基于循证的中医临床实践指南研制方法研究
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摘要
过去20年来,由于临床实践的极大差异、医疗措施的明显不恰当使用及人们对医疗费用的关注等原因,临床实践指南的开发与应用得到了迅猛地发展。临床实践指南可促进临床诊疗质量提高,帮助患者取得更好的治疗效果。在指南指导下结合患者的具体病情做出诊断和治疗的决策,有助于循证医学的原则在临床医疗实践中得到更好的贯彻和实施,规范临床医生的医疗行为,提高医疗服务质量。
目前我国卫生保健系统同样面临着以上难题,因此更需要应用经科学系统开发的临床指南来解决具体相关问题、规范临床服务。随着科研水平的提高和成果转化力度的提升,临床试验为中医临床实践指南的制定提供了一定的循证医学证据,指南已经由“基于共识的临床指南”逐渐发展为“循证临床指南”,即在广泛收集临床证据的基础上,按照循证医学的方法开发出一组临床指导意见,并将推荐意见与相关的证据质量明确地联系起来,依据对现有证据进行评价的结果来确定推荐意见,制订指南。
本研究从临床实践指南的综述入手,结合脑梗死中医循证临床实践指南的示范性研制和实施,对基于循证的中医临床实践指南的意义、建立、评价、关键问题及其解决、报告规范等方面进行探讨,为下一步开展中医药规范化研究提供方法学依据。
[研究目的]
1.系统分析、评价现有中医临床实践指南,探讨基于循证的中医临床实践指南指定和实施的必要性、适用性和现实意义。
2.建立基于循证医学原则的,系统全面和科学合理,符合中医辨证论治特点的临床实践指南研制、实施、评价以及报告规范的方法学框架。
3.结合脑梗死中医循证临床实践指南的应用实践,分析、解决基于循证的中医临床实践指南研制难点和关键问题的思路策略。
[研究思路和方法]
本研究首先系统检索和分析了国内外临床实践指南的相关文献,明确了临床实践指南的概念、基本原则和制定方法,阐述了临床实践指南实施和评价的必要性、内容、方法及指标体系等,比较了临床实践指南与系统评价及其他类型国际标准文件的异同点,说明了临床实践指南实施的效果。
在此基础上,采用定性研究和定量分析相结合的研究方法,结合我国现有中医临床实践指南,采用AGREE等进行评价分析,探讨了中医临床实践指南编制的基本思路,提出了基于循证的中医临床实践指南指定和实施的必要性、适用性和现实意义。
结合脑梗死中医循证临床实践指南的开发和应用实践,通过深入访谈、调查问卷、专家共识(头脑风暴法、德尔斐法、共识会议等)、个案研究、临床推广试验效果评价等多种定性定量研究方法,提出了基于循证的中医临床实践指南的制定与实施方法学流程,探讨了其难点及关键问题,提出了相应的解决对策,形成了基于循证的中医临床实践指南报告规范。
[发现与结果]
本研究通过对文献进行系统梳理和评价,对国内发表的中医临床实践指南进行评价和分析,得出结论：中医循证临床实践指南的研制具有极其重要的意义,有助于循证医学的原则在临床医疗实践中得到贯彻和实施,规范中医药临床诊疗技术,促进医疗服务质量,帮助临床医生和患者选择最佳的治疗方案和决策,取得更好的疗效。区别于西医学,中医临床实践指南制定中应体现辨证论治的特色和优势,建立既符合循证医学方法学要求,又体现中医药诊疗核心内容的方法学框架至关重要。
通过系统全面的方法学探索,本研究探讨了研制中医循证临床实践指南的原则,提出基于循证医学的临床实践指南主要分为5个步骤进行制定：成立临床实践指南工作组；确定指南的主题和目的；开发循证指南；临床指南的起草；指南的修改、评审及定稿。结合脑梗死中医循证临床实践指南的开发和应用实践,通过深入访谈、调查问卷、专家共识(头脑风暴法、德尔斐法、共识会议等)、临床推广试验效果评价等多种定性定量研究方法,提出了基于循证的中医临床实践指南的研制、评价与实施方法学流程。
在此基础上,探讨了中医循证临床实践指南的难点及关键问题：中医诊疗技术的规范性和一致性的探讨；循证医学证据的选择；指南实施效果的评价等。结合案例分析,提出了相应的解决对策：开展标准化研究为指南提供证据；根据目的选择适宜的共识法和临床试验评价指南的后效评价。
During the past 20 years, as a result of the large differents between practical behaviors,the inuse of the medical cure,and the care of the medical expanses,the establish and application of clinical guideline has been improved quickly. The clinical guideline can improve the quality of the clinical standard and help the patients get the most efficient clinical effects.
diagnosis and treatment of decision made under the guidance of the guideline with the specific patients can help to implemented the principle of evidence-based medicine better in clinical practice, standardize the clinician's medical behavior, improve the medical service quality.
At present our country health care system also faces the problems, so clinical guidelines development by science are more needed to solve related problems and standard clinical services. With the development of scientific research and achievement transformation, clinical trials provided some evidence,for the formulation of TCM clinical practice guidelines.Thus "the clinical guidelines based on consensus " transformates to "the evidence-based clinical guidelines ",.which means that on the ground of clinical evidence, according to some methods of evidence-based medicine,a set of clinical guidelines has been developed and recommended opinions are linked to existing evidence.So according to the result of evidence evaluation,we can determine the recommendation and formulate guidelines.
In this study, accompany by the development and application of the clinical guideline of cerebral infarction as a example, the author analyzed and summarized the definition, basic theory,evaluation of clinical guideline, tried to establish the guidelines,to deal with key issues and the measurement, so that the author can apply the study for the standardized study of TCM.
Objectives
1 by System analysising and evaluating existing Chinese medicine clinical practice guidelines, Try tou discussthe necessity,pplicability and realistic significance..
2.Try to establish the evidence-based systematic and scientific methodology structure of clinical guidelines,including how to design,meature,appraise of a certain disease.
3.Try to propose strategies for resolution of the difficulties and key issres in designing an evidence-based Chinese clinical guidelines while analyuzing the experience of preliminary application of of cerebral infarction.
Methods
Firstly,the study review and analyse domestic and international clinical practice guidelines, clear the concept, basic principle and establishment method, of the clinical practice guidelines, explained the necessity methods and index system, of Clinical practice guidelines, compared the clinical practice guidelines, system evaluation and clinical pathway, and explains implementation effect of clinical practice guidelines.
