浅谈循证医学在不典型心肌梗塞的特点与认识中的应用

当前，广大临床医生在学术界中最关注和研讨的热门话题是循讧医学《evidence-based．medicine，EBM》。长期以来，医生往往根据经验、直觉、推论或零散的、非系统的研究结果或替代指标等来处理病人。判断一种疗法是否有效往往更重视实验室及其他辅助检查的结果，而对死亡、致残、日常生活能力、生活质量及病人满意度等病人更有意义的长期临床预后指标却重视不够。重理论和机理而轻临床最终结局，重短期效果而轻远期是否利大于害，把属于假说阶段的尚未被可靠临床研究证实的结果当成最后结论予以推广等是临床治疗实践中常见的现象。80年代以来，许多实验结果发现，一些理论上应该有效的治疗方法实际上无效或害大于利；另一些似乎无效的治疗方法却被证实利大于害，应该推广。因此，只有理论是不够的，理论还需实践来检验。对疗效的评价应更加重视与临床有关的终点指标。直觉、经验和病理的推论并不总是可靠的，临床研究结果是处理病人更为可靠的证据，因此，医务人员必须将个人的临床专业知识和临床经验与现在的最佳临床研究结果和患者的选择相结合，为患者制定最佳的医疗决策，这就是循证医学的核心思想。

Discussed shallowly follows the card medicine in the atypical myocardial infarction characteristic and the understanding application

Presently,general clinicians most pay attention to and the deliberation hot topic of discussion in the academic circles are follow the card medicine evidence--based, medicine, EBM＂. Since long ago, doctor often according to the experience, the intuition, the deduction or scattered, the non--system findings or the substitution target and so on processes the patient. Judges one ther apy whether effective often takes the result which the laboratory and other assistances inspect, but to the death, cripples, patients and so on daily life ability,quality of life and patient degree of satisfaction has the significance long term clinical prognosis target to take actually insufficiently. But but heavy theory and mechanism light clinical final result, heavy short-- term effect light forward whether benefits is bigger than the evil, belongs the hypothesis stage not yet to regard as by the reliable clinical research confirma- tion result the final conclusion to promote and so on is in the clinical treatment practice the common phenomenon. Since the 80＇s, many experimental results discovered that, some theoretically should the effective method of treatment in fact invalid or the evil is bigger than the advantage;Some as if invalid method of treatment actually is proven the practical value to be bigger than in addition the evil, should promote. Therefore, only then the theory is insufficient, the theory also must practice examines. The appraisal should even more take to the curative effect with the clinical related end point target. Intuition, experience and pathology deduction not always reliable,the clinical findings process a patient more reliable evidence, therefore, the medical personnel must unifies individual clinical specialized knowledge and the clinical experience and the present best clinical findings and patient＇s choice, formulates the best medical decision--making for the patient,this is follows the card medicine the core thought.