一名放射科医生忍不住想给大家科普一些东西
楼主在一家不大不小的医院的放射科工作，每天都能遇到这么两种人，一是要插队的，二是要求早点拿报告的。
首先给大家科普一下放射科的工作流程，病人先从临床医生那里开检查单——挂号处付钱——到放射科登记处登记——到指定的机房拍片，做CT或MRI等——等待1小时或更长时间（根据不同医院不同检查而定）——到登记窗口取报告。
一般来说医生都是按照病人排号的顺序来操作的，当然有些病人是有优先权的。第一种是急诊病人（并非挂急诊号的病人）这个我下面会具体说，第二种是老年病人，80岁以上的，第三种是比较吵的小孩子，如果小孩比较吵闹，不肯配合，一般我们会让家长哄睡着了在做，一旦小孩睡着了，怕他在醒过来，因此我们也是让他提前做的。
接下来就要说说那些千方百计想要插队提前做检查的病人。楼主工作了这么久，遇到过各种各样要插队的理由，其中说的最多的就是，我家很远的，来一趟不容易。然后就是，医生我疼的受不了了，让我先做一下吧。说实话，真不是我们不通人情，来医院看病的哪个不是远远的赶来的，住在医院附近的人毕竟是少数吧。又哪个不是这里痛那里痛的？的医疗就是病人多，医疗资源少，看病排队也是没办法的，这个要插队那个要先做的，到时候肯定搞得乱七八糟。
然后，就有奇葩来了，好嘛，门诊不让先做，我去挂个急诊号，反正就相差几块钱，现在谁还在乎这么点钱呢！没错，这么做的人还真是越来越多了。白天医院病人多，要排队，晚上人少啊，挂个急诊号，又不用等，一举多得么！
对于这种人，楼主真心想问，你真的知道什么叫急诊吗？不懂的话网上查查啊，不然在去问问医生，你这样的也叫急诊吗？在这里举一个楼主至今印象深刻的奇葩病人为例。
那天楼主上夜班，急诊室打电话来说有个车祸的，怀疑有颅内出血的病人。楼主立马准备起来，没多久急诊室那边就推着一病人来了。好家伙，浑身上下全是血，因为此人没有家属，所以急诊医生护士陪过来的。一般急诊我们医院都是配一名外科一名内科，两名护士。然后这病人刚抬上去做CT，门外就冲进来一人，气势汹汹的说要去院领导那投诉我们。为什么呢？原来是因为那个外科医生送车祸病人来做CT，就把他晾在急诊了，而他正好排在那个车祸病人后面。照他的话，那个车祸的肯定要花很多时间去处理，不如先给他看了，而他的要求也不高，他是来复查的，拍个片子就行了。
楼主当时就呵呵了，你做复查就不能等到明天早上再来，你来急诊凑个毛热闹！你丫那是急诊吗？再说了一般人看到这架势都会主动让伤重病人先做的。你到好，还嫌人家占时间了。医生好说歹说，此人就是不走，最后那外科医生没办法，只好先去给他开单子去了。
后来那人来拍片，我都没给他好脸色看，真心觉得这人活到狗身上去了。
其实有人老说医生态度怎么怎么不好，我到觉得有时不如去想想你自己，毕竟一个巴掌是拍不响的。虽然别的医生怎么待病人我是不知道的。但在我们科室，对于那些主动让给老年人或者一些不方便的人先做检查的患者，我们都会忍不住对他们好一点，放体位的时候动作轻一点。反倒那些动不动就要插队，而且一到医院就便秘脸的人，我们自然也就不耐烦了。
再说一个白天挂急诊病人，当时门外等了很多病人，楼主也一直是按顺序一个一个来的。然后就有个20多岁的小伙儿，拿着张单子一副很了不起的样子走到我面前说，医生给我先做下，我是急诊的。楼主看了眼单子，头颅CT，然后问了句谁做，你做？那小伙儿点点头。楼主一阵无语，说了句排队，就没理他了。在他等的那段时间里，来了个急诊病人，心衰呼衰，插着管子进来的。楼主当然就让他先做了。于是那小伙儿有意见了，都是急诊为啥他就能先做了。我就跟他说，你要是也躺着进来，我也让你先做！于是，楼主又被投诉了:态度不好！呵呵
再说一个跟插队无关的，过年的时候。还是楼主值班，急诊室打来电话说有个病人过来做CT，这个病人有问题
，让我随便糊弄一下过去了。是有什么问题呢，啥叫让我糊弄一下呢。
原来，这个病人说有个外星人把她抓走，在她脑子里放了一个晶片，说是在监视她。奇葩的是，她不是一个人来的，是她的母亲陪她一起来的。她母亲也说她女儿被外星人抓了！到底是母女都是深井冰的概率大，还是外星人真的入侵地球的概率大呢？
再给大家科普一件事，去医院看病要穿宽松的衣服我想大部分人都是知道的。但很多人不知道，如果是肺不舒服来放射科拍胸片，有些衣服一样是不能穿的。特别是夏天，那些衣服上有亮片，珠子，都是要换掉的。虽然机房里会准备一件衣服备换，但这个穿那个穿的肯定不是很卫生的，而且换衣服太费时间了，门口病人多的时候楼主恨不得立个牌子在外面，请换好衣服再进来！
体检中心的确是提前上下班的，因为很多人做完体检都是要去上班的，所以一般体检中心早上6，7点就上班了。因为体检有胸片项目，所以我们放射科也会抽出一个人提前上下班。具体每家医院都不一样的。不过做宫颈的医生是有点过分，好医生还是很多的，碰到不好的就跟我一样来天涯发泄发泄。
这个不否认，有医院同事认识的会帮忙插个队什么，但那只是在病人少的情况下。如果病人多一样还是按顺序来的。病人也不是傻的，比他后来的却比他先做，他肯定要闹意见的。不过做预约检查，下班后给他开小灶的倒是很常见的。
再说说那些贪小便宜的病人。这种病人也是经常见的。比如说某个病人脚痛，医生开单子来拍片，那病人就会说，医生啊，我膝盖也痛，能不能拍脚的时候把我的膝盖也拍进去啊。我:...脚跟膝盖的拍法是不一样的，没办法一起拍的。病人:那你在帮我拍一个膝盖吧，反正都拍了，我不要片子就是了。我:...医生怎么开我就怎么拍的，真不能随便拍。看病真不是买菜啊，还讨价还价买一送一的！
看你做什么了，一般体检胸片你跟医生讲一下，肚子以下穿个铅围裙什么的，影响不是很大的。其实x线没这么可怕，对孕妇造成影响的概率也是很小的，只是现在医疗环境那么差，大部分医院都不愿意冒这个险。万一出点什么事，就麻烦了。所以一般医院备孕妇女都不做的。
不要把x线妖魔化，偶尔一次两次不会有问题的，而且拍胸片的话照射野不会包括下半生。灯泡照亮的地方是有射线的，你下次可以注意看看，有没有包括下体。其实我们给病人盖铅衣是为了让病人放心。很多时候调好放射野不盖铅衣的也是很多的。