According to the theory of the clinical guideline,the author value the existing domestic Chinese clinical guideline by the AGREE, discusses the basic thought of TCM clinical practice guidelines,and presented the ecessity, applicability and realistic significance.of clinical practice guidelines based on evidence-based medicine.
Combined with the development and application practice of the TCM evidence-based clinical practice guidelines about cerebral infarction, through some qualitative and quantitative research methods, such as in depth-interview, questionnaire, expert consensus (brainstorming method, Delphi, consensus conference, etc), case studies, promotion evaluation of clinical test,the authou put forward to the formulation and implementation methodology flow, about the evidence-based medicine clinical practice guidelines,discuss the difficulties, key issues and the solution.
Findings
Through the systematic review and evaluation of the literature,by evaluating the existing domestic published TCM clinical practice guidelines and analysis, this study drew a conclusion:TCM evidence-based clinical practice guidelines research has very important significance. It can help the principle of evidence-based medicine implemented in clinical practice standardize Chinese medicine clinical medical technologies, promote medical service quality, help clinicians and patients to choose the best treatment plan and decision-making, and thus achieve better curative effect. Compare to western medicine, Chinese medicine clinical practice guidelines should reflect in making its features and advantages of differentiation, establish methodology framework which accords with the methodology of evidence-based medicine and also reflect the core content.
Through the systematic methodological exploration, this study explores the principle of the development about theTCM evidence-based guidelines and put forward to the theory that Based on evidence-based medicine clinical practice guidelines are mainly divided into five steps:Establish clinical practice guidelines group; Determine the theme and purpose; Development evidence-based guidelines; Draft clinical guidelines; revise, Review and finalize. The guideline. through some qualitative and quantitative research methods, such as in depth-interview, questionnaire, expert consensus (brainstorming method, Delphi, consensus conference, etc), case studies, promotion evaluation of clinical test,the authou put forward to the formulation and implementation methodology flow, about the evidence-based medicine clinical practice guidelines,discuss the difficulties, key issues and the solution; Discuss the standardization and the consistency of TCM treatment technology; Choose the evidence-based medical evidence; Guide to the methodology of the implementation and evaluation. Combined with case analysis, the corresponding countermeasures are put forward: Carry out standardized study to provide evidence for guideline; Choose appropriate consensus method and clinical test evaluation according to the objective for the aftereffects evaluation.
目前我国卫生保健系统同样面临着以上难题,因此更需要应用经科学系统开发的临床指南来解决具体相关问题、规范临床服务。随着科研水平的提高和成果转化力度的提升,临床试验为中医临床实践指南的制定提供了一定的循证医学证据,指南已经由“基于共识的临床指南”逐渐发展为“循证临床指南”,即在广泛收集临床证据的基础上,按照循证医学的方法开发出一组临床指导意见,并将推荐意见与相关的证据质量明确地联系起来,依据对现有证据进行评价的结果来确定推荐意见,制订指南。
本研究从临床实践指南的综述入手,结合脑梗死中医循证临床实践指南的示范性研制和实施,对基于循证的中医临床实践指南的意义、建立、评价、关键问题及其解决、报告规范等方面进行探讨,为下一步开展中医药规范化研究提供方法学依据。
[研究目的]
1.系统分析、评价现有中医临床实践指南,探讨基于循证的中医临床实践指南指定和实施的必要性、适用性和现实意义。
2.建立基于循证医学原则的,系统全面和科学合理,符合中医辨证论治特点的临床实践指南研制、实施、评价以及报告规范的方法学框架。
3.结合脑梗死中医循证临床实践指南的应用实践,分析、解决基于循证的中医临床实践指南研制难点和关键问题的思路策略。
[研究思路和方法]
本研究首先系统检索和分析了国内外临床实践指南的相关文献,明确了临床实践指南的概念、基本原则和制定方法,阐述了临床实践指南实施和评价的必要性、内容、方法及指标体系等,比较了临床实践指南与系统评价及其他类型国际标准文件的异同点,说明了临床实践指南实施的效果。
在此基础上,采用定性研究和定量分析相结合的研究方法,结合我国现有中医临床实践指南,采用AGREE等进行评价分析,探讨了中医临床实践指南编制的基本思路,提出了基于循证的中医临床实践指南指定和实施的必要性、适用性和现实意义。
结合脑梗死中医循证临床实践指南的开发和应用实践,通过深入访谈、调查问卷、专家共识(头脑风暴法、德尔斐法、共识会议等)、个案研究、临床推广试验效果评价等多种定性定量研究方法,提出了基于循证的中医临床实践指南的制定与实施方法学流程,探讨了其难点及关键问题,提出了相应的解决对策,形成了基于循证的中医临床实践指南报告规范。
[发现与结果]
本研究通过对文献进行系统梳理和评价,对国内发表的中医临床实践指南进行评价和分析,得出结论：中医循证临床实践指南的研制具有极其重要的意义,有助于循证医学的原则在临床医疗实践中得到贯彻和实施,规范中医药临床诊疗技术,促进医疗服务质量,帮助临床医生和患者选择最佳的治疗方案和决策,取得更好的疗效。区别于西医学,中医临床实践指南制定中应体现辨证论治的特色和优势,建立既符合循证医学方法学要求,又体现中医药诊疗核心内容的方法学框架至关重要。
通过系统全面的方法学探索,本研究探讨了研制中医循证临床实践指南的原则,提出基于循证医学的临床实践指南主要分为5个步骤进行制定：成立临床实践指南工作组；确定指南的主题和目的；开发循证指南；临床指南的起草；指南的修改、评审及定稿。结合脑梗死中医循证临床实践指南的开发和应用实践,通过深入访谈、调查问卷、专家共识(头脑风暴法、德尔斐法、共识会议等)、临床推广试验效果评价等多种定性定量研究方法,提出了基于循证的中医临床实践指南的研制、评价与实施方法学流程。
在此基础上,探讨了中医循证临床实践指南的难点及关键问题：中医诊疗技术的规范性和一致性的探讨；循证医学证据的选择；指南实施效果的评价等。结合案例分析,提出了相应的解决对策：开展标准化研究为指南提供证据；根据目的选择适宜的共识法和临床试验评价指南的后效评价。
During the past 20 years, as a result of the large differents between practical behaviors,the inuse of the medical cure,and the care of the medical expanses,the establish and application of clinical guideline has been improved quickly. The clinical guideline can improve the quality of the clinical standard and help the patients get the most efficient clinical effects.
diagnosis and treatment of decision made under the guidance of the guideline with the specific patients can help to implemented the principle of evidence-based medicine better in clinical practice, standardize the clinician's medical behavior, improve the medical service quality.
