基于脑梗死中医全程适时干预方案的实施过程评价研究
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摘要
背景：
中风病以其高发病率、高复发率、高致残率、高死亡率及越来越高的防治费用,给国家和社会造成巨大的经济损失,已成为影响我国国计民生的重要公共卫生问题。中医防治中风病在综合治疗方案的优化、临床指南的形成方面取得了丰富的研究成果,但是在成果转化应用方面尚不充分。近年来,依据大量包括流行病学调查和临床试验在内的循证医学证据明确了脑卒中的多种诊治措施,并形成了多个指南,但在临床实践和循证指南之间依然存在巨大的鸿沟。中风病综合治疗方案或指南的实施及过程评价研究相对较缺乏,方案或指南在形成后没有更好的进入临床,加速科研成果向临床应用的转化成为中风病防治中的关键环节。本研究基于脑梗死中医全程适时干预方案进行方案的实施过程评价研究,属于T3转化(将指南变成实践,推广性转化)研究的范畴。
目的：
初步建立“脑梗死中医全程适时干预方案”的实施过程评价指标,评价方案的执行情况,以期为方案的进一步优化提供参考意见。
方法：
1.通过文献研究,复习国内外关于中风病综合治疗方案的研究概况进而提出问题,通过对方案实施过程评价和依从性文献的学习,总结中医综合方案实施过程评价的方法和理念。
2.借鉴现代医学研究结果,以两项中风病诊疗指南为依据,初步建立“脑梗死中医全程适时干预方案”的实施过程评价指标。
3.采用初步建立的实施过程评价指标对“脑梗死中医全程适时干预方案”的实施过程进行评价,考评方案在临床中的执行情况并探讨指标的科学性和可行性,分析方案实施中存在的障碍及影响方案依从性的因素。
结果：
1.以循证医学证据和专家共识为基础形成的指南(WHO西太区资助发布的《脑梗死中医临床实践指南》和中华中医药学会内科分会主持发布的《中风病临床诊疗指南(ZYYXH/T22-2008)》)为依据,对“脑梗死中医全程适时干预方案”和SOP进行解析,提取关键环节形成11项核心评价指标：包括治疗方案执行指标和临床评价执行指标,具体指标为：证候判断评分、辨证选择中药配方颗粒评分、三七总皂苷注射液执行评分、针灸治疗执行评分、推拿治疗执行评分、康复训练治疗执行评分、抗血小板药执行评分、神经保护剂执行评分、康复评价执行评分、NIHSS评定执行评分和头颅影像学检查执行评分。
2.对所纳入100个病例的方案实施过程进行评价,结果：“证候判断”执行得分均数为4.47,得分率为89.4%;“辨证选择中药配方颗粒”执行得分均数为7.90,得分率为79.0%；“三七总皂苷注射液”执行得分均数为4.08,得分率为81.6%；“针灸治疗”执行得分均数为6.42,得分率为64.2%；“推拿治疗”执行得分均数为5.02,得分率为50.2%；“康复训练”执行得分均数为7.20,得分率为72.0%；“抗血小板药”执行得分均数为3.53,得分率为88.3%；“神经保护剂”执行得分均数为1.20,得分率为60.0%；“头颅影像学检查”执行得分均数为1.67,得分率为83.5%；‘'NIHSS评定”执行得分均数为4.91,得分率为98.2%；“康复评定”执行得分均数为4.77,得分率为95.4%；总分均数为51.17,得分率为75.3%。11项评价指标得分率由高到低依次为：NIHSS评定、康复评定、证候判断、抗血小板药、头颅影像学检查、三七总皂苷注射液、辨证选择中药配方颗粒、康复训练、针灸治疗、神经保护剂、推拿治疗。临床评定方面的各项评价指标执行均较好,得分率均超过80%,其中NIHSS评定和康复评定两项指标执行得分率均超过95%；在治疗方面,抗血小板药、三七总皂苷注射液、辨证选择中药配方颗粒三项执行情况较好,康复训练、神经保护剂、针灸治疗和推拿治疗三项治疗内容的执行较差。
3.采用了3种综合评价方法对5个临床研究中心的方案执行情况进行比较。综合指数法,A～E5个中心的综合指数Ⅰ依次为2.403、2.720、3.001、1.580、0.959,根据综合指数I对各临床研究中心进行评价排序,从高到低依次为中心C、中心B、中心A、中心D和中心E。TOPSIS法,A～E5个中心的Ci值依次为0.7310、0.5705、0.9158、0.5289、0.3410,根据Ci值从高到低排序依次为中心C、中心A、中心B、中心D和中心E。秩和比法,A～E5个中心的RSR值依次为0.6455、0.7545、0.7818、0.4727、0.3455,根据RSR值对评价对象的优劣进行排序,从高到低依次为中心C、中心B、中心A、中心D和中心E,对各中心进行分档排序,中心C为第1档,中心A、B为第2档,中心D、E为第3档。以上评价结果基本一致,可将上述3种方法联用,评价不同研究中心方案实施过程,特别是TOPSIS法与秩和比法结合应用,其结果既能排序又能合理分级,可更加全面的反应干预对象的实施过程。
结论：
通过文献研究、理论研究和临床研究建立的“脑梗死中医全程适时干预方案”的实施过程评价指标体系能够评价出研究方案执行情况及其变化,并分析方案实施中存在的障碍和影响方案依从性的因素。在复杂干预的多中心临床研究中,通过对各中心的方案实施过程进行评价,监测其各项诊治措施的执行程度,有助于及时、动态掌握项目执行情况,对项目进行反馈以便及时发现存在的问题。
Background:
Stroke has bring about huge economic losses to the state and society, because of its high morbidity, recurrence rate, disability rate, mortality rate and rising control cost; it has become to an important public health problem effect on our contry. We have got lots of research achievement in comprehensive treatment program of TCM optimization and formation of Clinical Practice Guidelines on stoke, but not sufficient in transformation and application of the achievements. In recent years, Multiple clinical practice guidelines of stoke based on a large number of epidemiological surveys and clinical trials have been established, but still there is a huge gap between clinical practice and evidence-based guidelines. Process evaluation study on comprehensive treatment program of Stroke or guidelines is relatively lack, the application of the programsand guidelines is insufficiency. Accelerate transformation progress from scientific research to clinical application is the key point of study on revention and treatment in Stroke. This study of process evaluation on long term timely intervention program of TCM of cerebral infarction belongs to T3Translational research.
Objective:
Preliminary Establish Evaluation index of Long Term Timely Intervention program of TCM of Cerebral infarction, evaluate the execution situation of the program, in order to provide a reference for further optimization of the program.
Method:
1. Through literature research, we reviewed the research profile of comprehensive treatment program of TCM on stoke, at home and abroad to ask questions, and put forward some problems;Through the study on the literature of process evaluation and compliance, we Summarized methods and concepts about process evaluation study of comprehensive program of TCM.
2. Draw on the results of modern medical research, and based on two stroke diagnosis and treatment guidelines, We preliminary established evaluation index of Long term timely intervention program of TCM of cerebral infarction.
3. Using the11evaluation index, we evaluated the execution situation of the program, in order to provide a reference for further optimization of the program, then we evaluated the scientific and feasibility of the evaluation index, and analysis the obstacles in the of program implementation and impact of program compliance.
Results:
1. Based on guidelines, we extract the key elements of the program, and formatted11 evaluation index, containing performance index of treatment program and clinical evaluation: Syndrome judgment score, Dispensing granules selection score, Panax notoginseng saponins Injection execution score, Acupuncture treatment execution score, Massage therapy execution score, Rehabilitation execution score, Anti-platelet drugs execution score, Neuroprotective agents execution score, Rehabilitation evaluation execution score, NIHSS assessment execution score, Imaging inspection execution score.
