霍勇教授访谈——介入治疗准入制度及规范化管理任重而道远

发布于:2009-12-07 15:28

医心：霍主任您好，此次敦煌心血管病论坛上您的讲课内容为“中国心血管介入治疗准入制度及规范化管理”，您能谈谈该准入制度及规范化管理对于我国介入医生来说有哪些益处？该准入制度对于甘肃省的介入医生来说又有哪些特殊的意义？

霍勇教授：我们国家心血管介入诊疗规范化的工作启动于2003年，正式开始于2007年，卫生部公布了222号文件——《心血管疾病介入诊疗技术管理规范》，正是这个文件的颁布，全国各个地区都开展了心血管介入诊疗的规范化管理的工作。应当说我们国家无论是心血管介入诊疗的发展还是规范化工作的开展，都具有地区的不平衡性。在西北地区，可能这些工作总体上慢于内地的一些省份。在甘肃省，尽管从医生或者医院层面上也做了大量的工作，但是与行政管理部门还存在衔接问题。所以，以目前看来甘肃省心血管介入诊疗最基本的医疗机构和医生的准入到目前为止都没有完全开展，所以从这个角度来说还需要做一些工作。但是现在看来我们总体只要是按照卫生部的安排，应当说今年年底完成心血管介入诊疗第一步资质的准入应当是没有问题的，全国都要完成，我相信甘肃省也没有问题。但是在此次会议上介绍“中国心血管介入治疗准入制度及规范化管理”，总体来说对于甘肃省的心血管介入治疗的发展乃至对全国的发展都有意义。甘肃省现在正是处于心血管介入诊疗发展比较快的一个时期，医院开展的例数越来越多，医院从事这项工作的医生也越来越多，从这个层面上很好地进行规范化管理，对于该专业长久健康的发展有着重要的意义。

医心：目前这一制度已经颁布，相关工作的进展如何？对于如何能够让全国的介入医生严格地遵照制度的规定进行操作，您有哪些好的建议？卫生部对违反规定进行操作的医生将采取哪些惩罚措施呢？

霍勇教授：目前看来，按照卫生部心血管介入诊疗规范化管理的安排，全国已经逐渐在建立三项规范化的制度：一个是认证制度，对于医疗机构和人员进行资质认证；第二个是培训制度，对于要进入这个行业、从事这个行业的人员进行正规的规范化的培训；第三个是质量控制和指标监控的一个质控制度。这三个制度的建立显然为我们国家心血管介入诊疗规范化的总体工作构成了一个很好的框架，应当说到目前为止全世界没有任何一个国家能够像中国这样从国家层面上做到规范化管理。我相信卫生部和卫生部医政司，对于这些工作的开展是很积极认真很严肃的，实际上对于这三项制度的建立和以后工作的开展都有一个详细的计划，当然这个工作不可能一蹴而就。对于心血管介入而言又是一个相对专业性很强的行业，对于卫生部来说有些工作还是要慎重地、逐渐地推进。当然，要有严格的奖惩制度，做得好的要奖励，做得不好的要进行一定的惩戒或者处罚。但是到目前为止，我相信由于中国地域发展的不平衡，各个省的这种情况都有，因此，我们应当逐渐的把工作稳步的推展开。但是不是没有底线，实际上从现在来看要求各个省今年年底要完成所有的心血管介入诊疗准入的工作，明年的上半年重点要完成质量控制的工作，明年下半年重点完成第一期心血管介入诊疗培训基地的培训工作。这三步的安排为我们近期完善这个工作提供了重要的部署。

医心：随着药物洗脱支架的不断发展，广泛应用于冠心病患者，但是很多患者同时还合并糖尿病，因此，药物洗脱支架在糖尿病患者中应用的安全性成了大家讨论的热点问题，近期雅培公司的XIENCE PRIMETM和XIENCE V®获得欧盟的批准可以用于糖尿病患者，您是如何评价药物洗脱支架对于糖尿病患者的安全性问题？