At present our country health care system also faces the problems, so clinical guidelines development by science are more needed to solve related problems and standard clinical services. With the development of scientific research and achievement transformation, clinical trials provided some evidence,for the formulation of TCM clinical practice guidelines.Thus "the clinical guidelines based on consensus " transformates to "the evidence-based clinical guidelines ",.which means that on the ground of clinical evidence, according to some methods of evidence-based medicine,a set of clinical guidelines has been developed and recommended opinions are linked to existing evidence.So according to the result of evidence evaluation,we can determine the recommendation and formulate guidelines.
In this study, accompany by the development and application of the clinical guideline of cerebral infarction as a example, the author analyzed and summarized the definition, basic theory,evaluation of clinical guideline, tried to establish the guidelines,to deal with key issues and the measurement, so that the author can apply the study for the standardized study of TCM.
Objectives
1 by System analysising and evaluating existing Chinese medicine clinical practice guidelines, Try tou discussthe necessity,pplicability and realistic significance..
2.Try to establish the evidence-based systematic and scientific methodology structure of clinical guidelines,including how to design,meature,appraise of a certain disease.
3.Try to propose strategies for resolution of the difficulties and key issres in designing an evidence-based Chinese clinical guidelines while analyuzing the experience of preliminary application of of cerebral infarction.
Methods
Firstly,the study review and analyse domestic and international clinical practice guidelines, clear the concept, basic principle and establishment method, of the clinical practice guidelines, explained the necessity methods and index system, of Clinical practice guidelines, compared the clinical practice guidelines, system evaluation and clinical pathway, and explains implementation effect of clinical practice guidelines.
According to the theory of the clinical guideline,the author value the existing domestic Chinese clinical guideline by the AGREE, discusses the basic thought of TCM clinical practice guidelines,and presented the ecessity, applicability and realistic significance.of clinical practice guidelines based on evidence-based medicine.
Combined with the development and application practice of the TCM evidence-based clinical practice guidelines about cerebral infarction, through some qualitative and quantitative research methods, such as in depth-interview, questionnaire, expert consensus (brainstorming method, Delphi, consensus conference, etc), case studies, promotion evaluation of clinical test,the authou put forward to the formulation and implementation methodology flow, about the evidence-based medicine clinical practice guidelines,discuss the difficulties, key issues and the solution.
Findings
Through the systematic review and evaluation of the literature,by evaluating the existing domestic published TCM clinical practice guidelines and analysis, this study drew a conclusion:TCM evidence-based clinical practice guidelines research has very important significance. It can help the principle of evidence-based medicine implemented in clinical practice standardize Chinese medicine clinical medical technologies, promote medical service quality, help clinicians and patients to choose the best treatment plan and decision-making, and thus achieve better curative effect. Compare to western medicine, Chinese medicine clinical practice guidelines should reflect in making its features and advantages of differentiation, establish methodology framework which accords with the methodology of evidence-based medicine and also reflect the core content.
Through the systematic methodological exploration, this study explores the principle of the development about theTCM evidence-based guidelines and put forward to the theory that Based on evidence-based medicine clinical practice guidelines are mainly divided into five steps:Establish clinical practice guidelines group; Determine the theme and purpose; Development evidence-based guidelines; Draft clinical guidelines; revise, Review and finalize. The guideline. through some qualitative and quantitative research methods, such as in depth-interview, questionnaire, expert consensus (brainstorming method, Delphi, consensus conference, etc), case studies, promotion evaluation of clinical test,the authou put forward to the formulation and implementation methodology flow, about the evidence-based medicine clinical practice guidelines,discuss the difficulties, key issues and the solution; Discuss the standardization and the consistency of TCM treatment technology; Choose the evidence-based medical evidence; Guide to the methodology of the implementation and evaluation. Combined with case analysis, the corresponding countermeasures are put forward: Carry out standardized study to provide evidence for guideline; Choose appropriate consensus method and clinical test evaluation according to the objective for the aftereffects evaluation.
引文
1.临床实践指南意义、建立方法和评价,刘鸣.中国卒中杂志,2006,1(1)：33-36
2. Marilyn J, Kathleen N. Clinical Practice Guidelines:Directions for a New Program Committee to Advise the Public Health Service on Clinical Practice Guidel ines, Institute of Medcine. Was he ing ton DC:National Academy Press,1999
3. 曾广基.澳大利亚临床诊疗指南的制定、实施与评估.现代医院,2009,9(1)：154-157
4. Jones J, Hunter D. Consensun methods for medical and health services research. BMJ,1995,311 (7001):376-380
5.Moynihan R, Oxman AD, Lavis J, et al. A review of organizations that support the use of research evidence in developing guidelines, technology assessments, and health policy, for the WHO Advisory Committee on Health Research. Oslo, Norwegian Knowledge Centre for the Health Services.2006.
6. Burgers JS,Grol R,Klazinga NS. et al. Towards evidence-based clinical practice: an international survey of 18 clinical guideline programs. Int J Qual HealthCare.2003; 15(1):31-45.
7. Murphy MK, Black NA, Lamping DL, et al. Consensus development methods and their use in clinical guideline development. Health Teehnol Assess.1998; 2(3): 1-88.
8. NIH Consensus Development Program. Consensus development conferences: Guidelines for the planning and management of NIH consensus development confer-ences. http://www.oralchelation.net/heartdisease/ChapterFive /page51. htm[Accessed 2007-12-22].
9. McGlynn EA, Kosecoff J, Brook RH. Format and conduct of consensus development conferences. Multination comparison. Int J Technol Assess Heahh Care.1990; 6(3):450-469.
