1例恶性胸膜间皮瘤的循证治疗

Evidence-based Treatment for a Patient with Malignant Pleural Mesothelioma

目的为1例确诊的恶性胸膜间皮瘤患者制定循证化疗方案。方法在充分评估患者病情的基础上，根据PICO原则，提出临床问题并转换成便于检索的形式，检索Cochrane图书馆（2007年第1期）、PubMed（1966～2007．2）和EMbase（1974年～2007年2月）。结果共检索出治疗恶性胸膜间皮瘤的随机对照试验5篇、系统评价4篇和卫生经济学评价1篇。根据检索结果，并结合患者病情和意愿，为患者制定出雷替曲塞联合顺铂的化疗方案，共进行5个周期的化疗，同时给予胸腔穿刺抽液及其它对症治疗。经过4月的随访证实，该方案适合患者。结论采用循证医学的方法为确诊的恶性胸膜间皮瘤患者制定最佳化疗方案可有效提高治疗效果。

Objective To formulate an evidence-based treatment plan for a patient with malignant pleural mesothelioma. Methods Based on an adequate assessment of the patient＇s condition and using the principle of PICO, we searched The Cochrane Library （Issue 1, 2007）, PubMed （1996 to February 2007） and EMbase （1974 to February 2007） to identify the best available clinical evidence. Results Five randomized controlled trials, 4 systematic reviews and 1 health economic evaluation were included. According to the current evidence, as well as the patient＇s clinical condition and preference, 5 cycles of raltitrexed plus cisplatin were given to the patient along with thoracic drainage and other symptomatic treatment. And the follow-up after 4 months indicated that this treatment plan was appropriate for the patient. Conclusion Evidence-based approaches helped us to prepare the most appropriate chemotherapy plan for this patient and will help improve the therapeutic results for patients with malignant pleural mesothelioma.