霍勇教授：实际上对糖尿病患者无论任何一种介入的治疗方法比起那些没有糖尿病的患者它的效果都是差的，到目前为止无论是金属裸支架、药物洗脱支架，其对糖尿病的效果显然劣于没有糖尿病的患者，这和疾病本身是有关系的。但是，糖尿病患者不治疗预后更差，在药物洗脱支架这个层面上，许多的药物洗脱支架尽管与金属裸支架相比在非糖尿病的一些病变中显示很显著的优越性，但是一旦在糖尿病的患者中，它的优势就显著地减少或者说它的优势就不太明显。当然这里我认为更重要的是我们从总体来说，药物洗脱支架无论对有糖尿病还是没有糖尿病的患者都是适合的，总体的事件率是降低的，但只是糖尿病的患者获益相对小。鉴于这种情况的产生，应当说我们对糖尿病本身、对于糖尿病血管病变的这种认识可能还有值得探讨的地方。对于糖尿病的患者如何选择更适合的药物洗脱支架可能还是一个值得探讨的问题。XIENCE V®依维莫司洗脱支架的推出也同样反映这个问题，就是说它本身对于糖尿病的治疗效果也还是好的，只是于SPIRIT Ⅲ和SPIRIT Ⅳ这两项研究里面都能看出来对于糖尿病患者它和紫杉醇涂层的TAXUS支架相比得益差别不大。但这个事情要从两方面看，一方面是XIENCE V®包括所有的药物洗脱支架对于糖尿病的效果是比较差的，就像我刚才已经提到的。但是另一方面，在以往的研究中，我们不难发现TAXUS支架在糖尿病的患者中比起其他支架比如CYPHER支架，还是有自己的优势。在这两个研究中，XIENCE V®和TAXUS相比在糖尿病患者中差别不大，提示XIENCE V®支架在糖尿病患者中比起其它支架如CYPHER支架，也可能有其一定优势。但是对糖尿病的患者到底怎么治疗，尤其是牵扯到应用药物洗脱支架的时候哪种药物洗脱支架更为有效安全，这确实是值得进一步研究的问题。

来源：医心网

上一篇：围手术期抗凝和抗血小板治疗的桥接

下一篇：黄从新教授专访

相关文章:

评论列表：（评论 6233 ）以下网友评论只代表网友个人观点，不代表本站观点。

2011-04-12 08:23:09 by: 匿名用户

comment5, <a href="http://histip.vugg.net/reter/rjasr.html">Optic neuritis in new york</a>, [url="http://histip.vugg.net/reter/rjasr.html"]Optic neuritis in new york[/url], http://histip.vugg.net/reter/rjasr.html Optic neuritis in new york, 2168, <a href="http://amrefq.vugg.net/bangquar/dpafs.html">Hutchinson first presbyterian church kansas</a>, [url="http://amrefq.vugg.net/bangquar/dpafs.html"]Hutchinson first presbyterian church kansas[/url], http://amrefq.vugg.net/bangquar/dpafs.html Hutchinson first presbyterian church kansas, oznr, <a href="http://tatuac.cx.cc/al.html">Denton county texas tax roll</a>, [url="http://tatuac.cx.cc/al.html"]Denton county texas tax roll[/url], http://tatuac.cx.cc/al.html Denton county texas tax roll, >:-[[[, <a href="http://tatuac.rewtyf.nom.vg/tl.html">Summit fire protection iowa</a>, [url="http://tatuac.rewtyf.nom.vg/tl.html"]Summit fire protection iowa[/url], http://tatuac.rewtyf.nom.vg/tl.html Summit fire protection iowa, >:]], <a href="http://morlit.cx.cc/lz.html">Attornys against fraud cleveland ohio</a>, [url="http://morlit.cx.cc/lz.html"]Attornys against fraud cleveland ohio[/url], http://morlit.cx.cc/lz.html Attornys against fraud cleveland ohio, frat, <a href="http://abmor.vugg.net/pressat/psece.html">California surf boards and wet suits</a>, [url="http://abmor.vugg.net/pressat/psece.html"]California surf boards and wet suits[/url], http://abmor.vugg.net/pressat/psece.html California surf boards and wet suits, dkmzwc, <a href="http://erenx.rewtyf.nom.vg/pu.html">Heather dale chase henrietta new york</a>, [url="http://erenx.rewtyf.nom.vg/pu.html"]Heather dale chase henrietta new york[/url], http://erenx.rewtyf.nom.vg/pu.html Heather dale chase henrietta new york, %-)), <a href="http://acoxx.vugg.net/napptug/cgscg.html">Summer emt 2007 northwest indiana il</a>, [url="http://acoxx.vugg.net/napptug/cgscg.html"]Summer emt 2007 northwest indiana il[/url], http://acoxx.vugg.net/napptug/cgscg.html Summer emt 2007 northwest indiana il, :[[[, <a href="http://backvonz.vugg.net/heyplod/lggpi.html">Poisonous plants in hawaii</a>, [url="http://backvonz.vugg.net/heyplod/lggpi.html"]Poisonous plants in hawaii[/url], http://backvonz.vugg.net/heyplod/lggpi.html Poisonous plants in hawaii, gabc, <a href="http://indet.cx.cc/iy.html">Rental housing in fredericksburg virginia</a>, [url="http://indet.cx.cc/iy.html"]Rental housing in fredericksburg virginia[/url], http://indet.cx.cc/iy.html Rental housing in fredericksburg virginia, 947, <a href="http://linkderwg.cx.cc/fv.html">Iowa state diagnostic veterinary</a>, [url="http://linkderwg.cx.cc/fv.html"]Iowa state diagnostic veterinary[/url], http://linkderwg.cx.cc/fv.html Iowa state diagnostic veterinary, nryzc, <a href="http://cruseask.vugg.net/spirgast/nmphc.html">J j jeffries portland maine</a>, [url="http://cruseask.vugg.net/spirgast/nmphc.html"]J j jeffries portland maine[/url], http://cruseask.vugg.net/spirgast/nmphc.html J j jeffries portland maine, %-DDD, <a href="http://corits.vugg.net/chafin/mbkcl.html">Central maine pre-release and contact information</a>, [url="http://corits.vugg.net/chafin/mbkcl.html"]Central maine pre-release and contact information[/url], http://corits.vugg.net/chafin/mbkcl.html Central maine pre-release and contact information, =OO, <a href="http://toversp.rewtyf.nom.vg/vt.html">Gary sellers shaker heights ohio marine</a>, [url="http://toversp.rewtyf.nom.vg/vt.html"]Gary sellers shaker heights ohio marine[/url], http://toversp.rewtyf.nom.vg/vt.html Gary sellers shaker heights ohio marine, =-[, <a href="http://brisgogb.vugg.net/enel/runzk.html">Jewish bakery new york</a>, [url="http://brisgogb.vugg.net/enel/runzk.html"]Jewish bakery new york[/url], http://brisgogb.vugg.net/enel/runzk.html Jewish bakery new york, =-(((, <a href="http://plasdec.vugg.net/cutsound/wfcfy.html">Bathtub door outlet in atlanta georgia</a>, [url="http://plasdec.vugg.net/cutsound/wfcfy.html"]Bathtub door outlet in atlanta georgia[/url], http://plasdec.vugg.net/cutsound/wfcfy.html Bathtub door outlet in atlanta georgia, 583292, <a href="http://rewtyf.nom.vg/tu.html">Hollywood video rentals brownsville texas</a>, [url="http://rewtyf.nom.vg/tu.html"]Hollywood video rentals brownsville texas[/url], http://rewtyf.nom.vg/tu.html Hollywood video rentals brownsville texas, pwoet,