10.訾明杰,刘保延,武晓东等.浅谈循证针灸临床实践指南常用的专家共识方法.中国针灸学会2009学术年会论文集：1059-1064
11.尹东奇,韩新民,汪受传等.基于德尔菲法的《中医、中西医结合流行性腮腺炎诊疗指南》第二轮专家问卷调查方法和结果分析.中医儿科杂志,2008,4(3)：53-58)
12.(王力宁,汪受传,韩新民等.《小儿反复呼吸道感染中医诊疗指南》指标的Delphi法评价与结果分析.中国中西医结合儿科学,2009,1(1)
13. National Institute for Clinical Excellence (NICE). Guideline Development Methods-Information for National Collaborating Centers and Guideline Developers.2004[EB/OL]. Available from:URL:http://www.nice.org.uk /archived site/clinical guidelines/archive guideline development methods 2004 guideline-development-methods-chapter_9_introduction. Jsp:9-1)
14.曾光.现代流行病学方法与应用[M].北京：北京医科大学、中国协和医科大学联合出版,1994：250-269
15.季新强,刘志民.Delphi法及其在医学研究和决策中的应用.中国药物依赖性杂志2006,15(6)：422-426
16.高艳,赵霞.Delphi法及其在中医临床指南研究中的应用.天津中医药,2009,26(3)：217-220)
17.技术预测与国家关键技术选择》研究组.从预见到选择——技术预测的理论与实践[M].北京：北京出版社,2001：53-57
18.刘东,苏石,马云凤,等.基于德尔菲法的城镇供水BOT项目风险规避策略[J].农机化研究,2004,26(4)：51-52
19.刘弘,经燕,辛茜庭.中医治疗痛经指南指标德尔菲法调查分析.中国中医基础医学杂志,2008,14(3)：238-241
20. Scotish Intercollegiate Guidelines Network (SIGN). A guideline developer' s handbook. Edinburgh:SIGN,2001. http://www.sign.ac.uk
1.党爱民,吕纳强.从2009ESC/ESH高血压指南的再评价看高血压诊治理念的变迁.中国处方药,2008,101：34-38
2. Zhang W, Moskowitz R W, Nuke G, et al.曹月龙,高宁阳,庞坚等[节译].国际骨关节炎研究学会髋与膝骨关节炎治疗指南——第一部分：对现有治疗指南的严格评价及对近期研究依据的系统回顾.国际骨科学杂志,2009,30(3)：138-144
3. Grol R, Dalhuijsen J, Thomas S, et al. Attributes of clinical guidelines that influence U s e of guidelines i n general practice:Observational study [J]. B M J,1998,317:858-861.
4. Duimel-Peeters IG, Hulsonboom MA, BergerMP, et al. Massage to prevent pressure ulcers:knowledge, beliefs and practice. A cross-sectional study among nurses in the Nethelands in 1991 and 2003. J Clin Nurs.2006,15(4):428-435
5. Hulsenboom MA, Bours GJ, Halfens RJ. Knowledge of pressure ulcer prevention: a cross-sectional and comparative study among nurses. BMC Nuts,2007,9(6): 2.
6. Bielitz H, Hertel F,Maften8 E, et al. Pressure ulcer prevention in German hospitals. An analysis Of nursing practice with regard to guideline recommendations. Pflege Z,2007,60(3):140-144.
7. de Laat EH, Pickkers P. Schconhoven L, et al. Guideline implementation results in a decrease of pressure ulcer incidence in critically ill patients. Crit Care Med,2007,35(3):815-820.
8. Szewczyk MT, Cwajda J, Cierzniakowska K. The guidelines for the effective prevention of pressure ulcers. Wiad Lek。2006,59(11-12):842-847.
9. McElhinny ML, Hooper C. Reducing hospital--acquired heel ulcer rates in an acute care facility:an evaluation of a nurse-driven performance improvement project. J Wound Ostomy Continence Nurs,2008,35(1):79-83
10. Paguay L, Wouters R, Def loor T, et al. Adherence to pressure ulcer prevention guidelines in home care:a survey of current practice. J Clin Nuts,2008, 17(5):627-636
11.全国高胆固醇血症控制状况多中心研究协作组.高胆固醇血症临床控制状况多中心协作研究-达标率及影响因素[J].中华心血管病杂志,2002,30：109-114
12. Wimpenny P, Van Zdm R. Appraising and comparing pressure ulcer guidelines. Woddviews Evid Based Nurs,2007,4(1):40-50
13.张晓林,李研.北京东城区社区医生对《中国高血压防治指南》的掌握与评价.中华全科医师杂志,2004,3(6)：380-382
14.余丹阳.我国社区获得性肺炎诊治指南的再评价.继续医学教育,20(2)：1-7
15.张雷,浦奎,王星.贯彻指南-开展急性心肌梗塞医疗质量评价.2007海河之滨心脏病学文章汇编：129-133
16. Woolf SH, G r o 1 R, Hutchinson et al. Clinical guidelines:Potential benefits, limitations, and harms of clinical guidelines [J]. BMJ,1999,318: 527-530.
17. Seal x itti DA. Evidence-based guidelines:Application to clinical practice[J]. Phays Ther,2001,81:1622-1628.
18. McElhinny ML, Hooper C. Reducing hospital-acquired heel ulcer rates in an acute care facility:an evaluation of a nurse-driven performance improvement project. J Wound Ostomy Continence Nurs,2008,35(1):79-83
19. Bielitz H, Hertel F,Maften8 E, et al. Pressure ulcer prevention in German hospitals. An analysis Of nursing practice with regard to guideline recommendations. Pflege Z,2007,60(3):140-144
20. Meijers JM, Schois JM, Jackson PA, et al. Differences in nutritionalcare in pressure ulcer patients whether or not using nutritional guidelines. Nutrition,2008,24(2):127-132
21. de Laat EH, Pickkers P. Schconhoven L, et al. Guideline implementation results in a decrease of pressure ulcer incidence in critically ill patients. Crit Care Med,2007,35(3):815-820.
22. Duimel-Peeters IG, Hulsonboom MA, Berger MP, et al. Massage to prevent pressure ulcers:knowledge, beliefs and practice. Across-sectional study among nurses in the Nethelands in 1991 and 2003. J Clin Nurs.2006,15(4): 428-435
23. de Laat EH, Schoonhoven L, Pickkers P, et al. Implementation of a new policy results in a decrease of pressure ulcer frequency. Int J Qual Health Care, 2006,18(2):107-112
24. Lohr K. Field M. eds. A provisional instrument for assessing clinical practice guidelines. In Guidelines for clinical practice:From development to use[M]. Washington DC:National Academy Press,1992.
25. Vlayen J, Aertgeerts B, Hannes K. et al. A systematic review of appraisal tools for clinical practice guidelines:Multiple similarities and o ne common deficit [J]. int J Qual Health Care,2005, 17(3):235-242.
26.]AGREE Collaboration. Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines:The AGREE project [J]. Qual Saf Health Care,2003,12:18-23.
