临床实践指南的制定、存在问题与运用：由表及里，临床医生如何读懂临床指南的内在

doi:10.12114/j.issn.1007-9572.2022.W0002

摘要/Abstract

摘要： 循证医学的出现极大地促进了医疗服务水平及卫生监管水平的提升，但当前临床工作者对已发表文献的批判性利用尚存不足，而且循证医学前沿研究方法所取得的成果也未惠及每一位中国临床工作者。本文对循证医学实践指南的制定进行通俗易懂的方法学说明，通过介绍临床实践指南的定义，梳理指南的标准制定流程，以帮助中国临床工作者更好地理解指南制定的理念。本文分别从"临床实践指南的制定""临床实践指南的制定过程中存在的问题""临床医生如何运用临床指南"3个部分进行分析，即将世界卫生组织（WHO）出版的和国际指南协作组织（GIN）与McMaster大学协作的两个指南制定标准简化、汇总成更为简洁、容易理解和操作的步骤，并用案例分析目前在临床实践指南制定过程中存在的问题，进而指导临床医生应用指南。

关键词: 循证医学, 临床实践指南, 指南制定, 指南评价, PICO格式

Abstract:

Evidence-based medicine has greatly contributed to the improvement of the level of medical services and health regulation. However, the critical use of the published medical literature and medical databases by Chinese clinical practitioners is insufficient, and the achievements of cutting-edge research methods of evidence-based medicine are not used by every Chinese clinical practitioner for benefit. This article provided a concise and well understood methodological illustration of the development of evidence-based medicine practice guidelines, to help Chinese clinical practitioners better understand the philosophy of guideline development by presenting the definitions of clinical practice guidelines and sorting out the standard development process of the guidelines. This paper analyzes from three parts, "Formulation of Clinical Practice Guidelines""Problems Existing in the Formulation of Clinical Practice Guidelines" and "How Clinicians Apply Clinical Guidelines". In this paper, the two guideline development standards, published by World Health Organization (WHO) and together with Guideline International Network (GIN) and McMaster University, were simplified, combined and summarized into were more concise. The problems existing in the formulation of clinical practice guidelines are analyzed with cases, in order to guide clinicians to apply the guidelines.

Key words: Evidence-based medicine, Clinical practice guidelines, Guideline development, Guideline evaluation, Population, intervention, comparison, and outcomes of clinics

叶志康,杨辉. 临床实践指南的制定、存在问题与运用：由表及里，临床医生如何读懂临床指南的内在[J]. 中国全科医学, 2023, 26(13): 1559-1567. DOI: 10.12114/j.issn.1007-9572.2022.W0002.
YE Zhikang,YANG Hui. The Development, Problems and Application of Clinical Practice Guidelines: How Clinicians Can Read the Essence of Clinical Guidelines from the Surface to the Inside[J]. Chinese General Practice, 2023, 26(13): 1559-1567. DOI: 10.12114/j.issn.1007-9572.2022.W0002.

图/表 1

参考文献 43

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结局	强化降压组（%）	常规降压组（%）	HR （95%CI）	绝对风险差值（%）
复合心血管事件（卒中、急性冠脉综合征、急性心力衰竭、冠状动脉血管重建术、心房颤动、心血管死亡）	3.5	4.6	0.74 （0.60，0.92）	1.1
卒中	1.1	1.7	0.67 （0.47，0.97）	0.6
急性冠脉综合征	1.3	1.9	0.67 （0.47，0.94）	0.6
急性心力衰竭	0.1	0.3	0.27 （0.08，0.98）	0.2
冠状动脉血管重建术	0.5	0.7	0.69 （0.40，1.18）	0.2
心房颤动	0.6	0.6	0.96 （0.55，1.68）	0
心血管死亡	0.4	0.6	0.72 （0.39，1.32）	0.2
全因死亡	1.6	1.5	1.11 （0.78，1.56）	0.1

结局	强化降压组（%）	常规降压组（%）	HR （95%CI）	绝对风险差值（%）
复合心血管事件（卒中、急性冠脉综合征、急性心力衰竭、冠状动脉血管重建术、心房颤动、心血管死亡）	3.5	4.6	0.74 （0.60，0.92）	1.1
卒中	1.1	1.7	0.67 （0.47，0.97）	0.6
急性冠脉综合征	1.3	1.9	0.67 （0.47，0.94）	0.6
急性心力衰竭	0.1	0.3	0.27 （0.08，0.98）	0.2
冠状动脉血管重建术	0.5	0.7	0.69 （0.40，1.18）	0.2
心房颤动	0.6	0.6	0.96 （0.55，1.68）	0
心血管死亡	0.4	0.6	0.72 （0.39，1.32）	0.2
全因死亡	1.6	1.5	1.11 （0.78，1.56）	0.1