据Medscape网站10月16日报道，硬皮病肺部并发症研究Ⅱ(Scleroderma Lung Study II)的最新研究成果，将成为2015年美国胸科医师学会大会(Chest 2015)上的一重大发现进行报告。

        此结果是基于该中心第一次研究结果，华盛顿塔科马港市麦迪根军队医学中心学术委员会主席-亚历山大.尼文说：“环磷酰胺已成为硬皮病患者的基础治疗药物。”

        为了提高环磷酰胺的疗效，研究者们最近进行了一项新的研究-他们在同样的硬皮病患者身上使用安慰剂和麦考酚酯与环磷酰胺做比较。

        尼文说，那些致力于SERVE-HF研究的呼吸专家和心脏病专家会对有关中枢性睡眠呼吸暂停伴慢性心力衰竭的研究感兴趣。研讨会提出了该研究与传统观念相悖的结果-在射血分数降低的心衰患者中采用适应性伺服式通气方法治疗会增加死亡率。

        蒙特利尔胸科协会主席布尔博说2015年《胸科学》会议为大家提供全面的学习机会，为临床提供新的指南。

       实践模拟实验

        尼文说，《胸科学》杂志2007年已建立了模拟中心。在该中心我们把重症病房的病床装上高仿真模拟人，虽然是无声的但同样有效。我们制造了一个包括气道管理装置，机械通气区域和呼吸机的货车，可以通过调节其中的参数来模拟气胸，供大家实践。今年我们还将模拟每一个危重气道管理者都应具有的实践经验-环甲膜切开术。而像肺功能和超声等实践模拟将会放入标准化病人中。

        布尔博也说，我们不必进入临床就能获得实践机会，而不是被动学习，我们将整合工作坊，问题式学习方法和游戏教育等学习方法，使医疗保健成为主动学习。

       新时代医疗

        组织者们还开创一个多学科多领域的医疗模式，通过模拟真实生活环境将医生护士呼吸治疗师们整合到一起。

        布尔博说：“我们进入了一个全新的医疗时代，它不再是只有重症管理、睡眠中心或长期护理，而是一个多学科多领域团队合作的时代。”

        会议结束时组织者留了一个有关于脓毒症管理的疑问，有兴趣者可以就脓毒症早期针对性治疗及其发病，恶化，预后等方面做出讨论的参与拯救脓毒症运动或提出一些全新的临床实践依据。

        原文如下：

        标题：Scleroderma, Sleep Apnea, Sepsis Highlights of CHEST 2015

        正文：MONTREAL — Late-breaking results from the Scleroderma Lung Study II will be among the top findings reported at CHEST 2015: American College of Chest Physicians Meeting.

        The trial builds on the first Scleroderma Lung Study, previously reported by Medscape Medical News, which "established cyclophosphamide as one of the cornerstones of care for scleroderma patients," said Alexander Niven, MD, from the Madigan Army Medical Center in Tacoma, Washington, who is cochair of the scientific program committee.

        The lack of sustained improvement with cyclophosphamide led researchers to their latest investigation — a prospective randomized placebo-controlled trial comparing mycophenolate mofetil with cyclophosphamide. "It will be a very important session," Dr Niven predicted.

        Respiratory specialists and cardiologists still digesting the practice-changing SERVE-HF trial will be interested in the session on the impact of the trial results on the management of central sleep apnea in heart failure patients, he added. A panel discussion will explore the clinical implications of the trial's surprise finding that adaptive servo ventilation increased mortality in heart failure patients with reduced ejection fraction, signaling "a really a dramatic departure from the conventional thinking in this area," Dr Niven reported.

        The wide array of session formats aimed at providing a full range of learning opportunities is a unique strength of the CHEST meeting, said Jean Bourbeau, MD, from the Montreal Chest Institute, who is cochair of the scientific program committee. "We have a lot of different methods of education that allow clinicians to understand new practices, but also to practice," he told Medscape Medical News.

        Hands-on Simulation Experience

        CHEST has been building on a centerpiece of this concept — the simulation center — since 2007, Dr Niven reported.

        In one of these sessions, "we will reconstruct a clinical ICU room with a high-fidelity human simulator on a real hospital bed. The simulation community would recoil if we called it a 'dummy'!" he said. There will be a cart with all the equipment for airway management, a mechanical ventilation area, and a real ventilator connected with tubing to the 'patient'. We will have the opportunity to adjust some of the parameters to simulate things like pneumothorax" so our learners can troubleshoot, Dr Niven explained.

        This year there will be an opportunity to perform a cricothyroidotomy, "which is a rarely performed, but very important emergency skill that all intensivists who manage airways should have practical experience in," said Dr Niven.

        Some hands-on opportunities, such as pulmonary function testing and ultrasound procedures, will involve live "standardized patients."

        "Usually, you have to go to an institution to get that kind of practice," Dr Bourbeau explained, but this is offered onsite. "Probably the worst way to learn is just to have someone telling you. We have tried to incorporate many other methods, such as workshops, problem-based learning opportunities to put new guidelines into practice, and educational games. All are quite different but allow the healthcare professional to become an active learner."

        New Era of Medicine

        Organizers are offering interdisciplinary programs, which are designed to encourage a multidisciplinary and multiprofessional focus on care and to attract a mix of doctors, nurses, and respiratory therapists by simulating real-world settings.

        "We are entering a new era of practicing medicine — whether in the intensive care unit or sleep medicine clinic or in chronic care medicine — which will require more and more of a multidisciplinary and multiprofessional team," said Dr Bourbeau.

        Organizers have saved a potentially controversial session on sepsis management as an adrenaline bolus at the end of the meeting. On the heels of three recent studies that have challenged the early goal-directed therapy approach to sepsis (PROCESS, ARISE, and PROMISE), speakers will address the Surviving Sepsis Campaign and discuss the impact that new evidence will have on current clinical practice.