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[ACC2011]承载使命,开创未来——继任ACC主席David R.Holmes教授专访
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编辑:Holmes 时间:2011/4/7 14:42:40专家访谈(专题)  关键字:David R.Holmes 信息技术系统 介入治疗策略 心脏团队 晨间血栓  

    <International Circulation>:  Our audience is primarily Chinese in China. Will they have access to this database of information?

  《国际循环》:我们的读者主要是在中国人,他们能够访问这一信息的数据库吗?

       Prof.Holmes: I think they will. I think the intent is to have this be a platform developed which will indeed allow just-in-time learning and education at the point of patient care.

    Holmes教授:我认为他们可以。我们的意图是为临床治疗提供一个真正的实时学习和教育的平台。

    <International Circulation>:  With advances in cardiovascular care and interventions comes increased costs, a wider range of potential complications, more intricate and complicated knowledge and specialty that the provider has to know. What is the best way to optimize intervention in 2011?

  《国际循环》:随着心血管治疗的进展、介入成本的增加以及并发症的增多,医疗服务者必须了解更为深奥复杂的专业知识,2011年优化介入治疗最佳方法是什么?

       Prof.Holmes:I think the optimal way to optimize intervention is to make sure we adhere to the fundamental principles that we learn more and more about. Those principle being: number one, interventional procedures, whether they be surgical procedures or whether they be in the catheter arena, should be tailored and focused towards specific needs. Those needs include relief of symptoms and relief of ischemia. Very few of the interventional procedures outside of acute infarction procedures result in improved survival and in the surgical arena, some result clearly in improved survival but in general, most of the time, the goal that we achieve most is relief of symptoms. Relief of symptoms and then relief of ischemia. I think by focusing on developing and continuing to implement appropriate use criteria (which will include the treatment of ischemia), we will really be able to make sure we are doing the right procedures in the right patients. The final piece that relates to that will be the widespread application of the “heart team” concept, which I think is essential in going forward. That was first most commonly brought to light in the SYNTAX trial. The SYNTAX trial came from Europe and then involved the United States, and made the point that in selecting the care of patients and identifying a treatment strategy we should have a team comprised of a cardiologist (sometimes a “quarterback cardiologist”, providing direction and supervision), an interventional cardiologist and a cardiovascular surgeon – viewing the data, discussing it with the patient, discussing the risk to benefit ratio (which is different between the two procedures) and then reaching the optimal conclusion. I think the future is going to be healthcare teams. That will be true for all the new procedures and those healthcare teams will include a wide variety of people. 

    Holmes教授:我认为优化介入治疗的最佳方法是我们遵守越来越多的基本原则。这些原则是:⑴介入治疗,无论是在外科领域或是导管室,都应当个体化,并关注患者的具体需求。这些需求包括缓解症状以及心肌缺血。除急性心肌梗死,介入手术很少能改善生存率,但在外科领域中,一些手术能明显改善生存率。一般来说,多数情况下,我们的目标多是缓解症状。症状一旦缓解,缺血随之缓解。我认为,通过继续实施适当的应用标准(包括缺血的治疗),我们才能真正确保对正确的患者实施正确的手术。与此相关的是“心脏团队”的广泛应用,我认为这至关重要。SYNTAX试验首次提出心脏团队,它强调,在患者护理和确定治疗策略上,我们应该有一个包括一位心脏病医生、一位介入心脏病医生和一位心血管外科医生在内的团队共同查看数据,与患者进行讨论,评估风险-获益比,最终达成共识。<

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