27.Holloway RG, Benesch C, Rush SR. Stroke prevention:narrowing the evidence-practice gap.Neurology,2000
28.Lindsay M P,Kapral K,Gladstone DJ. The Canadian Stroke Quality of Care Study:establishing indicators for optimal acute stroke care. Canadian Medical Association Journal,2005
29. NHS-Quality Improvement Scotland. Stroke Services:Care of the Patient in the Acute Seting.Clinical Standards,2004
30.王伊龙,张振伟,王拥军等.2008年北京地区脑梗死住院患者医疗服务质量评价研究.中国卫生质量管理,2010,17(1)：11-15
31.周永,王安心,王文娟等.缺血性卒中医疗服务标准指标初步筛选结果分析.中国卫生质量管理,2010,17(1)：16-19
32.梁晓珊,何秀芳,廖枝成等.Delphi法在筛选慢性病自我管理评价指标中的应用研究.中国医药指南,2010,8(21)：149-152
1.临床实践指南意义、建立方法和评价,刘鸣.中国卒中杂志,2006(1)：33-36
2. Scotish Intercollegiate Guidelines Network (SIGN).A guideline developer's handbook. Edinburgh:SIGN,2001. http://www.sign.ac.uk
3.詹思延.临床指南研究与评价工具简介[J].中国循证儿科杂志,2007,2(5)：375-377.
4.刘建平.传统医学证据体的构成及证据分级的建议[J].中国中西医结合杂志,2007,27(12)：1061-1062.
5.罗忠毅.数字化中医古籍的理想模式及其相关问题研究(学位论文).成都：成都中医药大学,2005.
6.凌江红.李家邦.中草药临床疗效系统评价概述.中医杂忠,2005.46(11)：870-872
7.康建华.古代骨肿瘤的证治方药规律研究(学位论文).广州：广州中医药大学,2006
8.孙洋.基于古今医案数据分析的心悸病证治规律研究(学位论文).哈尔滨：黑龙江中医药大学,2008
9.艾丽丝.桂枝茯苓丸古今运用靠探(学位论文).北京：北京中医药大学,2006
10.张桂菊.补肺法儿科文献研究(学位论文).济南：山东中医药大学2007
11.曹洪欣,王永炎.中医循证临床实践指南[M].北京：中国中医药出版社,2011
12.中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6)：379-380.
13.全国第四届脑血管病学术会议.脑卒中患者临床神经功能缺损程度评分标准(1995).中华神经科杂志,1996,29(6)：381-383.
14.国家药典委员会.中华人民共和国药典临床用药须知·中药卷[S].北京：化学工业出版社,2005.
15.杨克虎主编.系统评价指导手册[M].北京：人名卫生出版社,2010：57.
16.于莉.中西医结合卒中单元治疗急性期脑卒中疗效的系统评价(学位论文).沈阳：辽宁中医药大学,2010
17.孙红娟,李广阔,孙喆.血府逐瘀胶囊治疗脑梗死60例疗效观察.医学理论与实践,2010,23(08)：946-947.
18.陈文霖.熄风通络颗粒对急性脑梗死患者肢体运动功能与IL-10的影响.广州中医药大学.2010
19.朱成全,肖烈钢,朱兆红.益气活血口服液治疗急性期老年缺血性中风临床研究.中国中医药信息杂志,2010,17(07)：10-12.
20.刘文武.灯盏生脉胶囊对缺血性中风二级预防(6个月)的初步研究.湖北中医学院.2009
21.何琪,陈海琦,叶凌.通心络胶囊治疗急性脑梗死的临床观察.现代医药卫生,2008,24(19)：2948-2949.
22.罗曼.通心络胶囊为主治疗缺血性中风35例临床观察.中医药导报,2008.14(05)：26-27.
23.彭旭,张智博,唐璐.通心络胶囊对急性脑梗死患者血清高敏C反应蛋白影响的临床观察,中医药导报,2008,14(2)：21-24.
24.吕少起.通心络胶囊结合西药治疗脑梗死60例疗效观察.疑难病杂志,2008,7(09)：546-547.
25.雷伟南,吴燕,黄立武.通心络胶囊对老年脑梗死恢复期患者日常生活活动能力及神经功能缺损的影响.河北中医,2007,29(08)：739-741.
26.邢跃.通心络胶囊配合治疗急性脑梗死疗效及对血液流变学、血脂的影响.中国社区医师(综合版),2007,29(23)：133.
27.俞梅,孙利荣.通心络胶囊治疗急性脑梗死疗效观察.中国中西医结合急救杂志,2007,14(2)：121.
28.韩力.脑心多泰胶囊治疗缺血性中风恢复期肝阳上亢、瘀血阻络证临床研究.天津中医药,2007,24(02)：101-103.
29.崔兵.调气熄风合剂治疗缺血性中风急性期实验与临床研究.山东中医药大学.2007.
30.王薇.通心络胶囊对脑梗死康复期治疗作用评价.疑难病杂志,2006,5(5)：331-333.
31.李志开,路国平.通心络胶囊治疗腔隙性脑梗死66例临床分析.延安大学学报(医学科学版),2006,4(03)：21-22.
32.王喜芹.通心络胶囊治疗急性脑梗死56例疗效观察.中国实用神经疾病杂志2006,9(06)：72.
33.曹辉,狄晴,张颖冬,等.通心络胶囊对急性脑梗死患者血浆内皮素水平的影响及其疗效观察.临床神经病学杂志,2005,18(05)：375-376
34.李建生,郭明冬.脑脉通颗粒治疗急性脑梗死的临床疗效评价(摘要),中华中医药杂志,2005,20(9)：563-565.
35.吴建平,李爱琴,郝素琴.脑心通治疗脑梗死131例临床观察.中西医结合心脑血管病杂志,2005,3(04)：319-320.
36.胡文立,徐霁华,陈宇丹,等.通心络对急性脑梗死治疗作用基础与临床研究.医学研究通讯,2005,34(01)：14-16.
37.赵英霖,金妙文,李作汉.天红口服液治疗急性脑梗死风痰瘀阻证临床研究.中西医结合心脑血管病杂志,2004,2(08)：454-456.
38.王万山,李永忠,李彦琴,等.复方丹参滴丸治疗脑梗死120例临床观察.中草药,2004,35(10)：1165-
39.刘京海,莫亚杰.通心络胶囊对急性脑梗死患者临床与脑血流影响.疑难病杂志,2004,3(03)：144-146.
40.杜金行,史载祥,吴以岭,等.通心络胶囊配合治疗急性脑梗死的临床研究.中国中西医结合杂志,2003,23(02)：94-96.
41.潘妍婷.脑心通治疗脑梗死病人的疗效观察.中西医结合心脑血管病杂志,2003,1(08)：493-494.
42.吴苏宁,刘顺兴,赵瑞平,等.龙寿丹对急性脑梗死患者血清肿瘤坏死因子及循环内细胞含量的影响.山东医药,2003,43(01)：16-17.
