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目的借助循证医学的方法为初诊中年空洞性肺结核患者确定治疗目标和治疗方案。方法在充分评估患者情况后,提出临床问题,从Cochrane Library(2009年第4期)、Medline(PubMed网站1996—2009年)、http://www.guideline.gov和www.cnki.net上检索治疗空洞性肺结核的系统评价和随机对照试验。评价证据的质量和适用性,结合患者意愿制定治疗方案,随访患者。结果共检索出与不同问题相关的随机对照实验论文28篇,系统评价或Meta-分析16篇,临床实践指南12篇,共纳入8个随机对照实验(RCT)、5篇系统评价/Meta分析,6篇临床实践指南。另有2篇无对照的系列病例观察一并纳入。通过对检索结果进行分析并结合患者意愿,为患者制定了合理的治疗方案和预期目标:最小影响病人正常生活下治愈病人,使痰菌转阴,防止耐药结核菌的产生,防止复发,改善症状,提高患者生活质量。随访10个月证实,该方案适合患者。结论采用循证治疗的方法,为初诊的空洞性肺结核患者确定合理的治疗目标和治疗方案,可有效地提高治疗效果。
Objective To determine the treatment goals and treatment options for newly diagnosed patients with middle-aged hollow tuberculosis through evidence-based medicine. Methods After adequately assessing the patient’s condition, clinical questions were raised and retrieved from the Cochrane Library (Issue 4, 2009), Medline (PubMed website 1996-2009), http://www.guideline.gov, and www.cnki.net Systematic reviews and randomized controlled trials of treatment of empty tuberculosis. Evaluation of the quality and applicability of evidence, combined with the wishes of patients to develop treatment options, follow-up patients. Results A total of 28 randomized controlled trials with different questions were retrieved, 16 were systematic reviews or Meta-analysis and 12 were clinical practice guidelines. Eight randomized controlled trials (RCTs), five systematic reviews / meta-analyzes were included, 6 clinical practice guidelines. Another two uncontrolled series of case observations were included. Through the analysis of the results of the search combined with the wishes of the patients, a reasonable treatment plan and expected target for the patients were formulated: minimal impact on the patient to cure patients in normal life, negative sputum bacteria to prevent the generation of drug-resistant TB, to prevent recurrence, improve Symptoms, improve patient quality of life. Follow-up 10 months confirmed that the program is suitable for patients. Conclusion The evidence-based treatment method for the initial diagnosis of patients with empty tuberculosis to determine reasonable treatment goals and treatment options, which can effectively improve the treatment effect.