2. We evaluated the execution situation of the program on100cases, the results:Syndrome judgment score is4.47,the Scoring rate is89.4%; Dispensing granules selection score is7.90,the Scoring rate is79.0%; Panax notoginseng saponins Injection execution score was4.08, the Scoring rate was81.6%; Acupuncture treatment execution score was6.42, the Scoring rate was64.2%; Massage therapy execution score was5.02, the Scoring rate was50.2%; Rehabilitation execution score was7.20,the Scoring rate was72.0%; Anti-platelet drugs execution score was3.53,the Scoring rate was88.3%; Neuroprotective agents execution score, was1.20,the Scoring rate was60.0%; Rehabilitation evaluation execution score was1.67,the Scoring rate was83.5%; NIHSS assessment execution score was4.91,the Scoring rate was98.2%; Imaging inspection execution score was4.77,the Scoring rate was95.4%; total score mean was51.17, the score rate was75.3%. Indexs score of clinical evaluation was better than that's of treatment program, especially in Rehabilitation evaluation and NIHSS assessment, the rates were both larger than95%. In the aspect of treatment plan, the execution of Dispensing granules selection score, Panax notoginseng saponins Injection execution score, and Anti-platelet drugs execution score was quite satisfactory, the execution of Acupuncture treatment execution score, Massage therapy execution score. Rehabilitation execution score, and Neuroprotective agents execution score was poor.
3. We used3kinds of comprehensive evaluation method to compare the execution of the program in5clinical research centers. Composite index method:Sort by composite index I of5Clinical Research Centers, they were in order of Center C, Centre B, Centre A, center D and Center E. TOPSIS method:Sort by Ci of5Clinical Research Centers, they were in order of Center C, Centre A, Centre B, center D and Center E. RSR method:Sort by RSR of5Clinical Research Centers, they were in order of Center C, Centre B, Centre A, center D and Center E. Distinguished the levels of5centers, center C was in the first level, center A and B was in the second level, center Dand E were in the third level.
The results used in3different methods were basically the same, so we can use3kinds methods above synchronously to evaluate implementation process of diffrente clinical research centers.
Conclusion:
The index system can evaluate the implementation of the program and its changes, and analyze the existing obstacles in the implementation of the program and impact of program compliance.
中风病以其高发病率、高复发率、高致残率、高死亡率及越来越高的防治费用,给国家和社会造成巨大的经济损失,已成为影响我国国计民生的重要公共卫生问题。中医防治中风病在综合治疗方案的优化、临床指南的形成方面取得了丰富的研究成果,但是在成果转化应用方面尚不充分。近年来,依据大量包括流行病学调查和临床试验在内的循证医学证据明确了脑卒中的多种诊治措施,并形成了多个指南,但在临床实践和循证指南之间依然存在巨大的鸿沟。中风病综合治疗方案或指南的实施及过程评价研究相对较缺乏,方案或指南在形成后没有更好的进入临床,加速科研成果向临床应用的转化成为中风病防治中的关键环节。本研究基于脑梗死中医全程适时干预方案进行方案的实施过程评价研究,属于T3转化(将指南变成实践,推广性转化)研究的范畴。
目的：
初步建立“脑梗死中医全程适时干预方案”的实施过程评价指标,评价方案的执行情况,以期为方案的进一步优化提供参考意见。