2011-04-12 10:11:29 by: 匿名用户

comment5, <a href="http://tatuac.rewtyf.nom.vg/rn.html">State of ohio department insurance commission</a>, [url="http://tatuac.rewtyf.nom.vg/rn.html"]State of ohio department insurance commission[/url], http://tatuac.rewtyf.nom.vg/rn.html State of ohio department insurance commission, 8((, <a href="http://linkderwg.cx.cc/fq.html">Murray county georgia animal control</a>, [url="http://linkderwg.cx.cc/fq.html"]Murray county georgia animal control[/url], http://linkderwg.cx.cc/fq.html Murray county georgia animal control, qylo, <a href="http://giomax.vugg.net/clasligh/koawo.html">Figure skating instruction connecticut</a>, [url="http://giomax.vugg.net/clasligh/koawo.html"]Figure skating instruction connecticut[/url], http://giomax.vugg.net/clasligh/koawo.html Figure skating instruction connecticut, 573, <a href="http://tatuac.rewtyf.nom.vg/qf.html">Gorham maine southern university</a>, [url="http://tatuac.rewtyf.nom.vg/qf.html"]Gorham maine southern university[/url], http://tatuac.rewtyf.nom.vg/qf.html Gorham maine southern university, 4308, <a href="http://erenx.cx.cc/wm.html">Previous mr indiana bodybuilding contest winners</a>, [url="http://erenx.cx.cc/wm.html"]Previous mr indiana bodybuilding contest winners[/url], http://erenx.cx.cc/wm.html Previous mr indiana bodybuilding contest winners, hjq, <a href="http://liagrapg.vugg.net/abro/tgaqg.html">St ignatius 3-day retreats california</a>, [url="http://liagrapg.vugg.net/abro/tgaqg.html"]St ignatius 3-day retreats california[/url], http://liagrapg.vugg.net/abro/tgaqg.html St ignatius 3-day retreats california, zftjp, <a href="http://backvonz.vugg.net/cirpratil/cgcoe.html">Silverton oregon evans valley</a>, [url="http://backvonz.vugg.net/cirpratil/cgcoe.html"]Silverton oregon evans valley[/url], http://backvonz.vugg.net/cirpratil/cgcoe.html Silverton oregon evans valley, pnoy, <a href="http://erenx.cx.cc/aa.html">Massachusetts real estate register</a>, [url="http://erenx.cx.cc/aa.html"]Massachusetts real estate register[/url], http://erenx.cx.cc/aa.html Massachusetts real estate register, 8-))),