说实话，楼主真的很讨厌那些明明不是急诊还挂个急诊号来装13的人，不忙的时候还好，一忙起来那些人就竟给你捣乱。
还是夜班的时候，楼主刚接班就来了一个粉碎性骨折的病人，做完要直接进手术室的。楼主忙的狗似的这时，奇葩来了。一个20多岁的妹子，脖子痛来拍颈椎。在外面死按铃，楼主没办法就趁操作的间隙跑出去。
说一下我们科室急诊的时候门口会挂一牌子，上写：急诊请按铃，按铃后稍作等待，请勿持续按铃。一般人都会按一下然后在旁边等，当然也有一直按的，楼主一般都会跑出去说稍等一下里面有病人在做，做完我马上过来。那病人也就能理解不按铃了。然后这个妹子，首先是拿了一张门诊单子来的，楼主告诉她门诊的现在不做了，你明天再来吧。于是这妹子挺机智，转身就去挂了个急诊号。本来没什么，但是这妹子对按铃真的很执着啊，跟吃了炫迈似的根本停不下来！楼主又疾跑出去跟她说，你稍等一下啊，里面有个重病人在处理，处理完了我就办你拍。好吗，感情这妹子听不懂人话，楼主一进去她又开始按铃。
我不知道别的医院怎么样，我们医院为了在你睡着的时候能听到铃声，那铃是特别响。这么说吧，急诊药房跟我们隔一条走廊，那边有人按铃我这儿都能听到。然后楼主就顶着魔音穿脑做完了那个骨折病人。
我当时再看到那个妹子的时候脸都是黑的，心里真的很想很想罢工不给她拍了。
还是晚上夜班，那时候刚处理完病人正得空闲的时候，奇葩来了。注意，是一群奇葩来了！那是一群十七八岁的小青年，男男女女大概7、8个，拿了张急诊CT单来。楼主一开CT室的门他们一群人就涌了进来。我就说不用这么多人进来的，谁做，一个人进来就行了。这时一个小姑娘开口说，医生，我们钱已经付了，你也不用给我们做，能让我们在CT室待会儿吗，外面有一群人追着要打我们。楼主当场就黑线了，感情你们也知道放射科的门都是铅做的一般人进不来吗。楼主就说，那你们得报警啊，躲在我这儿也不是办法，要是有病人来了我还得工作呢。那小姑娘说，没事的，有病人来我们就走，现在让我们待会儿吧医生。楼主只好答应了。
结果那群人运气还不错，不一会儿就有他们的同伴打电话来说追他们的那群人走了，于是他们也就说说笑笑离开了。楼主望着他们背影，真是越来越不懂年轻人了:-(
呵呵，开这么个帖子还能被人喷了。楼主的立场很明确，不是急诊就不要去挂急诊号。就算挂了急诊号也请给真正的急诊病人留一条生路，胡搅蛮缠不就为了能插个队先做吗？你等一下不会死，但别人等一下就可能有生命危险。这个时候胡闹的恕我真不能给好脸色看！
经常有备孕妈妈问这类的问题，楼主统一回复下好了。关于x线拍片，只要不是针对下腹部的检查一般都是没关系的。CT的话影响比较大，因为做一次CT的力量相较于拍片来说是几百倍的。但是一般医院你拍过片子的话也会劝你放弃这一胎，因为将来孩子有什么不好的话，就算还有许多其他因素，病人第一个想到的肯定是拍片的原因。所以这孩子要不要，就看你自己选择了。
这种病人也是常有的，现在工作久了，一般看病人的脸色表情也能分辨出来了。哪个骨折哪个没骨折，哪个真头疼哪个装的，基本上能对九成。有的病人被别人撞了来医院就各种装，就希望医生给他看严重一点好多赔钱，一般这种人一眼就能看出来。
楼主趁午休过来瞄一眼，今天工作一切顺利。大部分病人都是蛮能理解我们的，而且也很好沟通。就是有一部分人，有一定的仇医心理，只要一踏进医院就拉长了张脸，觉得医院就是坑钱的地方。
还有很多觉得有人走后门才先做的，其实大部分都是自己妄想出来的。有很多病人不仅仅只有一项检查。往往都是先在放射科排个号，再去B超室排个号。然后那边快那边先做。所以有的病人觉得那人明明比我后来怎么就先做了，肯定是走后门的。其实他之前已经来过了。
说到这里我想到我们科室有个逗比，他一个亲戚来做CT，然后他穿着白大褂在病人堆里挤，边挤边喊:大家都让一让啊，我们是走后门的！...结果可想而知。后来那逗比请我们全科室吃饭了，因为他给我们造成了大麻烦。
上面有人说这个不是科普贴，手机看的找不到那个回复了。其实楼主一开始想来科普的就是什么人可以在放射科享受到不排队就能先做的待遇，并没有要科普专业知识，不然说三天三夜也说不完。
我们医院MRI都是要预约的，每天要做的病人要早在前几天就定好了，不会有插队的现象存在。反而CT，拍片，门口总是乱哄哄的，有的病人明明从登记到现在才等了二十分钟，他就要说他都等了一个小时了还不给他做。
现在我们科室的门都是电动的，我记得我以前实习的时候，那个门是要自己推得，来一个病人开门关门，一天要上百次。那时实习一年两个手都是老茧。有的病人还嫌你动作慢了。我去啊，那个门你倒是推推看！
说实话楼主觉得医院在管理上面也有很多不当的地方。毕竟医院跟其他的服务行业不一样，在其他地方可以说顾客是上帝，在医院主导权可不能交给病人手里。告知是另一方面，协商也是另一方面。不能病人怎么说，医生就得怎么做。就像挂急诊，不能是个人就给挂。好歹先看一下这病人到底急不急吧。
另外医院只要有医生被投诉，不管是不是医生的错，结果都是扣钱。我不知道其他医院是怎么样的，反正我们医院有人投诉扣200。
个人觉得那些有事没事就去投诉医生的人基本上就是这么几个。大部分病人来医院是为了看病的，到处做检查都来不及，谁有那个闲工夫跑楼上投诉去。
我记得实习的时候有个人来做阴超，进来的时候看到屋子里有5、6个实习生吓了一跳，其中有男生。我们老师跟她说，如果病人不愿意可以去隔壁房间叫另一个医生给她做。那病人没说什么就躺下了。结果做完没多久那病人一转身就把我们老师投诉了。
话说我们医院急诊现在有另一个名字，叫“夜门诊”，不知道其他医院有没有这个说法？
参照我之前说的，看照射野，有的机房是拍胸片的，射线是水平照射的，而拍四肢的机房，射线是垂直向下的。你的具体情况我也不是不很清楚。这么说吧，只要不在照射的方向，离开机器两米远，即使中间没有任何东西相隔也是照不到射线的。以前我们老师是这样跟我们说的，如果是你的亲戚朋友问你这个问题，你可以告诉他们不用担心，怀孕后按要求定时检查，如果检查都没问题这个孩子是可以要的。但如果是不相识的病人，千万不能跟她说没关系这样的话，因为以后出了事明明不是放射线的问题最后还是会赖到这上面来。所以...
