2008年6月27~29日第三届中意心脑疾病论坛于北京成功举办。本届论坛首次实现多学科联盟，并汇集中意两国著名专家最新最全面的心脑血管疾病各类临床治疗方案，共同着眼于心脑血管疾病的预防和治疗，为两国专家交流提供一个极好的交流平台。《国际循环》特派记者采访本次论坛的两国发起者及发言的部分著名专家，使读者有机会近距离领略大家风采。

增进中意交流，控制卒中危险因素—中意心脑疾病论坛发起者Augusto Zaninelli教授专访

<International Circulation>: Stoke is a very critical challenge all over the world. So different countries should face the challenge hand in hand. Is there any cooperation project between China and Italy?

Prof. Zaninelli: Stroke is a very important issue for people around the world， Europe， and in China. We have to work for stroke prevention. Prevention is very important because when stroke appears， it is very lethal. Europe has more experience in traditional risk factors; bad lifestyle， obesity， diabetes， and so on. On the other hand， China and Chinese doctors have more experience in hypertension as it is one of the most important risk factors in China and the rest of Asia. For this， it is possible to integrate models for risk factor control. In comparison between two important systems; the Italian health system， which the WHO found is one of the most advanced systems in the world， and the Chinese system which is a very big system. 

<International Circulation>: How about the  interchange between the Chinese doctors and Italy doctors now? What should we do to enhance these communications?

Prof. Zaninelli: This congress is one practical example of integration between two cultures and brings to light two different approaches to stroke and cardiovascular disease in general. The cooperation is good in events like this where Chinese delegates can appreciate the speech of Italian speakers and the Italian delegates can know and understand the culture and history of a great country like China.

This congress is a good challenge for growth in medical culture. One of the most important future topics is to have a medicine that can bring accessible treatment to patients. Often， in developed countries like Italy， we use more technology， more instruments， more diagnosis assisted by sophisticated computerized systems， etc. and maybe we lose direct contact with the patient. On the other hand， the Chinese medicine system overall is very centered on the patient. This is very important to keep a good feeling with the patient， and ideally we can have a good mix between technology and good feelings for the patient care.

加强健康生活方式指导，完善慢病管理模式——中意心脑疾病论坛发起者胡大一教授专访

   《国际循环》：我国心血管疾病管理现状如何？ 近年来取得了哪些主要成就和进展？目前哪些方面还需要我们继续努力和加强？

    胡大一教授：第一，以往医生可能更关注一些具体的技术，例如如何熟练掌握射频消融、支架置入及杂交手术等，但却忽略了如果先进的技术没有优秀的医疗服务和疾病管理模式来承载，则很难实现新技术为患者更好服务的目的。相对而言，支架手术开展并不困难，但如何使急性心肌梗死患者尽早开通血管是更关键的问题，因为“时间就是心肌，时间就是生命”。此时，在急诊如果没有绿色通道，没有D2B（Door to Balloon）这样的医疗模式承载，则技术本身没有任何的价值。第二，中国在慢性疾病的管理上探索了不少的模式，例如糖尿病、高血压等疾病的管理近年来取得了一定的成就，但对于中国这样的人口大国而言仍需进一步的努力。对此，医生需学习如何从被动变为主动，对患者进行主动服务，不是患者求治于医生，而是需要医生经常与患者进行沟通，如提醒患者何时服药、何时调整剂量等。

    从欧洲十年间的两次调查报告来看，虽然近年来有大量的循证医学证据涌现，药物的处方量也在不断进行调整，但冠心病患者群的糖尿病、肥胖发生率持续增加，十年来高血压控制率没有任何的变化。而目前药物洗脱支架（DES）应用非常广泛，介入医生必定会对患者强调出院后继续抗血小板治疗，但是很多医生容易忽略对患者健康生活方式的教育，例如戒烟、合理饮食及加强运动等。仅以戒烟一项为例，研究表明戒烟可使冠心病患者显著获益，并且与应用他汀、阿司匹林、ACEI、ARB等药物相比，低费用高收益，但这一最基本而有效的措施却没有得到足够的关注。此外，戒烟和良好的生活方式应该首先从医生做起，这样才能更有效地教育患者。

   《国际循环》：中国与欧洲国家在心血管疾病管理方面存在哪些差距？

    胡大一教授：在心血管疾病的管理方面，意大利还是有很多先进的模式值得我们借鉴。毕竟他们在慢性疾病的管理方面进行探索的时间较长，在心力衰竭、心律失常起搏器和抗凝管理等方面有很多经验值得借鉴。希望未来中国医生的关注重点能够从单纯的关注疾病治疗的技术转向疾病的管理模式的探索中来，这也需要年富力强学科带头人的积极带动，使医生转移关注的焦点。

组建急诊系统，缩短卒中救治时间——意大利心血管医生心脏病学院预防学会主席Furio Colivicchi教授专访

<International Circulation>: Organized stroke care，including emergency call centre， stroke triages， emergency medical services (EMS)， emergency rooms (ER)， stroke units (SU)， rehabilitation hospitals and community health care， is the most effective method for stroke care. How organized stroke care run in Iatly? Could you please introduce the experience about it?

Prof. Colivicchi: At the moment， in Italy we are developing a network of stroke units and acute care units within the emergency departments of our referral centers， which are the hospitals. We have a network of hospitals in the Italian National Health Service， which is a public network of hospitals， including community centers; which are the so-called spoke centers and then we have referral centers which are the so-called hub centers. Patients with the most severe conditions such as acute stroke or acute myocardial infarction are moved with ambulances or helicopters from peripheral/community hospitals to referral centers. The experience is very favorable at the moment because we have very good results in providing acute care to most patients and improving the overall outcomes in terms of cardiovascular events following acute events. The experience is positive and we are trying to implement this strategy all over the country and following a plan which has been developed by the Italian Ministry of Health. This is our experience at the moment.

<International Circulation>: During the emergency care of stroke， time is key factor. Patients have the thrombolysis opportunity for ischemic stroke only they could enter the hospital within time window. How many percent of stroke patients entering hospital within 3 hours in Italy? What do Italy do to reduce time delay and how about the outcome?

Prof. Colivicchi: We are collecting data through some registries. I have to say that at the moment the percentage of acute stroke patients reaching the hospital within 3 hours is very low; it still is about less than 5%. So the thrombolysis is performed in not more than 3%~4% of patients in urban areas; people in rural areas have lower percentages of reaching a hospital within 3 hours. We are working hard on the emergency medical system in order to reach a percentage of about 20% of patients reaching the hospital within 3 hours. This is our goal for the next five years and we are working hard on it. We have certain areas of Italy in which we are achieving very good results; large urban areas， while for rural areas we have big problems because they are dispersed in the mountains all over the country so it is difficult to reach the hospitals.