2011-04-12 10:11:32 by: 匿名用户

comment1, <a href="http://plasdec.vugg.net/smithca/yjnyj.html">22 e 35th st new york</a>, [url="http://plasdec.vugg.net/smithca/yjnyj.html"]22 e 35th st new york[/url], http://plasdec.vugg.net/smithca/yjnyj.html 22 e 35th st new york, :O, <a href="http://sattid.cx.cc/tr.html">Lovell town office maine</a>, [url="http://sattid.cx.cc/tr.html"]Lovell town office maine[/url], http://sattid.cx.cc/tr.html Lovell town office maine, dvdlj, <a href="http://tatuac.rewtyf.nom.vg/qr.html">How to start a kennel iowa</a>, [url="http://tatuac.rewtyf.nom.vg/qr.html"]How to start a kennel iowa[/url], http://tatuac.rewtyf.nom.vg/qr.html How to start a kennel iowa, 86944, <a href="http://corits.vugg.net/olour/xqzki.html">Mitch cole chandler arizona</a>, [url="http://corits.vugg.net/olour/xqzki.html"]Mitch cole chandler arizona[/url], http://corits.vugg.net/olour/xqzki.html Mitch cole chandler arizona, 7072, <a href="http://giomax.vugg.net/risding/odquz.html">2300 carlson northbrook illinois</a>, [url="http://giomax.vugg.net/risding/odquz.html"]2300 carlson northbrook illinois[/url], http://giomax.vugg.net/risding/odquz.html 2300 carlson northbrook illinois, ugqxc, <a href="http://indet.cx.cc/hp.html">Home heating oil help in massachusetts</a>, [url="http://indet.cx.cc/hp.html"]Home heating oil help in massachusetts[/url], http://indet.cx.cc/hp.html Home heating oil help in massachusetts, =-))), <a href="http://toversp.rewtyf.nom.vg/rv.html">Wisconsin senior care programs</a>, [url="http://toversp.rewtyf.nom.vg/rv.html"]Wisconsin senior care programs[/url], http://toversp.rewtyf.nom.vg/rv.html Wisconsin senior care programs, %-)), <a href="http://backvonz.vugg.net/cirpratil/">.</a>, [url="http://backvonz.vugg.net/cirpratil/"].[/url], http://backvonz.vugg.net/cirpratil/ ., gsde, <a href="http://linkderwg.cx.cc/xh.html">Search and the ohio revised code</a>, [url="http://linkderwg.cx.cc/xh.html"]Search and the ohio revised code[/url], http://linkderwg.cx.cc/xh.html Search and the ohio revised code, 3271, <a href="http://plasdec.vugg.net/adprak/fkiyq.html">Meagan johnson overland park kansas</a>, [url="http://plasdec.vugg.net/adprak/fkiyq.html"]Meagan johnson overland park kansas[/url], http://plasdec.vugg.net/adprak/fkiyq.html Meagan johnson overland park kansas, 999037, <a href="http://maysenp.cx.cc/ik.html">California penal code regarding broken glass</a>, [url="http://maysenp.cx.cc/ik.html"]California penal code regarding broken glass[/url], http://maysenp.cx.cc/ik.html California penal code regarding broken glass, ntzcl, <a href="http://erenx.rewtyf.nom.vg/vz.html">Adjutant general new mexico</a>, [url="http://erenx.rewtyf.nom.vg/vz.html"]Adjutant general new mexico[/url], http://erenx.rewtyf.nom.vg/vz.html Adjutant general new mexico, 494490, <a href="http://toversp.rewtyf.nom.vg/xi.html">Oklahoma city macom radio</a>, [url="http://toversp.rewtyf.nom.vg/xi.html"]Oklahoma city macom radio[/url], http://toversp.rewtyf.nom.vg/xi.html Oklahoma city macom radio, rocqc, <a href="http://unrenj.vugg.net/arim/zboqu.html">Learn spanish language in colleyville texas</a>, [url="http://unrenj.vugg.net/arim/zboqu.html"]Learn spanish language in colleyville texas[/url], http://unrenj.vugg.net/arim/zboqu.html Learn spanish language in colleyville texas, 7856, <a href="http://tencet.rewtyf.nom.vg/sd.html">Urban institute gay population ohio</a>, [url="http://tencet.rewtyf.nom.vg/sd.html"]Urban institute gay population ohio[/url], http://tencet.rewtyf.nom.vg/sd.html Urban institute gay population ohio, 99204, <a href="http://plasdec.vugg.net/riobar/rbqmn.html">Teachers credit union idaho falls</a>, [url="http://plasdec.vugg.net/riobar/rbqmn.html"]Teachers credit union idaho falls[/url], http://plasdec.vugg.net/riobar/rbqmn.html Teachers credit union idaho falls, inrmsa, <a href="http://cruseask.vugg.net/protnews/bnsjp.html">Michigan proud equestrians program</a>, [url="http://cruseask.vugg.net/protnews/bnsjp.html"]Michigan proud equestrians program[/url], http://cruseask.vugg.net/protnews/bnsjp.html Michigan proud equestrians program, 201, <a href="http://sialisg.vugg.net/keyman/gyfmt.html">Florida fsbo home mobile</a>, [url="http://sialisg.vugg.net/keyman/gyfmt.html"]Florida fsbo home mobile[/url], http://sialisg.vugg.net/keyman/gyfmt.html Florida fsbo home mobile, 0453, <a href="http://brisgogb.vugg.net/nimem/fgtyh.html">Deadwood south dakota buffet</a>, [url="http://brisgogb.vugg.net/nimem/fgtyh.html"]Deadwood south dakota buffet[/url], http://brisgogb.vugg.net/nimem/fgtyh.html Deadwood south dakota buffet, ttqmv,

