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。

2010-09-28 17:19:19 by: 匿名用户

Going to, <a href="http://awpx.pogh.2y.net/jb.html">Lampost inn ann arbor michigan</a>, [url="http://awpx.pogh.2y.net/jb.html"]Lampost inn ann arbor michigan[/url], http://awpx.pogh.2y.net/jb.html Lampost inn ann arbor michigan, 390929, <a href="http://yniq.dytu.2y.net/">Bastrop county sheriff texas</a>, [url="http://yniq.dytu.2y.net/"]Bastrop county sheriff texas[/url], http://yniq.dytu.2y.net/ Bastrop county sheriff texas, pmrqv, <a href="http://tvdn.trdsd.2y.net/">Optomotrists in weston florida</a>, [url="http://tvdn.trdsd.2y.net/"]Optomotrists in weston florida[/url], http://tvdn.trdsd.2y.net/ Optomotrists in weston florida, 810, <a href="http://kysv.pogh.2y.net/xe.html">Pool supplies peoria illinois</a>, [url="http://kysv.pogh.2y.net/xe.html"]Pool supplies peoria illinois[/url], http://kysv.pogh.2y.net/xe.html Pool supplies peoria illinois, 91593, <a href="http://eveh.rtstr.2y.net/">K-9 training in ohio kayla</a>, [url="http://eveh.rtstr.2y.net/"]K-9 training in ohio kayla[/url], http://eveh.rtstr.2y.net/ K-9 training in ohio kayla, 091986, <a href="http://ebjl.pogh.2y.net/bb.html">Brazilian steakhouses in texas</a>, [url="http://ebjl.pogh.2y.net/bb.html"]Brazilian steakhouses in texas[/url], http://ebjl.pogh.2y.net/bb.html Brazilian steakhouses in texas, 433, <a href="http://necc.rtstr.2y.net/">Worm fiddling festival florida</a>, [url="http://necc.rtstr.2y.net/"]Worm fiddling festival florida[/url], http://necc.rtstr.2y.net/ Worm fiddling festival florida, 752823, <a href="http://gjmo.trdsd.2y.net/">Georgia okeeffe flower paintings</a>, [url="http://gjmo.trdsd.2y.net/"]Georgia okeeffe flower paintings[/url], http://gjmo.trdsd.2y.net/ Georgia okeeffe flower paintings, bupyd, <a href="http://rahg.srths.2y.net/nb.html">Oklahoma department of wildlife conversation</a>, [url="http://rahg.srths.2y.net/nb.html"]Oklahoma department of wildlife conversation[/url], http://rahg.srths.2y.net/nb.html Oklahoma department of wildlife conversation, 153686, <a href="http://wdeh.dytu.2y.net/">Mason city iowa newspaper</a>, [url="http://wdeh.dytu.2y.net/"]Mason city iowa newspaper[/url], http://wdeh.dytu.2y.net/ Mason city iowa newspaper, dxkfl, <a href="http://xmjw.trdsd.2y.net/">Velvet ice cream festival utica ohio</a>, [url="http://xmjw.trdsd.2y.net/"]Velvet ice cream festival utica ohio[/url], http://xmjw.trdsd.2y.net/ Velvet ice cream festival utica ohio, 797, <a href="http://cxhz.pogh.2y.net/">Newton county missouri sexual offender registration</a>, [url="http://cxhz.pogh.2y.net/"]Newton county missouri sexual offender registration[/url], http://cxhz.pogh.2y.net/ Newton county missouri sexual offender registration, 6666, <a href="http://intq.dytu.2y.net/">Volga lake iowa real estate</a>, [url="http://intq.dytu.2y.net/"]Volga lake iowa real estate[/url], http://intq.dytu.2y.net/ Volga lake iowa real estate, 86585, <a href="http://tysh.pogh.2y.net/pa.html">Iris forist oceanside california</a>, [url="http://tysh.pogh.2y.net/pa.html"]Iris forist oceanside california[/url], http://tysh.pogh.2y.net/pa.html Iris forist oceanside california, 656,

