戴啟明醫(yī)師(完整版)
【正文】 法之應(yīng)用 邱文達(dá) ,陳杰峰 2020) EBM worksheet 1. Clinical scenario 2. Background knowledge 3. Question by PICO 4. Search strategy 5. Search oute 6. Citations 7. Evidence appraisal 8. Conclusion 9. Plainlanguage explanation Step A Step B Step C Step D 建構(gòu)完整的臨床問(wèn)題 ? 詢問(wèn)與臨床決策或行動(dòng)有關(guān)的特殊知識(shí) ? 包含四個(gè)必要成分 : ?病人和 /或問(wèn)題 (Patient) ?介入 (或暴露 ) (Intervention) ?比較，如果有關(guān)的話 (Comparison) ?臨床結(jié)果，如果有關(guān)的話應(yīng)包括時(shí)間 (Oute) PICO (實(shí)證醫(yī)學(xué) : 臨床實(shí)踐與教學(xué)指引 Sharon E. Straus等原作 陳杰峰 ,王慈蜂編譯 2020 ) 1. Clinical scenario 王先生， 45歲男性，從昨天開(kāi)始解黑便，胃鏡檢查發(fā)現(xiàn)胃部有一個(gè)潰瘍且已有血塊覆蓋，內(nèi)視鏡治療只能注射 diluted epinephrine，故建議氫離子阻斷劑(PPI)治療，但是要用多少劑量 ? 1支 ,2支 ,5支 …… 特徵 再出血率 Forrest I Active bleeding Ia Active pulsation 90% Ib Active oozing 30% Forrest II Bleeding stigmata IIa Visible vessel 50% IIb Clot 20% IIc Black base 5% Forrest III No bleeding signs Clear ulcer base 5% knowledge Role of acid in haemostasis ?Impairs clot formation – Impairs platelet aggregation and causes disaggregation ?Accelerates clot lysis Predominantly acidstimulated pepsin ?May impair integrity of mucus/bicarbonate barrier =胃內(nèi) PH重要 !! pH Matters ? Intragastric pH3: Correlated with DU healing1 ? Intragastric pH4: Correlated with healing of gastric ulcer2 amp。 50:118593 Median pH profiles in eight healthy subjects after receiving an intravenous infusion of 80 mg of pantoprazole
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