Connors A F
Department of Health Evaluation Sciences, University of Virginia School of Medicine, Charlottesville 22908, USA.
New Horiz. 1997 Aug;5(3):195-200.
To discuss the advantages of different methods of determining the effectiveness of healthcare interventions, to evaluate the basis for the assumption that right heart catheterization is effective, and to consider how right heart catheterization may fail to improve outcomes in some circumstances.
Published English language literature on right heart catheterization and patient outcomes.
We recently reported an association between the use of right heart catheterization in the initial care of critically ill patients and increased risk of death. This finding is troubling and warrants future study. In this article I address the role of randomized controlled trials and observational studies in the evaluation of the effectiveness of healthcare interventions. I discuss the basis in the published literature for assuming that right heart catheterization improves outcomes. Finally I present a variety of problems with right heart catheterization which might allow this procedure, which logically should help patients, to fail to achieve a beneficial effect for some patients.
We must do appropriate prospective studies to determine who benefits from right heart catheterization and who does not. We owe our patients nothing less.
探讨确定医疗保健干预措施有效性的不同方法的优势，评估右心导管插入术有效的假设依据，并思考右心导管插入术在某些情况下可能无法改善预后的原因。
已发表的关于右心导管插入术和患者预后的英文文献。
我们最近报告了在危重病患者的初始治疗中使用右心导管插入术与死亡风险增加之间的关联。这一发现令人不安，值得未来进行研究。在本文中，我探讨了随机对照试验和观察性研究在评估医疗保健干预措施有效性中的作用。我讨论了已发表文献中认为右心导管插入术可改善预后的依据。最后，我提出了右心导管插入术存在的各种问题，这些问题可能导致这个从逻辑上讲应该对患者有帮助的操作未能对某些患者产生有益效果。
我们必须进行适当的前瞻性研究，以确定哪些人能从右心导管插入术中获益，哪些人不能。我们对患者负有这样的责任。