43.杨冀平.急性脑梗塞中、西医研究概况和中风醒脑口服液治疗急性脑梗塞临床研究.成都中医药大学.2003
44.乔蓉.脑脉通口服液治疗急性脑梗塞的临床疗效观察及对血浆纤维蛋白原、血小板聚集率影响的研究.北京中医药大学.2003
45.宋德林,徐旭日.龙芪如意益脑液治疗脑梗死的临床研究.中西医结合心脑血管病杂志,2003,1(09)：512-514.
46.丁小君,徐严明,刘凌,等.通心络治疗急性脑梗塞疗效观察及作用分析.华西医学,2003,18(04)：494-495.
47.朱亨熠,郑安,李栋,等.中风Ⅱ号口服液治疗急性脑梗塞的临床与实验研究.中国中西医结合杂志,2002,22(01)：37-39.
48.杜少辉,黄洁,陈东风,等.牛珀至宝微丸对急性脑梗死一氧化氮影响的临床与实验研究.中国中西医结合急救杂志,2002,9(03)：129-131.
49.王艳菊,池明宇,姜秋颖,等.通脉胶囊治疗急性缺血性脑卒中临床观察.辽宁中医杂志2002,29(06)：331-332.
50.蔡业峰,黄燕,连新福,等.中风回语丹治疗急性缺血性中风失语症30例疗效观察.新中医,2002,34(08)：23-24.
51.张泽兰,李作孝.脑心通治疗44例急性脑梗死临床疗效的观察.中国民政医学杂志,2001,13(02)：74-76.
52.项建平,公伟宏,郑全安.龙寿丹胶囊对脑梗死患者TCD影响.时珍国医国药,1999,10(10)：767-768.
53.梁伟雄,李先涛,赖世隆,等..中药脑栓康治疗急性缺血性中风气虚血瘀证的临床试验.广州中医药大学学报,1999,16(04)：253-258.
54.赵希才,刘玉玲,侯校友,等.消栓通冲剂对脑梗塞患者血液流变学的影响.中国冶金工业医学杂志,1996,13(06)：345-346.
2. Marilyn J, Kathleen N. Clinical Practice Guidelines:Directions for a New Program Committee to Advise the Public Health Service on Clinical Practice Guidel ines, Institute of Medcine. Was he ing ton DC:National Academy Press,1999
3. 曾广基.澳大利亚临床诊疗指南的制定、实施与评估.现代医院,2009,9(1)：154-157
4. Jones J, Hunter D. Consensun methods for medical and health services research. BMJ,1995,311 (7001):376-380
5.Moynihan R, Oxman AD, Lavis J, et al. A review of organizations that support the use of research evidence in developing guidelines, technology assessments, and health policy, for the WHO Advisory Committee on Health Research. Oslo, Norwegian Knowledge Centre for the Health Services.2006.
6. Burgers JS,Grol R,Klazinga NS. et al. Towards evidence-based clinical practice: an international survey of 18 clinical guideline programs. Int J Qual HealthCare.2003; 15(1):31-45.
7. Murphy MK, Black NA, Lamping DL, et al. Consensus development methods and their use in clinical guideline development. Health Teehnol Assess.1998; 2(3): 1-88.
8. NIH Consensus Development Program. Consensus development conferences: Guidelines for the planning and management of NIH consensus development confer-ences. http://www.oralchelation.net/heartdisease/ChapterFive /page51. htm[Accessed 2007-12-22].
9. McGlynn EA, Kosecoff J, Brook RH. Format and conduct of consensus development conferences. Multination comparison. Int J Technol Assess Heahh Care.1990; 6(3):450-469.
10.訾明杰,刘保延,武晓东等.浅谈循证针灸临床实践指南常用的专家共识方法.中国针灸学会2009学术年会论文集：1059-1064
11.尹东奇,韩新民,汪受传等.基于德尔菲法的《中医、中西医结合流行性腮腺炎诊疗指南》第二轮专家问卷调查方法和结果分析.中医儿科杂志,2008,4(3)：53-58)
12.(王力宁,汪受传,韩新民等.《小儿反复呼吸道感染中医诊疗指南》指标的Delphi法评价与结果分析.中国中西医结合儿科学,2009,1(1)
13. National Institute for Clinical Excellence (NICE). Guideline Development Methods-Information for National Collaborating Centers and Guideline Developers.2004[EB/OL]. Available from:URL:http://www.nice.org.uk /archived site/clinical guidelines/archive guideline development methods 2004 guideline-development-methods-chapter_9_introduction. Jsp:9-1)
14.曾光.现代流行病学方法与应用[M].北京：北京医科大学、中国协和医科大学联合出版,1994：250-269
15.季新强,刘志民.Delphi法及其在医学研究和决策中的应用.中国药物依赖性杂志2006,15(6)：422-426
16.高艳,赵霞.Delphi法及其在中医临床指南研究中的应用.天津中医药,2009,26(3)：217-220)
17.技术预测与国家关键技术选择》研究组.从预见到选择——技术预测的理论与实践[M].北京：北京出版社,2001：53-57
18.刘东,苏石,马云凤,等.基于德尔菲法的城镇供水BOT项目风险规避策略[J].农机化研究,2004,26(4)：51-52
19.刘弘,经燕,辛茜庭.中医治疗痛经指南指标德尔菲法调查分析.中国中医基础医学杂志,2008,14(3)：238-241
20. Scotish Intercollegiate Guidelines Network (SIGN). A guideline developer' s handbook. Edinburgh:SIGN,2001. http://www.sign.ac.uk
1.党爱民,吕纳强.从2009ESC/ESH高血压指南的再评价看高血压诊治理念的变迁.中国处方药,2008,101：34-38
2. Zhang W, Moskowitz R W, Nuke G, et al.曹月龙,高宁阳,庞坚等[节译].国际骨关节炎研究学会髋与膝骨关节炎治疗指南——第一部分：对现有治疗指南的严格评价及对近期研究依据的系统回顾.国际骨科学杂志,2009,30(3)：138-144
3. Grol R, Dalhuijsen J, Thomas S, et al. Attributes of clinical guidelines that influence U s e of guidelines i n general practice:Observational study [J]. B M J,1998,317:858-861.
4. Duimel-Peeters IG, Hulsonboom MA, BergerMP, et al. Massage to prevent pressure ulcers:knowledge, beliefs and practice. A cross-sectional study among nurses in the Nethelands in 1991 and 2003. J Clin Nurs.2006,15(4):428-435
5. Hulsenboom MA, Bours GJ, Halfens RJ. Knowledge of pressure ulcer prevention: a cross-sectional and comparative study among nurses. BMC Nuts,2007,9(6): 2.