说个真是事，有位妈妈怀孕后照过射线，之后做检查一切OK。但孩子生下来后有一边的外耳是残缺的。我想医生都知道，外耳是软骨，B超是看不到的，但那病人就觉得是医院的错。如果不是医院B超没有检查出来，她在受到射线后就把孩子打掉了，她还把孩子扔B超室门口自己回家了。最后怎么处理的我就不知道了。
（来源：直播党@雨霖铃）
已投稿到：
以上网友发言只代表其个人观点，不代表新浪网的观点或立场。“在心衰治疗上，过去我们犯了一些错误，未来不应该是这样。“
单位：心在线
作者：刘屹
发布时间：
　　访谈嘉宾　　PierGiuseppe Agostoni，国际心肺运动研究和教育学会主席，意大利米兰大学心脏科心衰与心肺功能研究室主任　　特约主持嘉宾　　刘巍教授，首都医科大学附属北京安贞医院副主任医师　　访谈实录　　刘巍教授：各位同仁大家好，欢迎收看本期心访谈，我是来自北京安贞医院的刘巍医生。我们今天很荣幸邀请到意大利米兰大学的PierGiuseppe Agostoni教授，与我们分享有关于心衰的热点话题，欢迎您的到来。　　Dr. Liu: Professor Agostoni, it is my great pleasure to be on behalf of the Great Wall conference, and also , to interview you on a few hot topics of heart failure, welcome.　　Agostoni教授：这是我的荣幸，我很享受在北京的时光，这两天天气也不错。　　Dr. Agostoni：It is my pleasure to be here, I really enjoy my time in Beijing and the beautiful weather having last two days.　　刘巍教授：您是心衰领域的知名专家，我想问的第一个问题是，就此领域而言，您认为今年美国心脏病学会（ACC）和欧洲心脏病学会（ESC）年会都带来了哪些最新信息？　　Dr. Liu: I know your time is very limited, it is our great opportunity to have you here, since you are a well-known specialist in the heart failure field. The first question I want to bring to our audience is, what do you think about the new information such as the new trials which were brought by the ACC conference and ESC conference this year?　　Agostoni教授：有很多新的研究正在进行，也有很多新结果的发布。好比LCZ-696，这种新合成的药物看起来非常有效，作为一种新产品，刚面市时就显示出这么好的结果，让我感到有些震惊，这个新药很有前景。　　也有很多针对于新型药物的试验处于临床2、3期研究阶段，比如作用于线粒体、调节心率方面的新药物，如新一代的依伐布雷定等。这些新药物会在将来发挥作用。这意味着，在5年以后我们会有更多的心衰治疗手段，而现在我们已经有了一些。　　Dr. Agostoni：there are several new trials ongoing and new results have been just released, these deals with drugs which like LCZ，which is the new combination drugs which seem to be extremely effective, I am always a little bit scare when a new stuff came out and it has such a wonderful result to beginning with, WOW, that is a promising idea.　　And there are also older trials ongoing with new drugs still in phase 2 or phase 3, and even in this field there are new mitochondria regulating drugs or there are some new drugs on heartbeat regulation, new generation of Ivabradine, the stuff like that，which may have a role in the future. So there is a lot of things on going, and may be that in 5 years from now, our therapeutic tools will be many more than one we have now, and we already have several.　　刘巍教授：非常感谢，您让我们了解到很多国际会议相关信息。在过去几十年中，心衰治疗有了很大的进展，比如β受体阻滞剂、血管紧张素转换酶抑制剂（ACEI）、醛固酮受体拮抗剂已为心衰治疗的&金三角&。　　您认为，在接下来的几年中，哪些药物又将会成为心衰治疗领域的新突破呢？您刚才已经提到了一些新药物。　　Dr. Liu: thank you very much, a lot of information from those big conferences worldwide. For the last decades, we have seen many breakthrough of the heart failure treatment in the medical treatments, such as β-blocker and ACE inhibitor or even aldosterone receptor antagonist. They lay the foundation for the treatment of heart failure, what do you expect to be the next breakthrough in the next decade in terms of medical treatment of heart failure, as you already mentioned a few new medications.　　Agostoni教授：在我看来，未来几年真正的突破是在可应用的药物、分子技术与患者之间的匹配。　　好比β受体阻滞剂，我们已经有了4种用于治疗心衰的不同药物，美托洛尔、奈必洛尔、比索洛尔、卡维地洛。每种药物都有不同的药理特点，比如，卡维地洛可以阻滞β1和β2受体，美托洛尔和比索洛尔只有β1受体选择性阻滞作用，奈必洛尔还可以刺激一氧化氮生成（产生血管扩张作用）。这些药物对不同患者的作用不尽相同，因此我们应该更好地了解个体患者的病情，并为他们遴选出最适合的药物。　　除了β受体阻滞剂外，我们现在还有很多不同种类的ACEI和血管紧张素Ⅱ受体拮抗剂（ARB），到底应该选择其中哪一种呢？还有各类醛固酮受体拮抗剂，它们价格不同，除此以外，彼此差别在哪里呢？一位患者，为什么我们选择药物A，而不是药物B呢？我对未来的看法就是，医生需要对患者和治疗药物进行更好的匹配。　　Dr. Agostoni: In my opinion, the true breakthrough in the near future is matching between available drugs, available molecules and the patient. For instance, β-blockers, we have now a four different drugs available for heart failure treatment, namely metoprolol, nebivolol，bisoprolol, carvedilol, each of this drug is different and has different pharmacological characteristic. For instance, carvedilol is β1 or β2, metoprolol, bisoprololare β1 only, nebivilol has NO to release, carvedilol is not facility activity and so on. Now they have different effect on the patient, so we have to better characterized each specific patient and use in this patient the drug which tailored best with him, so we need to do a tailoring between patients and drug characteristics, and this is true for β-blocker, and it is true for ACE inhibitors. Because we have several AECI now and ARB, and it is not clear whether to choose one or the other, or I will tell aldosterone drugs, we have several aldosterone drugs available, and they have different costs for the community, but we don't know is it any different or is there a patient who deserve anti-aldosterone drug A versus anti-aldosterone drug B, so we don't know , and this is my opinion in the future,& we are able to better match patients and drugs.　　刘巍教授：如何应用已有药物来治疗同样的患者，您给我们带来了很多新的理念，我想这就是我们现在正在应用的精准医学--我们不仅只是按照指南来治疗患者，而是要进行个体化治疗。　　Dr. Liu：that bring us a very new idea of how to use these old drugs to treat the same patients, and I think this is so-called precise medicine which we are applying now, and this is no longer just we treat the patients according to the guideline simply, but we need to treat the patient individually.　　Agostoni教授：是的，我非常同意您的观点，我们需要对患者进行个体化治疗。　　指南同样重要，但是将来我希望指南不仅是简单地告诉我们，可以用药物A、B、C、D来治疗。我希望指南能够告诉我们，如果患者具有1、2、3点特征，那么药物A应该被首先推荐应用；如果患者符合2、3、4点特征，那么此时推荐药物B。当然这会耗费很多，因为我们需要用很多技术手段来综合评价患者，我们需要进行B型脑钠肽（BNP）检查，需要知道患者的心功能、呼吸功能等。　　心衰是一个综合征，涉及到脑部、心脏、呼吸、肌肉、肾脏系统等。有的心衰患者存在的主要问题是肾脏，有的是心功能，另一位患者可能存在呼吸或交感功能障碍，我们需要对个体患者进行针对性治疗。我们需要提出这样的思考，每位患者都是不同的，我们不能用同一种药物来治疗所有患者，未来不应该发生这样的事情。　　