我国著名心血管专家胡大一近日召开的第23届长城国际心脏病学会议上，称“根据统计资料，我国一半的心脏支架都不靠谱”。但在我国通过植入支架来介入治疗心血管疾病存在滥用的情况，目前我国每台心脏介入手术平均使用约1.6个支架，依此推算，2011年中国介入支架使用量超过65万个。(10月14日《中国青年报》)

Our country famous cardiovascular experts b held recently in the 23rd of the Great Wall international cardiology conference,says"According to the statistical data,Our country half of the stents are not by spectrum".But in our country through the stent to intervention in the treatment of cardiovascular diseases exist of abuse,At present our country per interventional heart surgery average use about 1.6 support,According to the calculated,In 2011, the Chinese intervention stents usage more than 650000.(On October 14,[The China youth daily])

　　心脏支架的过度使用，安放支架所带来的“差价回扣”的确是一个重要的诱因。一个国产支架出厂价不过3000，卖给患者价格翻六七倍，进口的则更甚的“牟利黑幕”已是业内外所共知的事实。“以药养医”传统的根深蒂固，也间接怂恿“动辄安支架”成为心血管治疗领域的“流行病”。

The excessive use of heart stent,Brought about by the stent placement"Spread rebate"It is an important incentive.A domestic support ex-factory price but 3000,Sold to patients with six or seven times over price,Import of what is more"Profit shady"This is the known facts."To raise the medical medicine"The traditional entrenched,Also indirectly urged"Frequently Ann support"Become in the field of cardiovascular treatment"epidemic".

　　但从另外一个角度而言，植入支架作为随现代医学发展而产生的一种新型医疗手段，亦存在其本身的优点和不可或缺性。比如，见效快、创伤小、可重复等。当下的问题，并非在于，支架手术及支架本身的不靠谱，而是支架手术的必要性常缺乏必要的论证。患者在急于摆脱病症“寻医心切”的心理晕轮作用下，加上与医生专业知识、信息上的不对称，往往成了宛如刀俎下“鱼肉”的“被支架”的对象。

But from another perspective,Implant stents as with modern medical development and produce a new type of medical means,Also the existence of its own advantages and indispensable sex.For example,rapid/Trauma small/Repeatable, etc.The current problems,Is not in,Support operation and support of itself without spectrum,But the necessity of the stent is often a lack of necessary argument.Patients in the rush to get rid of the disease"Search cure eager"Psychological halo effect,With professional knowledge and the doctor/Information asymmetry,Often became like under a persecutor"fish"of"Be support"object.

　　即便通过限制医生收回扣、红包等方式，减少并有效防范了“以药养医”的常规渠道，但“支架手术”作为惯用的介入治疗方式，并不可能完全通过行政禁令或政策来予以刚性的规定。它的实施权根本而言仍掌握在当事医生手上，患者并没有太多置喙的话语空间，对医生抱以巨大依赖和期盼的他们，实处于绝对弱势的位置。

Even through the limit the doctor receiving kickbacks/Red envelope, etc,Reduce and effectively preventing the"To raise the medical medicine"Regular channels,but"stent"As a conventional intervention treatment,Don't be completely through the administrative ban or policy to be rigid regulations.The implementation of the fundamental right for it still controls in the party on the doctor,Patients and not too much to put in a word of discourse space,Hold to the doctor with great dependence and expect them,Feet in absolute weak position.