6. Bielitz H, Hertel F,Maften8 E, et al. Pressure ulcer prevention in German hospitals. An analysis Of nursing practice with regard to guideline recommendations. Pflege Z,2007,60(3):140-144.
7. de Laat EH, Pickkers P. Schconhoven L, et al. Guideline implementation results in a decrease of pressure ulcer incidence in critically ill patients. Crit Care Med,2007,35(3):815-820.
8. Szewczyk MT, Cwajda J, Cierzniakowska K. The guidelines for the effective prevention of pressure ulcers. Wiad Lek。2006,59(11-12):842-847.
9. McElhinny ML, Hooper C. Reducing hospital--acquired heel ulcer rates in an acute care facility:an evaluation of a nurse-driven performance improvement project. J Wound Ostomy Continence Nurs,2008,35(1):79-83
10. Paguay L, Wouters R, Def loor T, et al. Adherence to pressure ulcer prevention guidelines in home care:a survey of current practice. J Clin Nuts,2008, 17(5):627-636
11.全国高胆固醇血症控制状况多中心研究协作组.高胆固醇血症临床控制状况多中心协作研究-达标率及影响因素[J].中华心血管病杂志,2002,30：109-114
12. Wimpenny P, Van Zdm R. Appraising and comparing pressure ulcer guidelines. Woddviews Evid Based Nurs,2007,4(1):40-50
13.张晓林,李研.北京东城区社区医生对《中国高血压防治指南》的掌握与评价.中华全科医师杂志,2004,3(6)：380-382
14.余丹阳.我国社区获得性肺炎诊治指南的再评价.继续医学教育,20(2)：1-7
15.张雷,浦奎,王星.贯彻指南-开展急性心肌梗塞医疗质量评价.2007海河之滨心脏病学文章汇编：129-133
16. Woolf SH, G r o 1 R, Hutchinson et al. Clinical guidelines:Potential benefits, limitations, and harms of clinical guidelines [J]. BMJ,1999,318: 527-530.
17. Seal x itti DA. Evidence-based guidelines:Application to clinical practice[J]. Phays Ther,2001,81:1622-1628.
18. McElhinny ML, Hooper C. Reducing hospital-acquired heel ulcer rates in an acute care facility:an evaluation of a nurse-driven performance improvement project. J Wound Ostomy Continence Nurs,2008,35(1):79-83
19. Bielitz H, Hertel F,Maften8 E, et al. Pressure ulcer prevention in German hospitals. An analysis Of nursing practice with regard to guideline recommendations. Pflege Z,2007,60(3):140-144
20. Meijers JM, Schois JM, Jackson PA, et al. Differences in nutritionalcare in pressure ulcer patients whether or not using nutritional guidelines. Nutrition,2008,24(2):127-132
21. de Laat EH, Pickkers P. Schconhoven L, et al. Guideline implementation results in a decrease of pressure ulcer incidence in critically ill patients. Crit Care Med,2007,35(3):815-820.
22. Duimel-Peeters IG, Hulsonboom MA, Berger MP, et al. Massage to prevent pressure ulcers:knowledge, beliefs and practice. Across-sectional study among nurses in the Nethelands in 1991 and 2003. J Clin Nurs.2006,15(4): 428-435
23. de Laat EH, Schoonhoven L, Pickkers P, et al. Implementation of a new policy results in a decrease of pressure ulcer frequency. Int J Qual Health Care, 2006,18(2):107-112
24. Lohr K. Field M. eds. A provisional instrument for assessing clinical practice guidelines. In Guidelines for clinical practice:From development to use[M]. Washington DC:National Academy Press,1992.
25. Vlayen J, Aertgeerts B, Hannes K. et al. A systematic review of appraisal tools for clinical practice guidelines:Multiple similarities and o ne common deficit [J]. int J Qual Health Care,2005, 17(3):235-242.
26.]AGREE Collaboration. Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines:The AGREE project [J]. Qual Saf Health Care,2003,12:18-23.
27.Holloway RG, Benesch C, Rush SR. Stroke prevention:narrowing the evidence-practice gap.Neurology,2000
28.Lindsay M P,Kapral K,Gladstone DJ. The Canadian Stroke Quality of Care Study:establishing indicators for optimal acute stroke care. Canadian Medical Association Journal,2005
29. NHS-Quality Improvement Scotland. Stroke Services:Care of the Patient in the Acute Seting.Clinical Standards,2004
30.王伊龙,张振伟,王拥军等.2008年北京地区脑梗死住院患者医疗服务质量评价研究.中国卫生质量管理,2010,17(1)：11-15
31.周永,王安心,王文娟等.缺血性卒中医疗服务标准指标初步筛选结果分析.中国卫生质量管理,2010,17(1)：16-19
32.梁晓珊,何秀芳,廖枝成等.Delphi法在筛选慢性病自我管理评价指标中的应用研究.中国医药指南,2010,8(21)：149-152
1.临床实践指南意义、建立方法和评价,刘鸣.中国卒中杂志,2006(1)：33-36
2. Scotish Intercollegiate Guidelines Network (SIGN).A guideline developer's handbook. Edinburgh:SIGN,2001. http://www.sign.ac.uk
3.詹思延.临床指南研究与评价工具简介[J].中国循证儿科杂志,2007,2(5)：375-377.
4.刘建平.传统医学证据体的构成及证据分级的建议[J].中国中西医结合杂志,2007,27(12)：1061-1062.
5.罗忠毅.数字化中医古籍的理想模式及其相关问题研究(学位论文).成都：成都中医药大学,2005.
6.凌江红.李家邦.中草药临床疗效系统评价概述.中医杂忠,2005.46(11)：870-872
7.康建华.古代骨肿瘤的证治方药规律研究(学位论文).广州：广州中医药大学,2006
8.孙洋.基于古今医案数据分析的心悸病证治规律研究(学位论文).哈尔滨：黑龙江中医药大学,2008
9.艾丽丝.桂枝茯苓丸古今运用靠探(学位论文).北京：北京中医药大学,2006
10.张桂菊.补肺法儿科文献研究(学位论文).济南：山东中医药大学2007
11.曹洪欣,王永炎.中医循证临床实践指南[M].北京：中国中医药出版社,2011
12.中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6)：379-380.
13.全国第四届脑血管病学术会议.脑卒中患者临床神经功能缺损程度评分标准(1995).中华神经科杂志,1996,29(6)：381-383.