Dr. Agostoni：Exactly, I totally agree with you. We need to do the patient individually, guidelines are extremely important, but I hope then in the future, guidelines would recognize a fact--that we can not just say OK, you can treat the patient with drug A、B、C、D.　　No! we have to have a few guidelines, which tell you if the patient characteristic is one two and three, then A is a drug to prefer, if the patient got this 2, 3 and 4, and then B is the best, but that is very expensive, because we need to evaluate the patient with several technique, we need to have a BNP measurement, we need to know cardiac function, we need to know the respiratory function of our patient so far.　　Heart failure is a syndrome which involve the brain, the heart, the lung circulation, the muscle, the kidney and so far, and one patient the major problem in heart failure is kidney, another patient is cardiac function, another patient is lung function or sympathetic activity, so we need to really tailor therapy on this specific patient, and we have to address this question in a way that each patient is a different case, we can not use the drug for every patient, this is not going to the future.　　刘巍教授：我认为心衰的治疗十分重要，因为就像您所提到的，心衰是所有心脏疾病的最终阶段，大约5个心脏病患者中就有1个心衰患者，这将是未来我们面临的最常见问题。不仅仅是在中国，全世界都是这样。这就是为什么我们需要知道每种药物的作用机制，甚至去了解所有种类的药物。非常感谢您采用了新的思维，带给我们如何用&老药&来治疗的新想法。　　现在很多新药物都已进入了中国市场，但价格并不便宜，因此我们需要为特定患者选择适合的药物，如调整心率的新药或抗利尿激素受体拮抗剂。您认为这些心衰治疗新药的未来如何？　　Dr. Liu：I think this is very important for treating the heart failure patient, because as you mentioned, heart failure is the end stage for all kind of heart disease, almost in five patients there is one heart patient having heart failure, so that will be the most common problem in the future, not only in China, but also worldwide. This is why we need to know the mechanism of each medication, even all types medication, so thank you very much to bring us this very new idea of treating the heart failure patients with the old medication but with a new knowledge.　　A lot of new medications are coming to the Chinese market which is not so cheap, so we need to select these medication for certain patients, such as medication to lower the heartbeat, and also the antidiuretic hormone antagonists medication. What is the future do you think for those new medications in treating heart failure?　　Agostoni教授：关于这个问题，很难有一个简单的答复。在现实生活中，很多患者存在严重的心力衰竭，除了β受体阻滞剂可以明显降低心率之外，伊伐布雷定也能起到类似作用。但是我并不认为，在一般的心衰治疗中需要伊伐布雷定。这个药物确实应用很方便，比β受体阻滞剂好用，但与β受体阻滞剂的比较并没有强有力证据，因此我并不认为伊伐布雷定可以代替β受体阻滞剂，只是在β受体阻滞剂不能很好地调控心率时，才可以在β受体阻滞剂应用基础上使用伊伐布雷定。对于有严重心衰，或心衰合并症如慢性阻塞性肺疾病或哮喘患者而言，可以谨慎应用伊伐布雷定。因为β受体阻滞剂是哮喘的禁忌用药；对于慢性阻塞性肺疾病患者，β受体阻滞剂应用很棘手。　　另一个在心衰方面需要关注的问题是心衰合并症。因为心衰通常和呼吸系统疾病相互关联。因此，我们不仅需要了解心衰方面的问题，还要了解患者的其他疾病情况，比如慢性阻塞性肺疾病、糖尿病等。　　此外，已有一些刚问世的醛固酮受体拮抗剂，但各个药物之间的效果对比情况我们还不是很清楚，现在有一些针对于这方面的研究，但还在初级阶段，无法评估哪种药物作用更好。　　总之，现在我们没有理由放弃那些用了很久的&老药&，比如螺内酯，这类药物价格更加便宜。在我的国家--意大利--我们需要以最低的消费提供最好的治疗，社会服务体系和政府都在关注用药问题，也许我们用得并不是厂商希望的用药，不过这就是另外一件事了。　　Dr. Agostoni: It is not easy to give you a simply answer, in reality in patient with severe failure, drugs reducing heartbeat on top of β-blockers obviously，like ivabradine may have a role, however I do not feel ivabradine has a role in the general heart failure treatment, in reality ivabradine is an easy use drug, much more easier than β-blockers，but the data we have comparing ivabradine and β-blockers are not so strong, and I don't think you can take away β-blockers and use ivabradine, you can only use ivabradine on top of β-blockers when they are ineffective in regulating the heart rates, that is a rare event, but possibly particular in patient with severe failure or in patient with some sort heart failure comorbidity, like COPD or asthma, when β-blockers may be contraindicated asthma or more difficulty to be using in COPD, when you can use them , but you have to be careful.　　And other major problem for heart failure is number of comorbidities you have, because heart failure is frequently associated to guys for instance they have lung disease as well, so when you start on a patient, you need to know not only the heart failure problem, but also if he has comorbidities, COPD, diabetes, namely there are several.　　As anti-aldosterone drug, We have several new drugs coming out to the market, and as you know, comparison between different drugs is not been done, or it is just a trial going now, it is really at the beginning, so I don't know if the group of anti-aldosterone drugs we are going to have someone which is better.　　At present there is no reason to not to give the old ones like spironolactone for instance, which are much much more cheaper , one of the problem I have in my country in Italy is to provide the best possible treatment for these patient at the lowest possible cost, because we have a socialized system for medicine and the government used to be careful in which drug I am using ,which is not the exactly the drug company wants me to do, but that is the different story.　　PierGiuseppe Agostoni教授　　刘巍教授：是的，在中国也是这样的处境，我们也需要以最少的花费来治疗心衰，因为心衰需要长时间的治疗。那么，下面让我们把话题转到心衰的长期治疗上面。我得知您发表了很多关于心衰患者心脏康复的著作，但是中国大多数医院并没有正式的心脏康复项目。您能否和我们谈谈对心衰患者进行康复治疗的重要性问题，以及怎样在这些医院开展心衰康复项目吗？　　