一例胸膜间皮瘤的循证治疗

目的为1例确诊的恶性胸膜间皮瘤患者制定最佳治疗方案。方法在充分评估患者病情的基础上,根据PICO原则,提出临床问题并转换成便于检索的形式,从各国胸科医师协会的网站,同时还包括Cochrane Library(2009年第1期)、PubMed(1966-2009第1期)、中文科技期刊全文数据库(CSJD,1989-2009第1期)和EMbase(1974-2009第1期)上进行检索。结果共检索出治疗恶性胸膜间皮瘤的随机对照试验20篇、系统评价/Meta分析9篇和卫生经济学评价1篇。根据检索结果,并结合患者病情和意愿,为患者制定出培美曲塞二钠联合顺铂方案化疗,共进行两个周期的化疗,同时给予镇痛等其他对症治疗。患者后期生活质量提高,证实该方案适合患者。结论采用循证医学的方法为确诊的恶性胸膜间皮瘤患者制定最佳治疗方案可有效提高治疗效果。

Evidence-based treatment for a case of malignant pleural mesothelioma

Objective To formulate the premium plan of evidence-based treatment for a patient with malignant pleural mesothelioma.Methods Based on an adequate assessment of the patient’s condition,the clinical problems were proposed and converted into the form for searching according to the principle of PICO.The problems were searched from the national College of Chest Physicians Association’s website,Cochrane Library (2009,No.1),PubMed (1966-2009,No.1),Chinese Science and Technology Academic Journal (CSJD 1989-2009,No.1) and EMbase (1974-2009,No.1).Results Twenty randomized controlled trials,9 systematic evaluation/meta-analysis,and one health economic evaluation were obtained.Based on the reference and the patient’s clinical condition and preference,2 cycles of raltitrexed plus cisplatin were given to the patient along with pain and other symptomatic treatment.Improved quality of life in patients was achieved,indicating that the program was suitable for the patients.Conclusion Evidence-based approaches help us work out the most appropriate chemotherapy plan for the patient,and thus improve the therapeutic effects.