14.国家药典委员会.中华人民共和国药典临床用药须知·中药卷[S].北京：化学工业出版社,2005.
15.杨克虎主编.系统评价指导手册[M].北京：人名卫生出版社,2010：57.
16.于莉.中西医结合卒中单元治疗急性期脑卒中疗效的系统评价(学位论文).沈阳：辽宁中医药大学,2010
17.孙红娟,李广阔,孙喆.血府逐瘀胶囊治疗脑梗死60例疗效观察.医学理论与实践,2010,23(08)：946-947.
18.陈文霖.熄风通络颗粒对急性脑梗死患者肢体运动功能与IL-10的影响.广州中医药大学.2010
19.朱成全,肖烈钢,朱兆红.益气活血口服液治疗急性期老年缺血性中风临床研究.中国中医药信息杂志,2010,17(07)：10-12.
20.刘文武.灯盏生脉胶囊对缺血性中风二级预防(6个月)的初步研究.湖北中医学院.2009
21.何琪,陈海琦,叶凌.通心络胶囊治疗急性脑梗死的临床观察.现代医药卫生,2008,24(19)：2948-2949.
22.罗曼.通心络胶囊为主治疗缺血性中风35例临床观察.中医药导报,2008.14(05)：26-27.
23.彭旭,张智博,唐璐.通心络胶囊对急性脑梗死患者血清高敏C反应蛋白影响的临床观察,中医药导报,2008,14(2)：21-24.
24.吕少起.通心络胶囊结合西药治疗脑梗死60例疗效观察.疑难病杂志,2008,7(09)：546-547.
25.雷伟南,吴燕,黄立武.通心络胶囊对老年脑梗死恢复期患者日常生活活动能力及神经功能缺损的影响.河北中医,2007,29(08)：739-741.
26.邢跃.通心络胶囊配合治疗急性脑梗死疗效及对血液流变学、血脂的影响.中国社区医师(综合版),2007,29(23)：133.
27.俞梅,孙利荣.通心络胶囊治疗急性脑梗死疗效观察.中国中西医结合急救杂志,2007,14(2)：121.
28.韩力.脑心多泰胶囊治疗缺血性中风恢复期肝阳上亢、瘀血阻络证临床研究.天津中医药,2007,24(02)：101-103.
29.崔兵.调气熄风合剂治疗缺血性中风急性期实验与临床研究.山东中医药大学.2007.
30.王薇.通心络胶囊对脑梗死康复期治疗作用评价.疑难病杂志,2006,5(5)：331-333.
31.李志开,路国平.通心络胶囊治疗腔隙性脑梗死66例临床分析.延安大学学报(医学科学版),2006,4(03)：21-22.
32.王喜芹.通心络胶囊治疗急性脑梗死56例疗效观察.中国实用神经疾病杂志2006,9(06)：72.
33.曹辉,狄晴,张颖冬,等.通心络胶囊对急性脑梗死患者血浆内皮素水平的影响及其疗效观察.临床神经病学杂志,2005,18(05)：375-376
34.李建生,郭明冬.脑脉通颗粒治疗急性脑梗死的临床疗效评价(摘要),中华中医药杂志,2005,20(9)：563-565.
35.吴建平,李爱琴,郝素琴.脑心通治疗脑梗死131例临床观察.中西医结合心脑血管病杂志,2005,3(04)：319-320.
36.胡文立,徐霁华,陈宇丹,等.通心络对急性脑梗死治疗作用基础与临床研究.医学研究通讯,2005,34(01)：14-16.
37.赵英霖,金妙文,李作汉.天红口服液治疗急性脑梗死风痰瘀阻证临床研究.中西医结合心脑血管病杂志,2004,2(08)：454-456.
38.王万山,李永忠,李彦琴,等.复方丹参滴丸治疗脑梗死120例临床观察.中草药,2004,35(10)：1165-
39.刘京海,莫亚杰.通心络胶囊对急性脑梗死患者临床与脑血流影响.疑难病杂志,2004,3(03)：144-146.
40.杜金行,史载祥,吴以岭,等.通心络胶囊配合治疗急性脑梗死的临床研究.中国中西医结合杂志,2003,23(02)：94-96.
41.潘妍婷.脑心通治疗脑梗死病人的疗效观察.中西医结合心脑血管病杂志,2003,1(08)：493-494.
42.吴苏宁,刘顺兴,赵瑞平,等.龙寿丹对急性脑梗死患者血清肿瘤坏死因子及循环内细胞含量的影响.山东医药,2003,43(01)：16-17.
43.杨冀平.急性脑梗塞中、西医研究概况和中风醒脑口服液治疗急性脑梗塞临床研究.成都中医药大学.2003
44.乔蓉.脑脉通口服液治疗急性脑梗塞的临床疗效观察及对血浆纤维蛋白原、血小板聚集率影响的研究.北京中医药大学.2003
45.宋德林,徐旭日.龙芪如意益脑液治疗脑梗死的临床研究.中西医结合心脑血管病杂志,2003,1(09)：512-514.
46.丁小君,徐严明,刘凌,等.通心络治疗急性脑梗塞疗效观察及作用分析.华西医学,2003,18(04)：494-495.
47.朱亨熠,郑安,李栋,等.中风Ⅱ号口服液治疗急性脑梗塞的临床与实验研究.中国中西医结合杂志,2002,22(01)：37-39.
48.杜少辉,黄洁,陈东风,等.牛珀至宝微丸对急性脑梗死一氧化氮影响的临床与实验研究.中国中西医结合急救杂志,2002,9(03)：129-131.
49.王艳菊,池明宇,姜秋颖,等.通脉胶囊治疗急性缺血性脑卒中临床观察.辽宁中医杂志2002,29(06)：331-332.
50.蔡业峰,黄燕,连新福,等.中风回语丹治疗急性缺血性中风失语症30例疗效观察.新中医,2002,34(08)：23-24.
51.张泽兰,李作孝.脑心通治疗44例急性脑梗死临床疗效的观察.中国民政医学杂志,2001,13(02)：74-76.
52.项建平,公伟宏,郑全安.龙寿丹胶囊对脑梗死患者TCD影响.时珍国医国药,1999,10(10)：767-768.
53.梁伟雄,李先涛,赖世隆,等..中药脑栓康治疗急性缺血性中风气虚血瘀证的临床试验.广州中医药大学学报,1999,16(04)：253-258.
54.赵希才,刘玉玲,侯校友,等.消栓通冲剂对脑梗塞患者血液流变学的影响.中国冶金工业医学杂志,1996,13(06)：345-346.