Dr. Liu：yes, that is the same situation in china, we still need to treat the heart failure patient with the medication at lowest price, because the heart failure patients need the long time treatment, so let's just move on to the long time management of the heart failure patients, I noticed that you have published quite a number of the manuscripts in the cardiac rehabilitation for the heart failure patients, but in china we don't have a very formal cardiac rehabilitation program in most of the hospital in china, so could you tell us the importance of cardiac rehabilitation, especially for the heart failure patients, and how to initiate a heart failure rehabilitation program in the hospital?　　Agostoni教授：心衰患者的每天运动量较前减少了，因为他们感到疲惫、呼吸困难，也有慢性肌肉疼痛。我们必须要提出&心脏康复&这个概念。　　心脏康复就像是一种非常便宜的&药物&。患者必须要意识到他们需要进行心脏康复。最重要的是，医生要告知并患者需要运动并进行监督。　　了解患者所需运动量及其疲惫原因的最佳方法就是进行心肺功能测试，这是医生的首要工作（之一）。在我看来，应对每位患者进行心肺功能测试，以了解每位心衰患者的基础运动量、康复运动时的心率。如果医院有正式的康复项目最好，这样能够让患者在医院进行集体康复训练；并可就根据患者的表现，来指导他在家里的运动。　　强烈建议每个心衰病房都应建立正式的心肺功能测验体系，就像我们给每位心衰病人进行超声与血液化验一样。如果医院没有心脏康复体系，那么，当患者出院时，医生应叮嘱患者：&请你一定要锻炼，比方说，每隔两小时内走500米，去做你可以做到的事情。&　　在米兰，我们医院有两种类型的康复体系。一种针对住院、无法出院、或接受了心脏外科大手术的患者。第二种为院外患者所设计，一周就诊两至三次，在每次1~2小时的沟通期间，我们会按照患者的需要，为其制定活动与心理辅导课程。这些都是由护士完成的。医生会在康复项目启动与完成阶段提供指导。　　患者出院后，我们有时通过远程监视系统，要求并监测患者在家里完成相应的锻炼；或者，很多情况下，我们请患者写下他们所做过的事情，与期待运动量进行对比，以上是对患者进行院外管理的最好方式。　　心衰患者的再入院，造成了极大的经济负担。心脏康复项目可以降低再住院率，减少医疗花费。　　Dr. Agostoni: patients with heart failure tends to limit themselves and to do every day a little bit less exercise than the day before, this is because they feel of fatigue, they feel short of breath. So far, however, that introduce the problem with a chronic muscle disease which is part of the syndrome, now we have to counteracted it by rehab, rehab is like a pill which is extremely cheap, patient has to realize that he really need to rehab himself, and you may have a formal program, but the most important thing is to tell the patient 'please do some exercise', and check if he does it or not.　　The best way to realize how much exercise he has to do and what are the causes of his fatigue is to perform a cardiac pulmonary exercise test, to do pulmonary exercise test in my opinion is mandatory in each heart failure patient to realize that what is limiting to him, how much is limited and what is the heart rate at which he need to rehabbed, you may have a formal rehab program with patient in the hospital doing exercise all together, it is better if you have, but even if you don't, once the patient goes home, you tell him, &please exercise, do five hundred meters for every two hours, do what every you can&, but the best way to do is that you do formal kind of pulmonary exercise, you know what the patient performance is and then on this your tailor is the exercise activity at home, so if you have done this, it is easier to tailor the exercise which the patient must do. And in this way, strongly recommended each heart failure unit have a kind of pulmonary exercise test that supposed to be there, you know we do echo to everybody, we do blood test to everybody, in reality patient do not lay on bed, patient need to do some activity because they need to go to work, they need to go shopping, they need to do whatever they have to do in the daily time, so evaluating the physical activities is our number one problem in our heart failure patient.　　We have two type of rehabs in hospital in Milan, one is for inpatient, the patient who are not able to be dismissed from, discharged from the hospital, or patient underwent major cardiac surgery. And second type of rehab which is for the outpatient, the patient coming in twice a week, three times a week, for 1 hour, 2 hours, whatever is needed to do. And they have physical activities lessons, psychological lessons and you check the patient. That is all done by the nurse, the doctor is present in the beginning and at the end. But nurses do all the problems.　　The patient is instructed to perform activity at home, in some case we surveillance this activity by the telemonitory, or in many cases we tell the patient just to write down what he has done. And he has a piece of paper, when it its written, this is your daily activities you have to do, and this is what he really has done, and so you double check it. What at the end, this is the best way to take the patient out of the hospital.　　What is expensive in heart failure treatment is re-hospitalization, and the patient with severe failure, we have re-hospitalization rate which may be three, four or five times per year, and that is expensive, so if you are able by taking the patient outside of the hospital to reduce the number of re-hospitalization, then you save money, so rehab becames a saving money system.　　刘巍教授：心梗患者呢？何时应对他们进行心脏康复治疗呢？　　Dr. Liu：How about the patient with acute myocardial infarction, when do you start the cardiac rehab for these patients?　　Agostoni教授：待心肌梗死患者病情稳定后，心脏康复开始得越早越好，这一点十分重要。尽快开始心脏康复十分重要，康复成功性越大。如果病情严重，则可以等待一些时间。谨记患者需要运动，如果患者未再发作心绞痛，病情平稳，应及早进行心脏康复。　　Dr. Agostoni: after the MI, this rehab must start as soon as possible, provide that the patient is stable. If the AMI is a devastating MI，you may have to wait a little bit, but if it is mild MI, you please rehab as soon as possible, because it maybe a major problem, if you take the patient with MI leave in the bed for two weeks, then rehab is much longer. If the patient stay in bed for a few days, then rehab is shorter and you can have greater success with it. So please remember the patient has to move and if he is stable from angina point of view, no ischemia attack, then rehab as soon as possible.　　