基于德尔菲法对冠心病痰瘀互结证辨证依据的研究
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摘要
[目的]基于德尔菲法专家咨询明确冠心病中医痰瘀互结证的辨证依据。[方法]在课题前期循证医学文献系统评价基础上,经过多次讨论修正,初步拟定《冠心病痰瘀互结证德尔菲法专家咨询问卷》,在全国范围内,先后开展了两轮德尔菲法专家咨询,共计88位专家参与。第1轮与第2轮咨询问卷的回收率及每位专家对各个问题的应答率,均为100%。[结果]冠心病痰瘀互结证德尔菲法专家咨询问卷的总信度为0.589 0,效度为71.724%,提示所拟定的专家咨询问卷稳定性及有效性尚可。对两轮咨询问卷条目的重要性、集中度、变异度及其排序进行分析,结果表明冠心病痰瘀互结证辨证依据的关键条目为胸闷、胸痛,苔腻,舌质暗(黯)紫,重要条目为舌有瘀斑、瘀点,肢体困重,唇青紫,备选条为脉弦涩,面色晦暗,体胖。[结论]该研究冠心病痰瘀互结证辨证依据的结果可作为临床辨证时的参考。
[Objective] To evaluate the relative importance of syndrome differentiation basis of intermingled phlegm-blood stasis syndrome in coronary heart disease. [Methods] On the basis of the literature evaluation system,expert consultation questionnaire for intermingled phlegm-blood stasis syndrome differentiation of traditional Chinese medicine(TCM) was formulated. two rounds of the modeling symptom quantitative evaluation of the importance of syndrome differentiation basis of intermingled phlegm-blood stasis syndrome in coronary heart disease was constructed. A total of 88 experts were participated. The recovery rate and each question response rate were 100% in two expert consultation questionnaires. [Results] The reliability and validity of two rounds of consultation total were0.5890 and 71.724%,which suggested that stability and validity of the questionnaire were acceptable. The key items for diagnosis of intermingled phlegm-blood stasis syndrome in coronary heart disease were chest tightness/pain,greasy coating,tongue dark purple. The important items were tongue with petechia or bruise,heaviness of limbs,bluish lips. The optional items were wiry and choopy pulse,dim complexion,obesity. [Conclusion] The results of this research could serve as a reference for diagnosis of intermingled phlegm-blood stasis syndrome in coronary heart disease.
[Objective] To evaluate the relative importance of syndrome differentiation basis of intermingled phlegm-blood stasis syndrome in coronary heart disease. [Methods] On the basis of the literature evaluation system,expert consultation questionnaire for intermingled phlegm-blood stasis syndrome differentiation of traditional Chinese medicine(TCM) was formulated. two rounds of the modeling symptom quantitative evaluation of the importance of syndrome differentiation basis of intermingled phlegm-blood stasis syndrome in coronary heart disease was constructed. A total of 88 experts were participated. The recovery rate and each question response rate were 100% in two expert consultation questionnaires. [Results] The reliability and validity of two rounds of consultation total were0.5890 and 71.724%,which suggested that stability and validity of the questionnaire were acceptable. The key items for diagnosis of intermingled phlegm-blood stasis syndrome in coronary heart disease were chest tightness/pain,greasy coating,tongue dark purple. The important items were tongue with petechia or bruise,heaviness of limbs,bluish lips. The optional items were wiry and choopy pulse,dim complexion,obesity. [Conclusion] The results of this research could serve as a reference for diagnosis of intermingled phlegm-blood stasis syndrome in coronary heart disease.
引文
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[10]谢伟,张伯礼.张伯礼治疗冠心病经验.中医杂志,2011,52(18):1539-1541.
[11]韩新民,尹东奇,王静,等.德尔菲法在中医诊疗指南中的应用[J].中医儿科杂志,2010,6(4):50-51.
[12]陈作,梁勇,郝征,等.高克俭主任治疗胸痹学术经验[J].天津中医药,2018,35(6):404-407.
[13]王静,韩新民. Delphi法及其在中医证候学中的应用[J].山西中医,2007,23(5):75-77.
[14]谢蓉,彭丹虹,李先涛,等.基于德尔菲法探讨中医痰证辨证依据[J].辽宁中医杂志,2017,44(1):16-20.
[2]袁蓉,王阶,郭丽丽.冠心病痰瘀互结证的近代研究及中医治疗进展[J].中国中药杂志,2016,41(1):34-37.
[3]刘鹏,张鹏,徐伟建,等.冠心病痰瘀辨证与冠脉病变特点的相关性研究[J].中西医结合心脑血管病杂志,2012,10(11):1281.
[4]韩学杰,张印生,沈绍功.冠心病痰瘀互结证的渊源和创新[J].中国医药学报,2004,19(10):623-625.
[5]赵志宏.冠心病中医治疗学[M].北京:中国医药科技出版社,2013:113.
[6]胡镜清,王传池,段飞,等.冠心病痰瘀互结证宏观诊断标准研究[J].中国中西医结合杂志,2016,36(10):1164-1168.
[7]毛静远,牛子长,张伯礼.近40年冠心病中医证候特征研究文献分析[J].中医杂志,2011,52(11):958-961.
[8]孔秀路,徐田华,胡思源,等.基于Delphi法的小儿厌食中医证候疗效评价量表的条目筛选[J].天津中医药,2014,31(9):522-525.
[9]李先涛.对冠心病痰瘀互结证(胸痹心痛)临床辨证的认识[J].辽宁中医杂志,2016,43(1):10-12.
[10]谢伟,张伯礼.张伯礼治疗冠心病经验.中医杂志,2011,52(18):1539-1541.
[11]韩新民,尹东奇,王静,等.德尔菲法在中医诊疗指南中的应用[J].中医儿科杂志,2010,6(4):50-51.
[12]陈作,梁勇,郝征,等.高克俭主任治疗胸痹学术经验[J].天津中医药,2018,35(6):404-407.
[13]王静,韩新民. Delphi法及其在中医证候学中的应用[J].山西中医,2007,23(5):75-77.
[14]谢蓉,彭丹虹,李先涛,等.基于德尔菲法探讨中医痰证辨证依据[J].辽宁中医杂志,2017,44(1):16-20.