方法：
1.通过文献研究,复习国内外关于中风病综合治疗方案的研究概况进而提出问题,通过对方案实施过程评价和依从性文献的学习,总结中医综合方案实施过程评价的方法和理念。
2.借鉴现代医学研究结果,以两项中风病诊疗指南为依据,初步建立“脑梗死中医全程适时干预方案”的实施过程评价指标。
3.采用初步建立的实施过程评价指标对“脑梗死中医全程适时干预方案”的实施过程进行评价,考评方案在临床中的执行情况并探讨指标的科学性和可行性,分析方案实施中存在的障碍及影响方案依从性的因素。
结果：
1.以循证医学证据和专家共识为基础形成的指南(WHO西太区资助发布的《脑梗死中医临床实践指南》和中华中医药学会内科分会主持发布的《中风病临床诊疗指南(ZYYXH/T22-2008)》)为依据,对“脑梗死中医全程适时干预方案”和SOP进行解析,提取关键环节形成11项核心评价指标：包括治疗方案执行指标和临床评价执行指标,具体指标为：证候判断评分、辨证选择中药配方颗粒评分、三七总皂苷注射液执行评分、针灸治疗执行评分、推拿治疗执行评分、康复训练治疗执行评分、抗血小板药执行评分、神经保护剂执行评分、康复评价执行评分、NIHSS评定执行评分和头颅影像学检查执行评分。
2.对所纳入100个病例的方案实施过程进行评价,结果：“证候判断”执行得分均数为4.47,得分率为89.4%;“辨证选择中药配方颗粒”执行得分均数为7.90,得分率为79.0%；“三七总皂苷注射液”执行得分均数为4.08,得分率为81.6%；“针灸治疗”执行得分均数为6.42,得分率为64.2%；“推拿治疗”执行得分均数为5.02,得分率为50.2%；“康复训练”执行得分均数为7.20,得分率为72.0%；“抗血小板药”执行得分均数为3.53,得分率为88.3%；“神经保护剂”执行得分均数为1.20,得分率为60.0%；“头颅影像学检查”执行得分均数为1.67,得分率为83.5%；‘'NIHSS评定”执行得分均数为4.91,得分率为98.2%；“康复评定”执行得分均数为4.77,得分率为95.4%；总分均数为51.17,得分率为75.3%。11项评价指标得分率由高到低依次为：NIHSS评定、康复评定、证候判断、抗血小板药、头颅影像学检查、三七总皂苷注射液、辨证选择中药配方颗粒、康复训练、针灸治疗、神经保护剂、推拿治疗。临床评定方面的各项评价指标执行均较好,得分率均超过80%,其中NIHSS评定和康复评定两项指标执行得分率均超过95%；在治疗方面,抗血小板药、三七总皂苷注射液、辨证选择中药配方颗粒三项执行情况较好,康复训练、神经保护剂、针灸治疗和推拿治疗三项治疗内容的执行较差。
3.采用了3种综合评价方法对5个临床研究中心的方案执行情况进行比较。综合指数法,A～E5个中心的综合指数Ⅰ依次为2.403、2.720、3.001、1.580、0.959,根据综合指数I对各临床研究中心进行评价排序,从高到低依次为中心C、中心B、中心A、中心D和中心E。TOPSIS法,A～E5个中心的Ci值依次为0.7310、0.5705、0.9158、0.5289、0.3410,根据Ci值从高到低排序依次为中心C、中心A、中心B、中心D和中心E。秩和比法,A～E5个中心的RSR值依次为0.6455、0.7545、0.7818、0.4727、0.3455,根据RSR值对评价对象的优劣进行排序,从高到低依次为中心C、中心B、中心A、中心D和中心E,对各中心进行分档排序,中心C为第1档,中心A、B为第2档,中心D、E为第3档。以上评价结果基本一致,可将上述3种方法联用,评价不同研究中心方案实施过程,特别是TOPSIS法与秩和比法结合应用,其结果既能排序又能合理分级,可更加全面的反应干预对象的实施过程。
结论：
通过文献研究、理论研究和临床研究建立的“脑梗死中医全程适时干预方案”的实施过程评价指标体系能够评价出研究方案执行情况及其变化,并分析方案实施中存在的障碍和影响方案依从性的因素。在复杂干预的多中心临床研究中,通过对各中心的方案实施过程进行评价,监测其各项诊治措施的执行程度,有助于及时、动态掌握项目执行情况,对项目进行反馈以便及时发现存在的问题。
Background:
Stroke has bring about huge economic losses to the state and society, because of its high morbidity, recurrence rate, disability rate, mortality rate and rising control cost; it has become to an important public health problem effect on our contry. We have got lots of research achievement in comprehensive treatment program of TCM optimization and formation of Clinical Practice Guidelines on stoke, but not sufficient in transformation and application of the achievements. In recent years, Multiple clinical practice guidelines of stoke based on a large number of epidemiological surveys and clinical trials have been established, but still there is a huge gap between clinical practice and evidence-based guidelines. Process evaluation study on comprehensive treatment program of Stroke or guidelines is relatively lack, the application of the programsand guidelines is insufficiency. Accelerate transformation progress from scientific research to clinical application is the key point of study on revention and treatment in Stroke. This study of process evaluation on long term timely intervention program of TCM of cerebral infarction belongs to T3Translational research.
