±3.88） d(P<0.05)。结论 PICCO测定EVLWI、ITBVI等指标可准确指导心源...     

PiCCO在急性呼吸窘迫综合征患者机械通气治疗中的应用

目的：探讨脉搏指示连续心排量监测（PiCCO）技术在急性呼吸窘迫综合征（ARDS）患者机械通气治疗中的应用价值。方法：ARDS并行血流动力学监测的患者40例,均需气管插管机械通气,根据血流动力学监测方式不同分为观察组与对照组各20例,观察组经股动脉放置PiCCO动脉导管,参考PiCCO指标的动态变化指导液体管理、血管活性药应用及呼吸机参数的调节。对照组行中心静脉导管留置,参考中心静脉压（CVP）、血乳酸、心率（HR）及尿量等情况指导补液。比较两组治疗前（T0）、治疗后24 h（T1）、治疗后48 h（T2）的HR、CVP、MAP、氧合指数（PaO2/FiO2）,比较观察组撤机前、SBT后30min以及拔管后30min时的PiCCO参数：中心静脉压（CVP）、血管外肺水指数（EVLWI）、全心舒张末期容积（GEDVI）、胸腔内血容积指数（ITBVI）和肺血管通透性指数（PVPI）。进行GEDVI、ITBVI与CVP之间的相关性分析。比较两组呼吸机治疗时间、ICU住院时间、28天内病死率。结果： 观察组患者T1、T2 的PaO2/FiO2 为245.4±18.7 mmHg、295.3±20.6 mmHg,分别高于对照组189.3±19.7 mmHg、236.5±20.2 mmHg,HR、CVP、MAP均降低,差异有统计学意义 （P均<0．01）。观察组撤机拔管后容量指标及血管外肺水较撤机前升高,差异有统计学意义（P＜0.05）。GEDVI、ITBVI与CVP的相关性分析发现,GEDVI与CVP及ITBVI与CVP相关系数分别为0．131、0．224,相关性较弱（P>0．05）。观察组呼吸机治疗时间、ICU 住院时间为7.78±2.31天、9.12±2.32天,对照组分别为15.12±3.68天、21.53±4.81天,观察组28天内病死率10%低于对照组30%,差异均有统计学意义（P均<0.01）。结论：应用PiCCO可更精准地监测ARDS患者血流动力学变化,强化液体管理,为ARDS撤离呼吸机创造条件,可使患者早日脱机,对临床有一定的指导价值。     

PICCO技术在严重脓毒症输液管理中的应用与护理

目的探讨PICCO监测技术对严重脓毒症患者输液管理与护理。方法通过PICCO（pulseindicatedconitinuouscardiacoutput）技术（PULSION公司,德国）,即经肺热稀释方法和脉搏轮廓分析法,对28例因严重脓毒症入住ICU的患者,监测MAP、CI、SI、SV、EVLWI、ITBVI、GEDVI,记录液体复苏前后的上述指标。结果复苏前与复苏终点（感染发生后6～10小时内）相比,ITBVI、GEDVI与SI有显著相关性,P〈0.01;HR与SI似呈负相关,P〉0.05;CVP、MAP与SI相关性较差,P〉0.05;复苏后的胸腔内血容量变化（ΔITBVI）与每搏输出量指数变化（ΔSI）有显著相关性,P〈0.01;全心舒张末期总容量指数变化（ΔGEDVI）与ΔSI显著正相关,P〈0.05;而ΔCVP、ΔHR、ΔMAP与ΔSI相关性较差P〉0.05。结论 ITBVI、GEDVI及容量复苏后的变化可以准确、可靠地评估患者容量状况,指导严重脓毒症患者的液体治疗。     