2010-09-28 17:19:20 by: 匿名用户

Its nice, <a href="http://vkax.trdsd.2y.net/">Bbb rated southern california moving companies</a>, [url="http://vkax.trdsd.2y.net/"]Bbb rated southern california moving companies[/url], http://vkax.trdsd.2y.net/ Bbb rated southern california moving companies, 22209, <a href="http://thvb.dytu.2y.net/op.html">Used mercedes benz 300 wagon texas</a>, [url="http://thvb.dytu.2y.net/op.html"]Used mercedes benz 300 wagon texas[/url], http://thvb.dytu.2y.net/op.html Used mercedes benz 300 wagon texas, >:-))), <a href="http://bitz.srths.2y.net/">Pagosa springs colorado building department</a>, [url="http://bitz.srths.2y.net/"]Pagosa springs colorado building department[/url], http://bitz.srths.2y.net/ Pagosa springs colorado building department, 632, <a href="http://wsxk.srths.2y.net/uf.html">Bluecross blueshield of southeast michigan employment</a>, [url="http://wsxk.srths.2y.net/uf.html"]Bluecross blueshield of southeast michigan employment[/url], http://wsxk.srths.2y.net/uf.html Bluecross blueshield of southeast michigan employment, zcb, <a href="http://eokg.rtstr.2y.net/qg.html">Alabama conceal carry firearm permits</a>, [url="http://eokg.rtstr.2y.net/qg.html"]Alabama conceal carry firearm permits[/url], http://eokg.rtstr.2y.net/qg.html Alabama conceal carry firearm permits, wudge, <a href="http://wytf.trdsd.2y.net/">Bullwhip toy indiana jones</a>, [url="http://wytf.trdsd.2y.net/"]Bullwhip toy indiana jones[/url], http://wytf.trdsd.2y.net/ Bullwhip toy indiana jones, =-DDD, <a href="http://gejh.dytu.2y.net/oq.html">Shingle roof repair connecticut</a>, [url="http://gejh.dytu.2y.net/oq.html"]Shingle roof repair connecticut[/url], http://gejh.dytu.2y.net/oq.html Shingle roof repair connecticut, :), <a href="http://toys.rtstr.2y.net/sb.html">Swingers sex in picayune mississippi</a>, [url="http://toys.rtstr.2y.net/sb.html"]Swingers sex in picayune mississippi[/url], http://toys.rtstr.2y.net/sb.html Swingers sex in picayune mississippi, 119627, <a href="http://ldgw.rtstr.2y.net/">Rogers county oklahoma population migration patterns</a>, [url="http://ldgw.rtstr.2y.net/"]Rogers county oklahoma population migration patterns[/url], http://ldgw.rtstr.2y.net/ Rogers county oklahoma population migration patterns, jvayb, <a href="http://gyhy.rtstr.2y.net/">Daewoo automobile service billings montana</a>, [url="http://gyhy.rtstr.2y.net/"]Daewoo automobile service billings montana[/url], http://gyhy.rtstr.2y.net/ Daewoo automobile service billings montana, kad, <a href="http://nxve.trdsd.2y.net/cu.html">Iowa hermit of the hills</a>, [url="http://nxve.trdsd.2y.net/cu.html"]Iowa hermit of the hills[/url], http://nxve.trdsd.2y.net/cu.html Iowa hermit of the hills, 095,

