Nowadays, the medical knowledge of taking medicine without injection, injection without infusion seems a little useless, and routine procedures such as asking medical history and physical examination are no longer popular. On the contrary, we use the "best" drugs, accept the "highest-end" examinations and perform the "most advanced" operations, and of course there are the most expensive expenses.
Zhang Chunlin, who was nearly seventy years old, was sitting opposite the reporter, obviously panting. "Now I have become a burden to my family. If it weren't for the two stents installed at that time, I would have angina pectoris at most and there would be no serious myocardial infarction. "
One day two years ago, Zhang Chunlin and his wife went to a big hospital in Beijing because of delivery angina. After the examination, the doctor told him that his condition was very dangerous and suggested installing a stent in the coronary artery for treatment. Zhang Chunlin's daughter is engaged in cardiovascular medicine abroad at this time. Originally, he wanted to communicate with his daughter before determining the treatment plan, but in view of the "emergency" that the doctor said, he and his wife did not hesitate and decided to operate immediately. Soon, Zhang Chunlin was pushed into the catheter room by the doctor. After more than an hour of surgery, he had two more stents in his body.
Zhang Chunlin, who thought he had fully recovered, didn't expect that he was admitted to the hospital for emergency treatment because of heart problems only one year and two months later, and the results of cardiac angiography this time showed that two stents were blocked, leading to acute myocardial infarction.
At this time, Zhang Chunlin's daughter had just returned to China to visit relatives, so he found out the CD of comparative surgery more than a year ago and showed it to her daughter. The daughter found that at that time, only 50% of his coronary artery was narrow, which was mild angina. Drug therapy can achieve good results, and there is no need to install stents at all. Hearing this, Zhang Chunlin was very angry and wanted to make the hospital responsible for his current illness by law. "But considering that my daughter will return to China for development in the future, I think I'd better forget it. She told me that this is the' hidden rule' of domestic hospitals. If I am so noisy, she will not be able to stand in this industry in the future. "
The treatment of coronary heart disease includes three traditional methods: drug therapy, surgical bypass therapy and drug intervention therapy, as well as new therapies such as gene therapy, which are still in the primary stage of research. In the 1980s, when coronary intervention technology, mainly stent surgery, entered China, it was praised by doctors as a revolution in the history of cardiovascular disease treatment and was called by patients as a technology that could "revive the dead".
Xu Hao, chief physician of the National Center for Cardiovascular Diseases of Integrated Traditional Chinese and Western Medicine of China-Japan Friendship Hospital, told the Beijing Science and Technology News reporter that, in short, cardiac stent surgery is to puncture a blood vessel, insert a catheter into the blood vessel, place a cylindrical hollow metal net tube where it needs to be placed, open the blocked blood vessel, and make the blood circulate again. The operation process is not complicated. The patient is operated under local anesthesia and can usually be discharged after a few days.
However, cardiac stent surgery can not be "once and for all", and medical staff soon found that the probability of stent restenosis in clinic is very high, which is called intimal hyperplasia in medicine. That is to say, the stent opens the blood vessels, so that the originally ischemic myocardium can get blood supply, but the atherosclerotic plaque will continue to grow in the stent, making the blood vessels narrow again.
Although the latest drug-coated stent-drug-eluting stent can reduce the incidence of in-stent restenosis from about 20% to below 10% and slow down cell proliferation, the problem of restenosis cannot be completely solved. Foreign studies show that from 1984 to 1999, the contribution of bypass and interventional therapy to stable angina pectoris is only 2%. Therefore, the attitude of doctors in some developed countries when dealing with coronary heart disease is usually that those who can be treated with drugs should never be equipped with stents, and one should never be equipped with two, and different experts in a hospital basically have the same understanding.
But at this point, domestic hospitals have not kept pace with foreign countries like the development of technology, or even run counter to it.