脓毒症休克伴发肺水肿病人的血容量及血管外肺水监测

目的：探讨PiCCO技术测得的容量参数较传统压力参数对脓毒症休克伴肺水肿患者血容量状态及血管外肺水指数（EVLWI）评估的准确性。方法：通过PiCCO技术（即经肺热稀释方法和脉搏轮廓分析法）对16例因严重脓毒症休克伴发肺水肿而入住ICU的病人,监测平均动脉压（MAP）、心脏指数（CI）、中心静脉压（CVP）、EVLWI、胸腔内血容量指数（ITBVI）、全心舒张末期容积指数（GEDVI）等指标。结果：ITBVI、GEDVI与EVLWI有显著相关性,前者r=0．55,P〈0．001,后者r=-0．61,P〈0．0001,而CVP与EVLWI相关性差;△FB （24h出入量变化）、△CVP与EVLWI无关,／XITBVI、△GEDVI与EVLWI相关,前者r=-0．57,P〈0．01,后者r=0．63,P〈0．005。结论：容量参数（如GEDVI、ITBVI）比传统压力参数（如CVP等）评估脓毒症伴发肺水肿患者的EVLWI更为准确、可靠。     

重症超声指导感染性休克治疗的临床观察

目的探究重症超声指导感染性休克治疗的临床观察效果。方法选取广东省中山市中医院2015年7月—2017年7月ICU收治的感染性休克患者100例,随机分为观察组及对照组,每组各50例。对照组患者给予连续心排血量监测(PiCCO)监测指导液体复苏,观察组患者给予重症超声监测指导。比较两组患者平均动脉压(MAP)、中心静脉压(CVP)、复苏液体量、6h复苏达标率、ICU入住天数、机械通气时间及28 d死亡率,并采用急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)及序贯器官衰竭评分(SOFA)对两组患者治疗前后进行评估比较。结果经治疗后,两组患者APACHEⅡ评分及SOFA评分均较治疗前明显降低(P<0.05),但两组比较差异无统计学意义(P>0.05);两组患者MAP和CVP均较治疗前显著改善(P<0.05),但两组比较差异无统计学意义(P>0.05);两组患者复苏液体量、6 h复苏达标率、ICU入住天数、机械通气时间及28 d死亡率比较差异无统计学意义(P>0.05)。结论重症超声监测指导感染性休克治疗的疗效显著,有利于促进患者血流动力恢复,减少液体复苏量,提高患者转归结果,值得临床推广应用。     

血管外肺水指数和胸腔内血容积指数在严重肺部感染合并感染性休克患者液体管理中的意义

目的探讨血管外肺水指数(EVLWI)和胸腔内血容积指数(ITBVI)在严重肺炎合并感染性休克患者液体管理中的指导意义。方法选择北京大学首钢医院重症医学科(ICU)2010年1月至2013年2月收治的106例严重肺炎合并感染性休克患者,采取前瞻性随机对照研究方法分为两组。EVLWI+ITBVI组54例,以脉搏指示连续心排出量(PiCCO)技术测定EVLWI和ITBVI指导液体管理;对照组52例,常规以中心静脉压(CVP)指导液体管理。比较两组患者早期目标导向性治疗(EGDT)的达标时间和达标率,治疗1 d和3 d的APACHEⅡ评分、SOFA评分、去甲肾上腺素用量、血清乳酸、血肌酐,72 h内液体管理数据,机械通气率、机械通气时间、住ICU时间及28 d病死率。结果EVLWI+ITBVI组6 h的EGDT达标率比对照组高(75.9%比55.7%,P<0.05),而EGDT达标时间和24 h的EGDT达标率无显著差异(P>0.05)。EVLWI+ITBVI组3 d时APACHEⅡ评分、SOFA评分、去甲肾上腺素用量、血乳酸较1 d明显下降,而对照组无显著变化;EVLWI+ITBVI组3 d时血肌酐无明显增加,而对照组明显增加(P<0.05)。EVLWI+ITBVI组0～6 h液体入量和液体平衡量比对照组多,其余时段入量、出量、平衡量两组比较差异无统计学意义(P>0.05)。EVLWI+ITBVI组机械通气率、机械通气的时间、住ICU时间和28 d病死率均较对照组明显减少(P<0.05)。结论与传统CVP指导的液体管理相比,ITBVI和EVLWI可以更精确评估和指导严重肺炎合并感染性休克患者的液体管理,减少机械通气时间和住ICU时间,降低病死率。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.