Objective:
Preliminary Establish Evaluation index of Long Term Timely Intervention program of TCM of Cerebral infarction, evaluate the execution situation of the program, in order to provide a reference for further optimization of the program.
Method:
1. Through literature research, we reviewed the research profile of comprehensive treatment program of TCM on stoke, at home and abroad to ask questions, and put forward some problems;Through the study on the literature of process evaluation and compliance, we Summarized methods and concepts about process evaluation study of comprehensive program of TCM.
2. Draw on the results of modern medical research, and based on two stroke diagnosis and treatment guidelines, We preliminary established evaluation index of Long term timely intervention program of TCM of cerebral infarction.
3. Using the11evaluation index, we evaluated the execution situation of the program, in order to provide a reference for further optimization of the program, then we evaluated the scientific and feasibility of the evaluation index, and analysis the obstacles in the of program implementation and impact of program compliance.
Results:
1. Based on guidelines, we extract the key elements of the program, and formatted11 evaluation index, containing performance index of treatment program and clinical evaluation: Syndrome judgment score, Dispensing granules selection score, Panax notoginseng saponins Injection execution score, Acupuncture treatment execution score, Massage therapy execution score, Rehabilitation execution score, Anti-platelet drugs execution score, Neuroprotective agents execution score, Rehabilitation evaluation execution score, NIHSS assessment execution score, Imaging inspection execution score.
2. We evaluated the execution situation of the program on100cases, the results:Syndrome judgment score is4.47,the Scoring rate is89.4%; Dispensing granules selection score is7.90,the Scoring rate is79.0%; Panax notoginseng saponins Injection execution score was4.08, the Scoring rate was81.6%; Acupuncture treatment execution score was6.42, the Scoring rate was64.2%; Massage therapy execution score was5.02, the Scoring rate was50.2%; Rehabilitation execution score was7.20,the Scoring rate was72.0%; Anti-platelet drugs execution score was3.53,the Scoring rate was88.3%; Neuroprotective agents execution score, was1.20,the Scoring rate was60.0%; Rehabilitation evaluation execution score was1.67,the Scoring rate was83.5%; NIHSS assessment execution score was4.91,the Scoring rate was98.2%; Imaging inspection execution score was4.77,the Scoring rate was95.4%; total score mean was51.17, the score rate was75.3%. Indexs score of clinical evaluation was better than that's of treatment program, especially in Rehabilitation evaluation and NIHSS assessment, the rates were both larger than95%. In the aspect of treatment plan, the execution of Dispensing granules selection score, Panax notoginseng saponins Injection execution score, and Anti-platelet drugs execution score was quite satisfactory, the execution of Acupuncture treatment execution score, Massage therapy execution score. Rehabilitation execution score, and Neuroprotective agents execution score was poor.
3. We used3kinds of comprehensive evaluation method to compare the execution of the program in5clinical research centers. Composite index method:Sort by composite index I of5Clinical Research Centers, they were in order of Center C, Centre B, Centre A, center D and Center E. TOPSIS method:Sort by Ci of5Clinical Research Centers, they were in order of Center C, Centre A, Centre B, center D and Center E. RSR method:Sort by RSR of5Clinical Research Centers, they were in order of Center C, Centre B, Centre A, center D and Center E. Distinguished the levels of5centers, center C was in the first level, center A and B was in the second level, center Dand E were in the third level.