刘巍教授：我很同意您的观点。一项好的心脏康复项目，将会有效降低心衰再入院率。很多年前，我在美国实习，那边的心衰项目是由心内和心脏移植外科专家组成的心衰团队共同完成的，在欧洲也是这样的吗？　　Dr. Liu：I am agree with you. With a good cardiac rehabilitation program, the re-hospital rates for the heart failure patient will be much decreased, this comes to another question, for myself, I was a fellow in united states years ago, so I am very familiar with the heart failure program, heart failure team in united states, which consists of both cardiologist and cardiac surgeon of the transplantation team, how about that in Europe? Are they similar?　　Agostoni教授：我在美国也进修学习过。欧洲有所不同，分类更细，根据不同需要，我们有不同的心脏团队。　　比如说，如果患者心功能不全合并二尖瓣反流，是否要进行经导管二尖瓣夹合术呢（MitraClip）呢？这时就需要心脏外科、心衰专家，影像专家共同决定，由心衰专家来牵头。有时，从事起搏器置入如心脏再同步化治疗（CRT）的专家也参与进来，影像科医生也会提供支持。同样，决定是否进行经导管主动脉瓣置换，也需要心脏团队来进行决策。　　因此，心脏团队不是仅由两个人组成的，而是由5~6个人组成。我们有不同的心脏团队，包括主动脉瓣、二尖瓣治疗团队等，每天或隔日进行交流，确保团队为患者提供最佳治疗方案。　　在心脏团队中，心衰、心脏外科、影像科医生会全程跟进，起搏器医生有时参与，心脏康复医生在需要时加入。总之，我们是根据心衰医生的治疗方案，来决定不同的团队组成。　　Dr. Agostoni: I have been a fellow in united states as well. We have different approach, it is more disciplinal, the problem is the cardiology nowadays does exist in the huge term, because you have the imaging cardiology doctor, you have the electronic physiology, you have the emergency doctor and so far. So we had different cardiac team, it depends on what you are doing.　　For instance if you have a patient with heart insufficiency, and mitral valve insufficiency as well, then you may decided to look if the patient need a MitralClip. In this instance, you have the surgeon, the heart failure specialist, and the imaging doctor who are together in the same field, frequently, we have also the doctor who put pacemaker like CRT, because the process must be driven by the heart failure job doctor, but the team must come out and tell about the possibility, so you need to know this guy is severe heart failure and severe MR insufficiency. Is MitralClip possible or not, in some case yes, but some cases not. So that the imaging doctor will help us to decide. Or, are we going to put our aortic valve replacement as TAVI like that, then again you need to have the heart team together.　　So the heart team is no more two people, the heart team is made five or six people together, and we see each other everyday or every other day in this heart team, but the heart team is not just exactly the same, so we have the aortic valve team and the mitral valve team, and so far it is separated into different groups to be able to follow up the patient from the best way.　　Obviously ,the heart failure doctor will be always there, and the surgeons are always there, but the imaging doctor is always there, the pacemaker doctor is sometimes there and the rehab doctor, may show up in depend, so we have different heart teams according to what the heart failure doctor think is the future for this patient.　　刘巍教授：这听起来非常令人激动，你们有这么多的专家来治疗护理每位患者。　　Dr. Liu：That sounds very exciting. For a single patient you have so many specialists taking care of this patient.　　Agostoni教授：在欧洲，CRT治疗需要花费1.5~2万欧元。中国也是如此吗？　　Dr. Agostoni: You know the pacemaker CRT costs 15,000~20,000 Euro, I don't know how much is in china.　　刘巍教授：在中国也是一样的。　　Dr. Liu：Most the same in china.　　Agostoni教授：确实很贵。对于左心室辅助装置（LVAD）也是如此，由心衰专家，麻醉科、心外科、影像科医生组成的心脏团队共同决策，仍是由心衰专家来主导。我们已有很多治疗手段，现在需要在确保治疗效果与节省经济花费之间寻求平衡。如果决策错误，将会导致极大的浪费。　　Dr. Agostoni: It is extremely expensive. So even if you think half an hour there are several people should put it or not, I mean if you decide not to do it, you save a bunch of money, but you need again to pick up the right device for the right patient. Now we have so many device available, you cannot put it all together, if it is not right for your patient will cost you a fortune. That is same for LVAD, left ventricle assistant device. We had heart failure LVAD, which include the anesthetist, the surgeon, the heart failure doctor, the imaging doctor for some part of it so far. And that again is heart transplant doctor, and that again, the heart failure doctor is the major. You say too many specialist for one patient, no, because you have to be sure that what you are doing is the right thing for this specific patient. If you take the wrong decision, that is a bunch of money. If you implant LVAD to the patient, and the patient died anyway. It is a bunch of money you have lost. If you put the LVAD in the patient who don't need it again, so we have to extremely concern about the balance between the good patient treatment and the economic conditions.　　刘巍教授：您刚才提到，在你的医院，开展了CRT、MitraClip、LVAD和经导管瓣膜病治疗，多少比例的心衰患者会接受这类治疗呢？　　Dr. Liu：These are a lot of issues for treating heart failure patient, and also you mentioned, now in your hospital, you have a lot of devices, such as CRT, MitralClip, and also those valve transcatheter procedures for the valvular heart failure patients, and also LVAD, so how many percent of the patient receive those devices in the hospital? I mean Heart failure patients.　　Agostoni教授：根据心衰严重程度而定。30%心功能3~4级的心衰患者会接受植入型心律转复除颤器或心脏再同步化治疗，未来可能这一比例会更高。我们需要确定置入起搏器将真正使患者获益，因为在急性期和慢性期，起搏器置入都可能会导致并发症发生，如心内膜炎。其他治疗也是一样的，比如，我所在的医院对我每年开展的LVAD治疗量是有限制的，每年5~10例，也许您觉得这个数目很大或过小，事实上，在我工作的意大利有1千万居民，据此我们将LVAD总体开展比例限定为60~70例/年，这个数字是合理的。　　