文档介绍：ARDS的治疗与循证医学
复兴医院ICU
ARDS&EBM
1972 Cochran 提出 evidence-based medicine ( EBM ) 1
EBM 的中心思想是-科学知识优于个人经验
1986 Sackett 首次用于抗血栓药推荐意见的临床研究 2
1. Cochran AL (1972) Nuffield Provincial Hospital Trust, London
2. Sackett DL (1986) Chest 89:2s-3s
ARDS&EBM
Sackett 将科学资料分为5级
Level 1: 大样本,随机研究课题,结果清晰; 假阳性或假阴性的错误很低
Level 2: 小样本,随机研究课题,结果不确定;假阳性和/或假阴性的错误较高
Level 3: 非随机,同期(contemporaneous)控制研究
Level 4: 非随机,历史控制和专家意见
Level 5: 病历,非控制研究和专家意见
ARDS&EBM
1997 肺动脉导管共识会( The Pulmonary Artery Catheter Consensus Conference )提出将科研结果分为5级
A: Supported by at least two level 1 investigation
B: Supported by only one level 1 investigation
C: Supported by level 2 investigation only
D: Supported by at least one level 3 investigation
E: Supported by level 4 or level 5 evidence
Crit Care Med 1997 25:910-925
ARDS&EBM
1995 Marin HK 提出了ARDS的证据质量和分级标准( The Quality of the Evidence and the Grading of mendation in ARDS)
Quality of the Evidence
Level 1: randomized, prospective, controlled investigation
Level 2: nonrandomized, concurrent-cohort investigation, historical-cohort investigation, and case series of ARDS
Level 3: randomized, prospective, controlled investigation of sepsis or other relevant conditions with potential application to ARDS
Level 4: case reports of ARDS
ARDS&EBM
Grading of mendation
A: Supported by at least two level 1 investigation
B: Supported by only one level 1 investigation
C: Supported by level 2 investigation only
D: Supported by at least one level 3 investigation
Ungraded: No available clinical investigation
Kollef MH 1995 N Engl J Med 332: 27-37
ARDS&EBM
应用EBM的原则评价ARDS的诊断,发病和治疗发现了很多问题
主要是缺乏前瞻性,随机的,控制的带有清晰的转归结果的研究
病死率
住院或ICU天数
无机械通气天数(ventilator-free days)
ARDS的病理生理
Pathophysiology process of ARDS
ARDS physiopathology