How to conduct a scientific medical examination?
2020-06-15
Many people have such questions about medical examinations: "Which items should I do for medical examinations? Are they more comprehensive and will not cost you money?"
First of all, I will ask the question, "How did you choose the medical check-ups before? Did you take the package given by the medical check-up center, and then cross out the cheapest one first, because the search is definitely not complete, and then cross out the most expensive one, because I think There must be a lot of unnecessary items. Finally, choose a compromised price. Is that the case?" I guess most of you are like this. The selection of medical checkup packages is similar to online shopping. It depends on the price. So today, let’s talk about which items are more recommended for the annual physical examination, and which ones can be done or not?
1. Basic information
Including height, weight, heart rate, blood pressure, etc., these will not be discussed, and the next start.
2. Blood test
We all know that a physical examination is definitely a blood test. In addition to the most basic blood routines and liver and kidney functions, we can see various dense blood test items in many physical examination items. Which of them are more important?
With the improvement of quality of life, the proportion of people with cardiovascular disease has increased year by year, and there is a trend of becoming younger. As an important reference for predicting cardiovascular disease, blood lipid examination has received more and more attention. It is recommended to be over 30 years old, or body type People who are overweight or have a family history of cardiovascular disease regard blood lipids as a mandatory item.
The blood flow shear rate is also called blood viscosity. When it comes to blood lipids, I will talk about this. There has been a hot test. In recent years, because of the lack of sufficient clinical data support, various guidelines have not recommended this test. If it is a routine physical examination Not recommended.
Tumor Markers Many tumors will produce special substances into the blood circulation during the growth process. Many early tumor patients are found through physical examination to see abnormal tumor markers. But now there are hundreds of tumor markers known, don't you always do it? Which ones are more recommended? Here, I personally recommend carcinoembryonic antigen (CEA, lung adenocarcinoma), carbohydrate antigen 72-4 (CA72-4, gastric cancer), alpha-fetoprotein (AFP, liver cancer and reproductive system tumors) during physical examination, Women can add CA153 (breast cancer) and CA125 (ovarian cancer), and men recommend adding prostate specific antigen (PSA, prostate cancer).
So who recommends the detection of tumor markers?
1. People over 40 years old;
2. Long-term exposure to carcinogens;
3. People with high cancer incidence or family history of cancer;
4. Those who have "cancer signals" in their bodies.
Infectious diseases are related to Hepatitis B, Hepatitis C, Hepatitis E, Syphilis, AIDS, etc. You can make your own choice based on your usual exposure. In addition, because hepatitis B is the highest incidence of infectious hepatitis in my country, the proportion of hepatitis B patients or carriers in the population is very high, and the probability that we are unconsciously exposed to hepatitis B virus is not low.
The blood tests in the physical examination are mainly these items. If there are no special circumstances, other blood test items can generally be done or not. Of course, if you have a history of chronic disease (such as type 2 diabetes, etc.), you need to do a blood test related to the disease.
3. Ultrasound
The popular name is B-mode ultrasound or color Doppler ultrasound. As a clinician's "eye", ultrasound is now almost capable of examining all organs except the lungs and gastrointestinal tract, and the accuracy is very high. The biggest advantage of ultrasound is that it is "non-invasive". Compared with the discomfort during gastrointestinal examination and the "eating radiation" that is worried during CT examination, ultrasound examination can be said to be a high-quality inspection item that almost everyone can accept. Common ultrasound examinations include: liver, gallbladder, pancreas, spleen, kidney, thyroid, breast, heart, neck blood vessels, and lower extremity blood vessels. You can propose to examine a certain part according to your needs. For example, people with long-term hypertension recommend to add cardiac ultrasound and neck vascular ultrasound examination for each physical examination.
4. X-ray and CT
Taking chest X-rays or chest X-rays has always been one of the methods for screening for lung diseases, but in recent years it has been gradually suggested to be replaced by low-dose CT scans of the chest. The reason is that chest radiographs are far less sensitive than CT in lung cancer screening. In general, the smaller lesions are not visible.
According to a multi-center study published by NEJM in 2011, chest CT screening can reduce the death rate of lung cancer by about 20%. As the "cancer king" who always accounts for the highest morbidity and mortality in China, this result can be said to be It makes a lot of sense. Modern medicine has quite effective cures for early lung cancer and precancerous lesions, so the sooner the lung cancer is discovered and diagnosed, the better the prognosis. For many people, the worry is whether CT should "eat more radiation", will it damage your health? The low-dose CT currently used for medical screening is generally to reduce the radiation dose to the ordinary 1/4~1/6, which is equivalent to the radiation dose of 1~2 chest radiographs, which is a very safe dose for the human body. , No need to worry about this. It is recommended that people aged 40 years or older, with a history of smoking, long-term passive smoking, and areas with more severe smog, use low-dose CT of the chest as a routine physical examination item every year.
5. Gastroscopy and enteroscopy
It is also a highly morbid and highly lethal cancer species in my country, especially gastric cancer. Early gastric cancer often has no symptoms. When you feel uncomfortable, go to the doctor. When it is found, it is often called the middle and late stage, and the prognosis will be far worse than that of early detection. With reference to our neighboring country, Japan, gastroscopy is a routine medical check-up for people over 45 years of age. In our country, the advice of experts is that it is best to have a gastroscopy every 2 to 3 years for people over the age of 50. Those who have no family history of gastric cancer under the age of 50 are recommended to have a gastroscopy every 5 years. Check the gastroscope once. For colonoscopy, many experts also recommend that the general population over the age of 50 should be checked every 2 to 3 years. High-risk groups (including history of enteric inflammatory disease; long-term chronic diarrhea, chronic constipation, history of mucus blood stool; chronic appendicitis or After appendectomy, biliary diseases, diabetes; history of lower abdomen radiotherapy, etc.), it is recommended to start the examination at 40 years old, and if there is a history of bowel cancer in the close relatives, it is recommended to start colonoscopy from the earliest age of the relative diagnosed bowel cancer minus 10 years old Screening. So the question is coming, why is the popularity of gastroscopy in my country so low? On the one hand, economic reasons, on the one hand, the lack of popular science (what I am doing), and on the other hand, people's fear of gastrointestinal examination. Not to mention ordinary people, many medical staff all have the expression of “going to the execution ground” when it comes to gastrointestinal endoscopy. Because the popularity of anesthesia in outpatient work is too late, painless gastroscopy and enteroscopy are rarely known. Everyone always feels that being a gastroscopy or enteroscopy is a very painful thing. In fact, almost all experienced People with painful gastroscopes will tell you this will be a comfortable experience.
Six, oral examination
In recent years, one of the popular medical examination projects can be said that the more social progress, the more attention is paid to oral health, and tooth cleaning has become a task that many people must do every year. Having a good tooth is not just for beauty, it is also important for good health. When conditions permit, it is recommended to have an oral examination once a year.
Seven, bone and joint inspection
Including cervical vertebrae, lumbar vertebrae, bone density, etc., it is not a necessary physical examination. It is generally recommended that such items can usually be increased if there are related symptoms. Although cervical spondylosis has become an occupational disease for more and more people in today's cities, my recommendation If you have discomfort in your neck and shoulders, you should go to the hospital honestly.
Of course, the medical examination package is different for men and women for screening diseases, and for women, age stratification will also lead to different examination items. Although sometimes it will recommend you many other kinds of tests, accompanied by various taller explanations (especially various genetic tests), but from my point of view, I mentioned in routine physical examination The first six items are recommended. Other inspection items need to look at the wallet and personal conditions.