Dr. Agostoni: It depends on the severity of the patient, if we talk about the patient in class three and four, nowadays 30% of the patient are treated with ICD or CRT. There must be more, but we many times because of several comorbidities, it is not worthwhile for us to go into this direction, or to avoid, the pacemaker is not only put, that is it. Pacemaker can have complications even in the acute phase, but also on chronic phase. If you have a pacemaker with an endocarditis on the lead, that is a problem. You need to be sure to put pacemaker in a patient who would benefit from it, who would have very mildly likely to have pacemaker complication. It is the same thing for LVAD, the same thing for MitralClip, the same thing for TAVI so far. For instance, for the LVAD problem, I have a number of LVAD limited per year I can put, so I have my hospital allowlled me between 5~10 per year, which you think maybe a lot, or maybe a little number, in reality, it is we think a fair number in my area which the country where I work in Italy. We have ten million on residence, we believe that the number of the IVAD we needed per year is 60~70, so that is our average need for LVAD device.　　刘巍教授　　刘巍教授：器械治疗很受心脏科医生关注。然而，中国的现存问题是，很多心衰患者可能会被拒绝收入院治疗，而是在急诊室接受治疗。你们国家也有同样的情况吗？怎样解决这一问题呢？　　Dr. Liu：Device is always the interesting, or be attractive to the cardiologist, but we come to a very serious question now exist in china, because even in my hospital, one of the largest hospitals in China for the cardiovascular disease, a lot of heart failure patients would be denied from the hospital they should, some of the patient will be stayed in ER, and couldn't be hospitalized, so do you have the same situation in your country? Or how do you solve the problem?　　Agostoni教授：在我们国家也会出现同样的情况，在每个急诊室，都会有很多患者躺在那里等待治疗。因为通常是老年人患有心衰，而家里一直有人照顾老人是很困难的一件事，因此老人被送到了急诊室。在我看来，心衰的治疗最好尽量在门诊解决。如果要收入院，就必须有专门的心衰病房。如果这些患者在普通病房接受治疗，我并不是说他们无法得到很好的治疗，但治疗确实会不充分。　　不尽人意的是，在意大利，仅有10%的患者是在心衰病房接受了治疗，其余90%是在普通病房接受治疗，虽然这样是一种治疗办法，但并不理想。因此，完善的门诊系统应与院内心衰病房关联起来，使门诊和住院患者得到连续性的治疗，由相同的医护人员照顾患者从门诊到住院的整个流程。这其中，远程监护系统非常重要，心脏康复也是项目的一部分。　　Dr. Agostoni: It is absolute the same situation, there are two reason because of this case, reason number one, heart failure is a disease of the elderly people, and taking care of the elderly patient at home may be difficult, because you need to have somebody of the family stay with him, and that is sometimes not possible, and because son and daughter all have to go work and stuff like that, so they send the patient to the hospital in emergency room, so if you have the emergency room, if you have the plenty of patients lying and being waiting for being treated. In my opinion, if you build up a heart failure problem, you must try to build it basically an outpatient base, as much as possible, but if you need to have the heart failure in hospital, then you have to have a heart failure department inpatient, because if the patient is in general medical department, then sometime he is not, I don't want to say not treated well, but he is treated in a less aggressive way, that should be done in a heart failure department.　　But unfortunately, we in Italy when one hundred of the patient with heart failure, only ten is in heart failure department, 90% are in the general medicine department, which is in need, but not probably a best situation, so the strong outpatient department and heart failure unit inside hospital, they must be linked, in my ward is continue between in and out patient, it is the same people, the same nurses taking care of patient when he is inside or outside of the hospital, and the telemonitor is again important and rehab is a part of program.　　刘巍教授：我们医院今年开设了心衰病房，希望能够解决急诊心衰患者的问题。正如您提到的，我们将门诊和住院关联在一起。我是心脏病介入医生，大多数时间我在做介入手术，最近我了解到了干细胞疗法在心衰、心肌病中的应用。欧美正在进行这方面的研究，如您所在的中心参加了C-CURE研究。您认为干细胞治疗终末期心衰的前景是什么？　　Dr. Liu：In my hospital, this year we opened up a heart failure program, we hope that heart failure program will solve the problem for patients in the ER. We just do what you have mentioned, we linked the outpatient with the inpatient service for the heart failure patients, and for myself, I am an interventional cardiologist, most of the time I am doing the percutaneous intervention, recently I know that lots of percutaneous stem cell treatment for heart failure, for cardiomyopathy, those trials are going on in unite states, or in Europe, such as the C-CURE study, I knew that your center is also one of the centers for this study, what is the perspective for this stem cell treatment, for the end stage heart failure patient?　　Agostoni教授：现在我们医院有两项研究正在进行，下定论还为时过早。如果您想听听我的看法，我想说的是，我们之前在干细胞治疗上犯了一些错误。因为，10年前我们第一次在患者身上开展干细胞疗法，确实太仓促了，没有完成所有必需的实验室研究，也没有得出结果。我们正在改进我们所应用的干细胞质量，我不确定以后会发生什么，我希望会有很好的前景，边走边看。　　Dr. Agostoni: We have two studies of stem cells going in our hospital nowadays, it is too early to say anything, if you want my personal opinion, we have made with the stem cells mistake because 10 years ago, we start with the first study of stem cells in patient, that was too early, we have not done all the laboratory study needed, that is a problem because we don't have the result, we are improving the quality of stem cells we are using, I am not sure what is going to be in the future, I hope it is good, but still we are very in the too early phase to say anything, so we have to work hard and watch and see.　　