循证医学与经验医学的关系
虽然我们提倡循证医学,但它还不能完全取代经验医学,亦不能忽视临床技能的学习和临床资料的积累。例如我国的中医学多来自理性思维和前人实践经验积累,有的尚缺乏现代医学理论支持。但中医学内容博大精深,历经数千年仍长盛不衰,为中华民族的繁衍生息作出重大贡献,并已面向世界。显然,仅有十几年发展史的循证医学是无法与之相比的。循证医学与经验医学应相互依存、互为补充,EBM应以医生的个人技能和经验为基础,将临床经验与科学依据结合起来。另外,生命科学极其复杂,特别是外科疾病千变万化,企图通过归纳与统计达到一般并非易事,我们不能完全机械地用其他自然科学的标准要求医学。而且任何事物都不可能是十全十美的,EBM的结论不可避免地也可能具有某些局限性,不加分析地盲目接受显然是不妥的。临床医生在应用EBM所获得的信息和结论时,要考虑到病人的特殊情况,应注意事物的普遍性与特殊性之间的辩证关系。人类社会已进入21世纪,让我们沿着正确的方向,为医学更大的发展而加倍努力!
(杨 镇)
参考文献
[1]Kreder HJ.Evidence-based surgical practice:what is it and do we need it?World J Surg,1999,23(12):1232.
[2]Cochrane协作网网上资料,Why the Cochrane Collaboration.1999,11:28.
[3]张鸣明,李幼平.循证医学简史.中华医史杂志,2002,32(4):230-233.
[4]Mcleod RS.Issues in surgical randomized controlled trials.World J Surg,1999,23(12):1210.
[5]Kestle JRW.Clinical trials.World J Surg,1999,23(12):1205.
[6]杨镇.我国实验外科应加强外科临床试验研究.中华实验外科杂志,2001,18(2):103-104.
[7]李强,郑小莉.如何正确开展临床诊断性研究.循证医学,2002,2(3):184-188.
[8]王家良.临床流行病学.上海:上海科学技术出版社,2001:221-223.
[9] 刘金来,周汉建,赵长林.临床治疗性研究的循证医学评价.循证医学,2002,2(3):177-183.
[10]Etchells E.Informed consent in surgical trials.World J Surg,1999,23(12):1215.
[11]Brouwers MC,Browman GP.Development of clinical practice guidelines:surgical perspective.World Jsurg,1999:23(12):1236.
[12]Glass GV.Primary,secondary and Meta-analysis of research.Edue.Res,1976,5:3-8.
[13]Baum ML,Anish DS,Chalmers TC,et al。A survey of clinical trials of antibiotic prophylaxis in colon surgery:evidence against further use of no-treatment controls。New Engl J Med,1981,305:795-799.
[14]Lau J,Schmid CH,Chalmers TC.Cumulative Meta-analysis of clinical trials builds evidence for exemplary medical care.J Clin Epidemiol,1995,48:45-57.
[15]姒无翼,龚纯.医史学.武汉:湖北人民出版社,1988:30.
[16]王家良.临床流行病学.上海:上海科学技术出版社,2001:286.
[17]中华医学会临床流行病学学会.全国临床科研设计专题研讨会纪要.中华医学杂志,1999,79(2):89.
[18]刘金来,赵长林.疾病预后研究的循证医学评价.循证医学,2002,2(2):108-111.
[19]杨镇.循证医学和循证外科.中国实用外科杂志,2001,1(21):1.
[20]Villeneuve JP,Pomier-Layvargues G,Duguay L,et al.Emergency portacaval shunt for variceal hemorrhage.Ann Surg,1987,206:48.
[21]Brenneman FD,Wright JG,Kennedy ED,et al.Outcomes research in surgery.World J Surg,1999,23 (12):1220.
[22]王家良.临床流行病学.上海:上海科学技术出版社,2001:359.
[23]Wright JG.Outcomes research:What to measure.World J Surg,1999,23(12):1224.
[24]杨朋,吴一龙,谷力加.评估肺癌患者生活质量的方法学,循证医学,2002,2(2):105-107.
[25]WHO The development of the WHO quality of life assessment instrument.Geneva:WHO,1993.
[26]Cella DF,Tulsky DS,Quality of life in cancer:Definition,purpose and method of measurement.Cancer Invest,1993,11:327-336.
[27]杨镇,张彤,孙政,等.门静脉高压症治疗效果的荟萃分析,第二届中国消化外科会议论文集,2002:68.
[28]王家良.临床流行病学.上海:上海科学技术出版社,2001:297.
[29]Krahn M.Principles of economic evaluation in surgery.World J Surg,1999,23:1242.
[30]Drummond M,O'Brien B,Stoddart G,et al.Methods for the economic evaluation of health care programmes.Oxford,Oxford University Press,1997.
[31]Gralnk IM,Jensen DM,Kovacs TOG,et al.The economic impact of esophageal variceal hemorrhage:cost/effectiveness implications of endoscopic therapy.Hepatology,1999,29(1):44.