2010-09-28 17:50:05 by: 匿名用户

Fast site, <a href="http://yact.trdsd.2y.net/">Cosmic bikes flagstaff arizona</a>, [url="http://yact.trdsd.2y.net/"]Cosmic bikes flagstaff arizona[/url], http://yact.trdsd.2y.net/ Cosmic bikes flagstaff arizona, =))), <a href="http://djmp.trdsd.2y.net/eg.html">New york state trooper diecast car</a>, [url="http://djmp.trdsd.2y.net/eg.html"]New york state trooper diecast car[/url], http://djmp.trdsd.2y.net/eg.html New york state trooper diecast car, efco, <a href="http://qlie.rtstr.2y.net/di.html">Rhode island teenney damage lawyers</a>, [url="http://qlie.rtstr.2y.net/di.html"]Rhode island teenney damage lawyers[/url], http://qlie.rtstr.2y.net/di.html Rhode island teenney damage lawyers, nszgq, <a href="http://myfj.rtstr.2y.net/oq.html">Golf tournaments bodega california</a>, [url="http://myfj.rtstr.2y.net/oq.html"]Golf tournaments bodega california[/url], http://myfj.rtstr.2y.net/oq.html Golf tournaments bodega california, 6759, <a href="http://yslk.pogh.2y.net/">Illinois state fair butter cow</a>, [url="http://yslk.pogh.2y.net/"]Illinois state fair butter cow[/url], http://yslk.pogh.2y.net/ Illinois state fair butter cow, %-[, <a href="http://htde.rtstr.2y.net/">Master of arts teaching ohio</a>, [url="http://htde.rtstr.2y.net/"]Master of arts teaching ohio[/url], http://htde.rtstr.2y.net/ Master of arts teaching ohio, inaayq, <a href="http://inrm.trdsd.2y.net/">Pittsburgh pennsylvania chemist lab technician</a>, [url="http://inrm.trdsd.2y.net/"]Pittsburgh pennsylvania chemist lab technician[/url], http://inrm.trdsd.2y.net/ Pittsburgh pennsylvania chemist lab technician, 5362, <a href="http://ezio.srths.2y.net/">Demoine iowa wells fargo home mortgage</a>, [url="http://ezio.srths.2y.net/"]Demoine iowa wells fargo home mortgage[/url], http://ezio.srths.2y.net/ Demoine iowa wells fargo home mortgage, 1216, <a href="http://mylu.trdsd.2y.net/wn.html">Southeast iowa rural real estate</a>, [url="http://mylu.trdsd.2y.net/wn.html"]Southeast iowa rural real estate[/url], http://mylu.trdsd.2y.net/wn.html Southeast iowa rural real estate, 710, <a href="http://mwsm.pogh.2y.net/bg.html">Swinging party in iola texas</a>, [url="http://mwsm.pogh.2y.net/bg.html"]Swinging party in iola texas[/url], http://mwsm.pogh.2y.net/bg.html Swinging party in iola texas, %-P, <a href="http://hxdd.rtstr.2y.net/">Emporia kansas radio stations</a>, [url="http://hxdd.rtstr.2y.net/"]Emporia kansas radio stations[/url], http://hxdd.rtstr.2y.net/ Emporia kansas radio stations, nai, <a href="http://spat.rtstr.2y.net/dc.html">Carolina mall north shopping wilmington</a>, [url="http://spat.rtstr.2y.net/dc.html"]Carolina mall north shopping wilmington[/url], http://spat.rtstr.2y.net/dc.html Carolina mall north shopping wilmington, 7601, <a href="http://pjpl.srths.2y.net/">William charles percell and oregon</a>, [url="http://pjpl.srths.2y.net/"]William charles percell and oregon[/url], http://pjpl.srths.2y.net/ William charles percell and oregon, =-), <a href="http://uipz.trdsd.2y.net/gi.html">Tulsa oklahoma planning commission</a>, [url="http://uipz.trdsd.2y.net/gi.html"]Tulsa oklahoma planning commission[/url], http://uipz.trdsd.2y.net/gi.html Tulsa oklahoma planning commission, 058470,

2010-09-28 17:50:07 by: 匿名用户

Going to, <a href="http://utqr.pogh.2y.net/hf.html">Plymouth wisconsin sports bars</a>, [url="http://utqr.pogh.2y.net/hf.html"]Plymouth wisconsin sports bars[/url], http://utqr.pogh.2y.net/hf.html Plymouth wisconsin sports bars, oucj, <a href="http://ckxy.pogh.2y.net/qo.html">Iowa 19th civil war reunion nixon</a>, [url="http://ckxy.pogh.2y.net/qo.html"]Iowa 19th civil war reunion nixon[/url], http://ckxy.pogh.2y.net/qo.html Iowa 19th civil war reunion nixon, gohgp, <a href="http://mwuj.dytu.2y.net/ae.html">Pro gas careers california</a>, [url="http://mwuj.dytu.2y.net/ae.html"]Pro gas careers california[/url], http://mwuj.dytu.2y.net/ae.html Pro gas careers california, %-)), <a href="http://vebm.dytu.2y.net/av.html">Home alone and teen and texas</a>, [url="http://vebm.dytu.2y.net/av.html"]Home alone and teen and texas[/url], http://vebm.dytu.2y.net/av.html Home alone and teen and texas, >:-], <a href="http://poxl.rtstr.2y.net/">Mcdonogh school baltimore maryland</a>, [url="http://poxl.rtstr.2y.net/"]Mcdonogh school baltimore maryland[/url], http://poxl.rtstr.2y.net/ Mcdonogh school baltimore maryland, 9280, <a href="http://fumz.dytu.2y.net/ob.html">Sunset point campground lubeck maine</a>, [url="http://fumz.dytu.2y.net/ob.html"]Sunset point campground lubeck maine[/url], http://fumz.dytu.2y.net/ob.html Sunset point campground lubeck maine, %[, <a href="http://zsod.trdsd.2y.net/wb.html">Volusia county courthouse deland florida</a>, [url="http://zsod.trdsd.2y.net/wb.html"]Volusia county courthouse deland florida[/url], http://zsod.trdsd.2y.net/wb.html Volusia county courthouse deland florida, >:], <a href="http://kpcf.rtstr.2y.net/uw.html">Animal carolina north state</a>, [url="http://kpcf.rtstr.2y.net/uw.html"]Animal carolina north state[/url], http://kpcf.rtstr.2y.net/uw.html Animal carolina north state, :((, <a href="http://jdcx.srths.2y.net/">Ohio attorneys for vehicular homicide</a>, [url="http://jdcx.srths.2y.net/"]Ohio attorneys for vehicular homicide[/url], http://jdcx.srths.2y.net/ Ohio attorneys for vehicular homicide, 8-D, <a href="http://evek.pogh.2y.net/bt.html">Oregon real estate default bankruptcy</a>, [url="http://evek.pogh.2y.net/bt.html"]Oregon real estate default bankruptcy[/url], http://evek.pogh.2y.net/bt.html Oregon real estate default bankruptcy, >:O, <a href="http://xdyb.srths.2y.net/">Bucks naked bbq freeport maine</a>, [url="http://xdyb.srths.2y.net/"]Bucks naked bbq freeport maine[/url], http://xdyb.srths.2y.net/ Bucks naked bbq freeport maine, 8-], <a href="http://ckqn.pogh.2y.net/cm.html">Oklahoma bees for sale</a>, [url="http://ckqn.pogh.2y.net/cm.html"]Oklahoma bees for sale[/url], http://ckqn.pogh.2y.net/cm.html Oklahoma bees for sale, :O,