The results used in3different methods were basically the same, so we can use3kinds methods above synchronously to evaluate implementation process of diffrente clinical research centers.
Conclusion:
The index system can evaluate the implementation of the program and its changes, and analyze the existing obstacles in the implementation of the program and impact of program compliance.
引文
[1]于永春.活血化瘀法治疗缺血性中风210例分析[J].实用中医内科杂志,2004,18(1)：59.
[2]李勇.益气活血振颓汤治疗缺血性中风偏瘫57例[J].浙江中医杂志,2002,3(9)：384.
[3]刘华.益气活血法治疗缺血性中风临床和药理研究10年回顾与展望[J].现代中西医结合杂志,2000,9(13)：1217.
[4]邹忆怀.王永炎教授运用化痰通腑治疗急性期中风的经验探讨[J].北京中医药大学学报,1999,22(4)：68.
[5]胡跃强,胡国恒等.清热化瘀颗粒治疗急性缺血性中风的临床研究[J].山东中医药大学学报,2004,28(1)：31-33.
[6]张根明,孙塑伦,高颖等.扶正护脑法治疗缺血性中风急性期的临床研究[J].北京中医药大学学报,2003,10(3)：7-10.
[7]冯学功.缺血性中风恢复期补肾培元、化痰祛瘀、散风通络治法初探[J].中医药学报,2001,29(3)：4-6.
[8]支惠萍,刘云等.益肾通络胶囊治疗缺血性中风疗效观察[J].上海中医药杂志,2000,34(5)：19-20.
[9]郭新峰,赖世隆.清开灵注射液治疗急性中风的Meta分析[J].广州中医药大学学报,2000,17(1)：9.
[10]李可建.清开灵注射液治疗缺血性中风急性期随机对照试验的系统评价[J].中华实用中西医杂志2006,19(8)：855-857.
[11]李可建.丹参制剂治疗缺血性中风急性期随机对照试验的系统评价[J].中医药学刊,2006,24(9)：1640-1642.
[12]李可建.刺五加注射液治疗缺血性中风急性期随机对照试验的系统评价[J].中成药,2006,28(10)：1458-1461.
[13]李可建.三七制剂治疗缺血性中风急性期随机对照试验的系统评价[J].临床荟萃,2007,22(1)：1-5.
[14]李可建.参麦注射液治疗缺血性中风急性期随机对照试验的系统评价[J].中医药学报,2006,34(4)：4-7.
[15]李可建.生脉注射液治疗缺血性中风急性期随机对照试验的系统评价[J].辽宁中医杂志,2006,33(8)：936-937.
[16]李可建.葛根素治疗缺血性中风急性期随机对照试验的系统评价[J].山东中医药大学学报,2006,30(2)：120-124.
[17]李可建.疏血通注射液治疗缺血性脑卒中急性期随机对照试验的系统评价[J].中国综合临床,2007,23(1)：7-10.
[18]李可建.银杏叶制剂治疗缺血性中风急性期随机对照试验的系统评价[J].中医药导报,2006,12(11)：1-5.
[19]李可建.灯盏花制剂治疗缺血性中风急性期随机对照试验的系统评价[J].中国医药导刊,2006,8(1)：41-44.
[20]李可建.脉络宁注射液治疗缺血性中风急性随机对照试验的系统评价[J].中华中医药杂志,2006,21(8)：471-474.
[21]马丽虹,李茂峰,李可建.红花注射液治疗缺血性中风急性期随机对照试验的系统评价[J].山东中医杂志,2006,25(9)：590-592.
[22]李可建.川芎嗪注射液治疗缺血性中风急性期随机对照实验的系统评价[J].时珍国医国药,2006,17(10)：1874-1876.
[23]李可建.补阳还五汤及其中成药治疗缺血性中风急性期随机对照试验的系统评价[J].2006,28(1)：58-62.
[24]李可建.黄芪注射液治疗缺血性中风急性期随机对照实验的系统评价[J].中医药通报,2006,5(6)：46-50.