　　这时，即便医生并非是出于“借机回扣”的目的，要求患者去安放支架，对患者而言，可能支架手术的繁多费用也非困难。但是，仍然存在一个严峻的基于医学科学伦理的悖论。一方面，医生根据自己的经验及专业眼光来判断病情及给予何种治疗的自主权；另一方面，医生专业水平的良莠不齐也导致了诊治精确度的差异及误诊的可能性，况且现代医疗检测及器械医疗技术的发达，亦助长了医生养成“治病器械化”缺乏全面综合诊疗的技艺退化及惰性增加。医疗资源的区域性“分化”，客观上也让医生没有太多时间去耐心诊疗每一位病人。

At this time,Even if the doctor is not out of"Looking rebate"purpose,Request the patient to a stent was put in place,As for patients,May support the operation of various expenses is not difficult.but,There are still a severe based on medical science ethics paradox.On the one hand,The doctor according to your own experience and professional eye to determine to what illness and treatment of autonomy;On the other hand,The doctor professional level of the good and bad are intermingled also led to the diagnosis and treatment of the precision difference and the possibility of misdiagnosis,Besides the modern medical detection and instruments medical technology developed,Also contributed to a doctor"Cure instrument change"The lack of a comprehensive diagnosis and treatment skills degradation and inert increase.The regional medical resources"differentiation",Objectively speaking, it also let the doctor don't have much time to patient medical each patient.

　　这些因现实条件及主观因素“失衡”下催生的“偶然误差”，是支架滥用的另一个不可忽视的推动因子。不妨说，支架滥用的存在，其实也是现代社会“诊疗粗糙化”的一个侧面征兆。医生和患者都没有太多主观精力去选择“最优化”的治疗方案，而都有意无意地直奔最快最简单的“手段”而去。

These for realistic conditions and subjective factors"imbalance"Next ecbolic"Accidental error",Is support abuse of another nonnegligible push factor.Might as well say,Support the existence of abuse,In fact, it is the modern society"Diagnosis and treatment coarse change"One aspect of the sign.The doctors and patients have no too many subjective effort to choose"optimization"treatment,And are intentionally or unintentionally straight to the fastest the most simple"means"And to.

　　这种“短平快”，尽管可能短时间内“治标于无形”，但鉴于，任何治疗手段都直接与人体血脉脏器相连，遑论在体内安放大大小小的“钢架”。其所产生的后遗症及护理上的麻烦也是让人不堪其扰，而且隐患巨大。

this"Short term rapid",Although may be a short time"Take temporary solution in intangible",But in view of,Any treatments are directly connected with the human body blood viscera,Let alone in the body was big and small"Steel frame".The complications and nursing problems also is to let a person to the interference,And great hidden danger.

　　除了要出台刀砍“以药养医”的机制，对于植入心脏支架及重大疑难疾患的治疗，应尽快引进专家评估委员会制度。从医生的患者人均问诊时间、到检查开药等一系列环节，评估医生治疗方案的合理性。如此，有利于规避医生为追求看病效率，而粗线条、流水线式作业。对于安放支架这样的可能会引发各种后遗症及高昂医药、养护费用的诊疗手段，医生也须尽到告知的义务，尽可能呵护患者独立选择的空间，保障其知情权。在“看病难”与“看病贵”并现的今天，很难一蹴而就。但如不从思路及机制上积极革新，类似“滥用支架”的过度医疗乱象难从源头上有效监控。成立医疗专家委员会定期抽查医生特定诊疗病例，不失为一个可以尝试的制衡之举。 (作者王艳春 单位：武汉大学)

In addition to the sword on"To raise the medical medicine"mechanism,To implant stents and major difficult disease treatment,Should introduce expert evaluation committee system as soon as possible.From a doctor's patients per capita inquiry time/To check prescribe and a series of links,Evaluate the rationality of the doctor's treatment scheme.so,To avoid the doctor to see a doctor for the pursuit of efficiency,Thick and/Line type operation.For stent placement such may cause various complications and high medicine/The cost of maintenance means of diagnosis and treatment,The doctor has to be done inform obligation,As far as possible care patients independent choice of space,Guarantee their right to know.in"See a doctor difficult"and"The doctor your"And now today,It is difficult to accomplish in one move.But if not from idea and mechanism innovation actively,similar"Abuse support"Excessive medical treatment of mess from source to the effective monitoring.Established medical experts committee regularly check the doctor specific cases of diagnosis and treatment,Can yet be regarded as a can try an checks and balances. (The author WangYanChun unit:Wuhan university)