Wang Heping, a member of the medical risk monitoring and early warning expert group of the Ministry of Health and director of the medical department of Beijing Kang Sheng Law Firm, told the reporter that heart stent surgery is very popular in China now, and he has been exposed to many similar disputes. 20 10 A tertiary hospital in Beijing gave a 70-year-old male patient 1 1 stent. The patient died the day after the operation. The reason for the examination was coronary artery stenosis. Originally, stents were placed to dilate blood vessels, but too many stents were placed to block blood vessels.
From June 5438 to October 2009 10, in a tertiary hospital in Beijing, a patient surnamed Cao underwent cardiac angiography and stent surgery because the relevant examinations were not comprehensive. During the operation, many stents could not pass through the patient's blood vessels, but the doctor did not take remedial measures, but continued to plug in eight stents. Due to the long operation time, the patient developed cardiogenic shock and died on the seventh day after hospitalization. The story that a cardiovascular hospital in Chengdu gave a patient a 17 stent surprised many people in the industry.
Hu Dayi, chairman of the Cardiovascular Branch of the Chinese Medical Association and director of the Heart Center of Peking University People's Hospital, also said that putting stents that should not be put in is one of the most serious and lifelong overtreatment, and the mental stress, side effects of drugs and inconvenience caused by other operations will not disappear with time. For example, some patients will feel uncomfortable after stent placement, and it will take one year to get used to it, and they will also take clopidogrel for one year after stent placement. Taking aspirin for life is antithrombotic. These two drugs can irritate the gastrointestinal tract and bring the risk of bleeding. He himself has met some patients who have "returned to the furnace". Some of them did not meet the indications for interventional therapy, but they were placed in one or more stents. Because the medicine was not taken on time after operation, it led to thrombosis and more serious myocardial infarction.
In 2008, about188,000 patients received percutaneous coronary intervention in China. The relevant person in charge of the Ministry of Health once said to this figure: "This really shows that coronary intervention technology has been popularized, but we don't know how many of these cases are not up to standard. For example, it is unreasonable and unsafe to use drug-eluting stents for patients with low risk of restenosis and high risk of bleeding. The potential problems of drug-eluting stents need further study. Suitable for most patients, but not for all patients, but many hospitals don't care about this. "
As for why cardiac stents are abused, experts have analyzed that it is undeniable that some hospitals regard them as economic growth points, and doctors also attach great importance to the benefits brought by stent surgery. A stent with a diameter of only a few millimeters and a weight of less than one tenth of a gram costs 20,000 to 30,000 domestically produced and more than 30,000 imported. Follow-up treatment after operation is also an expense.
Wang Heping told reporters that before and after the medical equipment enters the hospital, it is a complete interest chain, and it needs to give certain kickbacks to the hospital and the doctors who perform surgery. The rebate is a one-to-one single-line contact, and manufacturers directly deal with doctors, which is an unspoken rule in the industry. In addition, the amount of rebate varies according to the equipment and suppliers. At present, many large hospitals in China are comparing how many stents are performed each year, because the more stents are performed, the greater the income will be. Even many hospitals give the relevant departments the index of stent implantation every year, asking how many cases of stent implantation should be achieved in that year.
In 2002, CYPHER, a drug-eluting stent developed by Johnson & Johnson Company, was first marketed in Europe and then allowed to enter China. At that time, the market price was 36,000 yuan, of which the profit rate of dealers could reach 50%. At one time, the proportion of stents used in China was as high as 98% of the total number of stents used. After the heart stent entered China, the Taxus chinensis developed by Boston Scientific Company chose direct sales, and the price was only 1.8 million yuan, which was half cheaper than the heart stent. However, the market share of paclitaxel stents in other countries is usually as high as 60%~70%, and the sales volume in China for half a year is almost zero.
In addition, Wang Heping also said that academic requirements are also an important reason for the proliferation of stents. At present, it is stipulated in our country that an academic paper must be published after a certain number of stent operations by doctors themselves, because a paper with a small sample size has almost no scientific research value. The publication of papers is also linked to the evaluation of professional titles. For example, more than three papers must be published in national core journals to evaluate senior professional titles, so doctors need a large number of scaffold samples.
Putting a stent that should not be put is one of the most serious over-medical treatments for life.