2010-09-28 17:50:25 by: 匿名用户

Fast site, <a href="http://cydp.dytu.2y.net/">Christian marriage couciling st louis missouri</a>, [url="http://cydp.dytu.2y.net/"]Christian marriage couciling st louis missouri[/url], http://cydp.dytu.2y.net/ Christian marriage couciling st louis missouri, 6582, <a href="http://yxzn.trdsd.2y.net/">Sex parties in clay springs arizona</a>, [url="http://yxzn.trdsd.2y.net/"]Sex parties in clay springs arizona[/url], http://yxzn.trdsd.2y.net/ Sex parties in clay springs arizona, %((, <a href="http://azsi.rtstr.2y.net/">Subaru car dealer in leeds alabama</a>, [url="http://azsi.rtstr.2y.net/"]Subaru car dealer in leeds alabama[/url], http://azsi.rtstr.2y.net/ Subaru car dealer in leeds alabama, :(, <a href="http://riph.srths.2y.net/">Pekingese puppies for sale new jersey</a>, [url="http://riph.srths.2y.net/"]Pekingese puppies for sale new jersey[/url], http://riph.srths.2y.net/ Pekingese puppies for sale new jersey, %-)), <a href="http://iaod.srths.2y.net/">Disneyland 2 day southern california residents</a>, [url="http://iaod.srths.2y.net/"]Disneyland 2 day southern california residents[/url], http://iaod.srths.2y.net/ Disneyland 2 day southern california residents, bzcit, <a href="http://cqjr.rtstr.2y.net/ii.html">Bicyle trail kansas city</a>, [url="http://cqjr.rtstr.2y.net/ii.html"]Bicyle trail kansas city[/url], http://cqjr.rtstr.2y.net/ii.html Bicyle trail kansas city, :]], <a href="http://nknz.dytu.2y.net/">Macon georgia belle newspaper</a>, [url="http://nknz.dytu.2y.net/"]Macon georgia belle newspaper[/url], http://nknz.dytu.2y.net/ Macon georgia belle newspaper, 693, <a href="http://weqr.dytu.2y.net/wb.html">Food vending carts for sale ohio</a>, [url="http://weqr.dytu.2y.net/wb.html"]Food vending carts for sale ohio[/url], http://weqr.dytu.2y.net/wb.html Food vending carts for sale ohio, 5342, <a href="http://dxlj.dytu.2y.net/ty.html">State programs health insurance iowa</a>, [url="http://dxlj.dytu.2y.net/ty.html"]State programs health insurance iowa[/url], http://dxlj.dytu.2y.net/ty.html State programs health insurance iowa, mdw, <a href="http://rvmv.trdsd.2y.net/">Coin dealers in chattanooga tennessee</a>, [url="http://rvmv.trdsd.2y.net/"]Coin dealers in chattanooga tennessee[/url], http://rvmv.trdsd.2y.net/ Coin dealers in chattanooga tennessee, 72190, <a href="http://hkjt.dytu.2y.net/">Arcades in peroria illinois</a>, [url="http://hkjt.dytu.2y.net/"]Arcades in peroria illinois[/url], http://hkjt.dytu.2y.net/ Arcades in peroria illinois, lpsd,

<1 486 487 488 489 1247 >