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將實證醫學納入臨床操作- 以Dextran之使用為例 徐圭璋 高雄榮民總醫院 kchsu@vghks.gov.tw “Leaks” between research practice Aware Accept Target Doable Recall Agree Done Valid Research 0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 = 0.21 Prof. Paul Glasziou, EBM Centre, U. of Oxford, UK 實證醫學實作案例 顯微外科醫師為避免所接合的微小血管在術後阻塞，常用許多抗血栓劑。 Dextran 是常用的其中一種，卻又有嚴重併發症的可能， 如過敏性休克、急性腎衰竭、急性呼吸窘迫症候群等。 本科幾乎為常規使用。 基於其可怕併發症，使用之必要性令人懷疑，值得重新評估 。 實證醫學五步驟 提出問題 (Question formulation) 搜尋證據 (Evidence search) 嚴格判讀 (Critical appraisal) 恰當運用 (Evidence application) 評估結果 (Outcome evaluation) 實證醫學五步驟 提出問題 (Question formulation) 搜尋證據 (Evidence search) 嚴格判讀 (Critical appraisal) 恰當運用 (Evidence application) 評估結果 (Outcome evaluation) Clinical Question (PICO) In patients with head and neck cancer, does use of dextran improve free flap survival rate? P (population): Pts with head neck cancer undergoing free flap surgery I (intervention): Dextran (or Rheomacrodex) C (control): none O (outcome): flap failure rate, morbidity OR mortality 實證醫學五步驟 提出問題 (Question formulation) 搜尋證據 (Evidence search) 嚴格判讀 (Critical appraisal) 恰當運用 (Evidence application) 評估結果 (Outcome evaluation) Search terms Strategy Databases: PubMed, MEDLINE Cochrane Library Keywords: free flap, Dextran, Rheomacrodex Limitation: Randomized Controlled Trial PubMed Dextran-related complications in head and neck microsurgery: do the benefits outweigh the risks? A prospective randomized analysis. Disa JJ, Polvora VP, Pusic AL, Singh B, Cordeiro PG. Plast Reconstr Surg. 2003 Nov;112(6):1534-9 MEDLINE Disa JJ. Polvora VP. Pusic AL. Singh B. Cordeiro PG. Dextran-related complications in head and neck microsurgery: do the benefits outweigh the risks? A prospective randomized analysis. [Clinical Trial. Journal Article. Randomized Controlled Trial] Plastic Reconstructive Surgery. 112(6):1534-9, 2003 Nov. Cochrane Library Dextran-related complications in head and neck microsurgery: do the benefits outweigh the risks? A prospective randomized analysis. Disa