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实施循证医学(evidence-based medicine,EBM)意味着医生需要综合考虑最佳临床研究证据、医生的临床经验和患者的意见进行临床决策。本文针对心血管疾病临床实践中临床决策的EBM框架进行了探讨。认为获得最佳证据,需要对不同来源的证据进行科学的评估和解读。EBM对心血管疾病诊疗领域产生了深远的影响,肯定了某些备受争议干预措施的疗效,而一些曾经认为有效的药物因被证明患者无获益而退出临床应用。我国心血管病的科学证据资源不足,影响到循证实践的能力。建议开展更高质量的随机临床试验,以支持有效的循证医学临床实践。
The implementation of evidence-based medicine (EBM) means that doctors need to make clinical decisions that take into account the best evidence of clinical research, the physician’s clinical experience and the opinions of the patients. This article explores the EBM framework for clinical decision making in clinical practice of cardiovascular disease. To think that the best evidence is obtained requires a scientific assessment and interpretation of the evidence from different sources. EBM has had a profound impact on the field of cardiovascular disease clinics, confirming the efficacy of some of the most controversial interventions, and some once considered efficacious drugs to be withdrawn for clinical use because of proven benefits to patients. The scientific evidence of cardiovascular disease in our country is insufficient, affecting the ability of evidence-based practice. It is recommended to conduct higher quality randomized clinical trials to support effective evidence-based medicine clinical practice.