2011-04-12 10:11:38 by: 匿名用户

comment6, <a href="http://plasdec.vugg.net/miccess/mhjtt.html">Farmtrac tractors dealers georgia</a>, [url="http://plasdec.vugg.net/miccess/mhjtt.html"]Farmtrac tractors dealers georgia[/url], http://plasdec.vugg.net/miccess/mhjtt.html Farmtrac tractors dealers georgia, 370, <a href="http://maysenp.cx.cc/sd.html">West virginia occupancy tax exemption</a>, [url="http://maysenp.cx.cc/sd.html"]West virginia occupancy tax exemption[/url], http://maysenp.cx.cc/sd.html West virginia occupancy tax exemption, gvmuk, <a href="http://erenx.rewtyf.nom.vg/pc.html">Loveland colorado piano lesson</a>, [url="http://erenx.rewtyf.nom.vg/pc.html"]Loveland colorado piano lesson[/url], http://erenx.rewtyf.nom.vg/pc.html Loveland colorado piano lesson, >:-]]], <a href="http://indet.cx.cc/vo.html">Orchard beach bronx new york</a>, [url="http://indet.cx.cc/vo.html"]Orchard beach bronx new york[/url], http://indet.cx.cc/vo.html Orchard beach bronx new york, 086744, <a href="http://linkderwg.cx.cc/dk.html">Diet food delivered hillsboro oregon</a>, [url="http://linkderwg.cx.cc/dk.html"]Diet food delivered hillsboro oregon[/url], http://linkderwg.cx.cc/dk.html Diet food delivered hillsboro oregon, %)), <a href="http://saismolw.vugg.net/kurna/okbvh.html">Syracuse indiana mail jounrnal</a>, [url="http://saismolw.vugg.net/kurna/okbvh.html"]Syracuse indiana mail jounrnal[/url], http://saismolw.vugg.net/kurna/okbvh.html Syracuse indiana mail jounrnal, :-], <a href="http://morlit.cx.cc/gv.html">Huber heights ohio county</a>, [url="http://morlit.cx.cc/gv.html"]Huber heights ohio county[/url], http://morlit.cx.cc/gv.html Huber heights ohio county, rifrc, <a href="http://toversp.cx.cc/sa.html">St patrick days parade madison wisconsin</a>, [url="http://toversp.cx.cc/sa.html"]St patrick days parade madison wisconsin[/url], http://toversp.cx.cc/sa.html St patrick days parade madison wisconsin, dsw, <a href="http://brisgogb.vugg.net/northwarc/nhktp.html">Lawyer new jersey craig dana</a>, [url="http://brisgogb.vugg.net/northwarc/nhktp.html"]Lawyer new jersey craig dana[/url], http://brisgogb.vugg.net/northwarc/nhktp.html Lawyer new jersey craig dana, zwf, <a href="http://saismolw.vugg.net/wouldten/xbmyy.html">Easement joint tenant undivided interest texas</a>, [url="http://saismolw.vugg.net/wouldten/xbmyy.html"]Easement joint tenant undivided interest texas[/url], http://saismolw.vugg.net/wouldten/xbmyy.html Easement joint tenant undivided interest texas, clzv, <a href="http://backvonz.vugg.net/thercu/sxlno.html">Illinois penny saver ads</a>, [url="http://backvonz.vugg.net/thercu/sxlno.html"]Illinois penny saver ads[/url], http://backvonz.vugg.net/thercu/sxlno.html Illinois penny saver ads, 8963,

2011-04-12 10:11:44 by: 匿名用户

comment6, <a href="http://igsoz.vugg.net/scaldio/">Who does liver transplants in wisconsin</a>, [url="http://igsoz.vugg.net/scaldio/"]Who does liver transplants in wisconsin[/url], http://igsoz.vugg.net/scaldio/ Who does liver transplants in wisconsin, :-PP, <a href="http://backvonz.vugg.net/bopert/hgsth.html">Movie listing peoria illinois</a>, [url="http://backvonz.vugg.net/bopert/hgsth.html"]Movie listing peoria illinois[/url], http://backvonz.vugg.net/bopert/hgsth.html Movie listing peoria illinois, 91338, <a href="http://rewtyf.nom.vg/kd.html">P-38 coming to columbus ohio</a>, [url="http://rewtyf.nom.vg/kd.html"]P-38 coming to columbus ohio[/url], http://rewtyf.nom.vg/kd.html P-38 coming to columbus ohio, >:-(, <a href="http://saismolw.vugg.net/khapni/">.</a>, [url="http://saismolw.vugg.net/khapni/"].[/url], http://saismolw.vugg.net/khapni/ ., :-)),

<1 160 161 162 163 1247 >