前景理论在重症医学临床决策中的应用

The Application of Prospect Theory in Decision-making for Critical Care Medicine

临床决策是每一个医生每天面临的工作,正确的临床决策不仅可以带给患者较好的结果,同时也可以让医生与患者及家属沟通更加良好。本文首先论述了重症医学的临床决策特点,每一个救治方案的收益与损失的权衡不仅仅是取决于患者病情,而且与决策者的风险偏好有明显关系。为了更好地解决这个问题,把诺贝尔奖获奖者丹尼尔的前景理论引入到重症患者的临床决策中,根据临床预期实现的不同概率进行分类,从行为心理学的角度进行分析,根据患者及家属的预期来确定是否实施某一特定的救治方案。以1例外科二次手术的决策过程为例说明了前景理论的实际应用,在临床上较好地平衡了收益与损失的关系,取得了良好的效果,初步说明前景理论在重症医学的临床决策中具有一定价值。

Medical decision-making is the work that doctors should face everyday, the correct medical decision-making will not only bring preferable consequence to patients, but also make a better communication for doctors with patients and their families. The thesis firstly explains the medical decision-making＇s characteristic of critical care medicine, to consider the benefit or loss in every treatment, which not only depends on the patient＇s condition, but also relates to the risk preferences of the decision makers. To solve the problem, the author introduces the Prospect Theory by Daniel--a Nobel Prize Winner into the medical decision making of critical care cases, to determine whether to implement a specific treatment programs by the classification of different probabilities in clinical expected, analysis from the behavioristic psychology, expectation of patients and the families. The author cites a decision of secondary surgery procedures to explain the practical application of the prospect theory, which can gives a balance between benefit and loss and achieved good results, preliminary illustrating the value of prospect theory in decision-making for critical care medicine.