刘巍教授：您说的非常好，接下来让我们聊聊不那么严肃的话题，您来过中国几次？　　Dr. Liu：Very good, so let's just talk about topic which is not so serious, and how many time have you been to china?　　Agostoni教授：这是第三次。我来过北京，也去过中国的边界--中国和尼泊尔交界的地方，在珠穆朗玛峰做过高原病的研究。我相信低氧是导致心衰的原因之一，在高海拔区域，我们可以研究低氧对心衰的影响。我很喜欢北京，在北京不同的地方购物很有意思，我很享受在这里的时光。　　Dr. Agostoni: That is my third time, I came only to Beijing, I have been to the China border between the Nepal and china several times to do experiment of high altitude, in the Everest region, so I was very in and out for the Chinese border over there. Because we believe that the hypoxia is model for heart failure, and at high altitude, we have only a hypoxia condition not the rest of heart failure, so you can just study hypoxia yourself, and that was also another time I was in China and nearby the border, but I enjoy Beijing very much, I have been shopping around different places in Beijing, it was fantastic and I really enjoy my time here.　　刘巍教授：您对中国的医院有什么感受呢？　　Dr. Liu：How about your impression of Chinese hospitals and also the conferences?　　Agostoni教授：我去过几家中国医院，它们的规模太大了。我工作的地方是一家心脏病专科医院，很小，不像我以前在美国西雅图工作过的医院那么大。但是都没有我在中国看到的医院大。两天前，我参观了参观中国人民解放军301医院，我很惊讶，这简直就是一个城市啊，并不是一所医院。很多医院秩序井然，非常干净。　　我也参观了一些中医医院。我想说的是，西方医学应把中国传统医学的理念纳入进来。在西方，我们将机体分成许多部分来分别看待，我们需要以整体思维来全面治疗，将患者看作是一个整体，这也正是心衰治疗的未来，不能只考虑肌肉、心脏或者肺脏，而不是把它们作为一体进行治疗。　　Dr. Agostoni: I have been to a few hospitals, and I was impressed by a few of them, they were huge, I worked in a hospital which is just indicated to the heart, so it is a small hospital, in this State, I was working in Seattle, it is huge but no one has been huge as I saw here. The two days ago, PLA 301, and I was astonished, it is a city not a hospital. So that was really, but almost all the hospital work very well, very clean, and also went to some Chinese traditional medicinal hospital.　　The thing I think you should remember if I can say something is your traditional medicine must be part of western/new medicine, and the concept that we need to treat the patient in logistic way, all the patients, the body is one. You know in western we divided the body in different pieces, pieces one and one, nowadays we have to try to put them again, go back to a whole body consideration. More logistic way to analyze. And I think this is the future, the heart failure must be treated in a logistic way. You cannot treat the muscle, treat the heart or the lung without treating all together.　　刘巍教授：这就是我们现在正在做的，将中国医学与西方医学相结合来共同治疗心衰病人。　　Dr. Liu：This is what we are doing now, integrating Chinese medication and also western medication in treating heart failure patient.　　Agostoni教授：确实是，去年我们在酝酿评价心衰患者的评分软件，已纳入从意大利24家医院招募的六千名心衰患者。这个评分系统叫做Mecki Score，是将代谢运动与心、肾参数关联在一起制定的评分，从一项非常详尽的研究中得出了六个参数，分别是：① 血红蛋白，因为贫血很重要；② 通过&肾脏病膳食改良试验&（MDRD）公式计算出的肾脏功能；③ 左室射血分数；④ 血清钠水平；⑤通气效率（VE/CO2）作为重要的心肺功能检测指标；⑥ 运动峰值氧耗检测。这些参数的诊断正确率为80%，是很有价值、值得信任的综合评分系统。　　Dr. Agostoni: Absolutely, we have just in the last year prepare score for evaluating heart failure patient, we have now six thousand heart failure patients, which PULMNOARY testing on five from 24 different hospital in Italy, this is a MECKI score, or a metabolic exercise combined with cardiac and kidney score , which is based on the six parameters which came from a complicate sophisticated study, this parameters are hemoglobin, because anemia is important, kidney function by MDRD, left ventricular rejection function, the sodium level, VE/CO2 as major cardio pulmonary testing, and peak exercise oxegen consumption. These six parameter are able to give you a prognosis which as 80% ability to be right. And this is strong, so we believe very much in this scoring system, because this scoring system is comprehensive to whole body.　　刘巍教授：这项评分系统也能反映动态的治疗过程。　　Dr. Liu：And also this score can be a dynamic of the treatment.　　Agostoni教授：是的，可以动态评估，而且可以免费使用。如何使病情最重的患者得到更多地关注，我们需要这个评分系统，我认为这是最好的方式。　　（编者注：Mecki Score评分系统可以在Apple Store下载。）　　Dr. Agostoni: Yes, can be dynamic, you can find them on the internet in free of charge, everybody can use it if you want, you just need to make then you go into the internet, and find out how to, this is scoring, and they provide using numbers, and thinking is the best way to stage your patient, because again, the patient need more attention on those who are the sickest, you need to have a scoring system.　　Mecki Score心衰评分系统　　刘巍教授：我非常赞成应用评分系统对心衰患者进行评价，将来，我们将会用评分系统来预测心衰患者的预后，并为其选择最好的治疗方法。今天您谈及了很多关于心衰方面的知识，包括新药物、新研究，以及心脏康复项目的重要性及其如何在中国开展。心衰评分系统也令我们印象深刻，非常感谢您。　　Dr. Liu：I really appraise that the scoring system for the heart failure patient, I think in the future, we will try to use those scoring in predicting the outcome of the patients with heart failure, and choose the best treatment for him. Today is very good, we have a lot of knowledge from you about heart failure, which including the new medications and also the new trials and also the cardiac rehabilitation program, the importance and how to initiate especially in china which we don't have. And also we knew about a lot of new knowledge like the scores for heart failure, and also impress us, are very encouraging to us. Thank you very much.　　Agostoni教授：非常感谢，我的荣幸。　　Dr. Agostoni: Thank you very much, my pleasure.（策划 编辑：刘屹&& 中文字幕：刘巍 吕寒& 视频后期 陈静&& 美编：柴明霞）相关链接：&&&&&&