[25]张伯礼,王玉来,高颖等.中风病急性期综合治疗方案研究与评价—附522例临床研究报告[J].中国危重病急救医学2005,17(5)：259-263.
[26]Zhang SH, Liu M, Asplund K, et al. Acupuncture for Acute Stroke[J]. Chochrane Database Syst Rev,2005, (2):CD003317.
[27]石学敏.以针灸治疗为中心的中风诊疗体系[J].江苏中医,1999,20(8)：3.
[28]李慧,梁伟雄,郭新峰.醒脑开窍针法治疗中风的Meta分析[J].广州中医药大学学报,2004,21(3)：215.
[29]Lei H, A i SC, Wen L,et al.Clinical Report on Improvement of Mobility of Affected Shoulder Joint Caused by Acute Cerebral Infarction Treated with Acupuncture and Massage [J]. World Journal of Acupuncture Moxibustion,2008, (1):29-32.
[30]吴振国,梅荣军.推拿关节综合治疗缺血性中风下肢肌张力增高30例[J].针灸临床杂志,2011,(05)：43-45.
[31]邹忆怀,王永炎.复方通络液外洗治疗中风病后“手胀”的探讨[J].中国全科医学,1998,1(1)：33-34.
[32]邹忆怀,李宗衡,张华等.王永炎教授“松”与“静”的观点在偏瘫康复中的应用[J].中国医药学报,2004,19(9)：540-541
[33]曾庆云.中西医综合康复方案对缺血性脑卒中早期偏瘫的影响的对比研究[D].山东中医药大学,2006.
[34]周东海,杜长海等.综合疗法治疗急性期缺血性中风病818例临床研究[J].北京中医,2004,23(1)：10-13.
[35]王建华,解庆凡,王永炎等.中风病急性期中医康复的研究[J].中国中医急症,2006,15(4)：337-338.
[36]张伯礼,王玉来,高颖等.中风病急性期综合治疗方案研究与评价—附522例临床 研究报告[J].中国危重病急救医学2005,17(5)：259-263.
[37]任丽.中医综合疗法治疗急性缺血性中风病的系统评价[D],山东中医药大学,2009.
[38]蔡业峰,付于,郭建文等.中医药治疗急性缺血中风的多中心随机对照研究[J].中药材,2007,30(9)：1192-1195.
[39]王拥军.组织化卒中医疗的概念及国内外特征[J].中国临床康复,2003,7(1)：6-7.
[40]王拥军.改变传统医疗模式,发展组织化卒中医疗体系[J].中国全科医学,2004,7(2)：69-70.
[41]GubitzG, SandercockP. Acute ischemic stroke[J]. BMJ,2000,320:692.
[42]Sinha S, Warburton EA. The evolution of stroke units towards a more intensive approach[J]. QJM,2000,93:633-638.
[43]Indredavik B, Fjartoft H, Ekeberg G, et al. Benefit of an extended stroke unit service with early supported discharge:A randomized, controlled trial [J].Stroke,2000,31(12):2989-2994.
[44]黄燕,汤湘江,黄培新.关于建设中西医结合卒中单元的探讨[J].中国临床康复,2003,7(31)：4283-4283.
[45]白小欣,黄胜平,李铁林,等.中西医结合脑卒中治疗新模式的探讨[J].医学与哲学.2006,2(5)：70-71.
[46]张春红,卞金玲,石学敏.石氏脑卒中单元促进脑卒中患者全面康复的效应[J].中国临床康复,2006,10(7)：140-141.
[47]石学敏.脑血管病与中风单元[J].天津中医药,2005,22(1)：1-3.
[48]郭琳.从醒脑开窍针法到石氏中风单元建设[J].中国针灸,2005,25(8)：581.
[49]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[D].辽宁中医药大学,2010.
[1]Goldies M, Gabrille S, Michael S, et al. Introduction to program evaluation for comprehensive tobacco control programs [M]. Atlanta (GA):Centers for disease control and prevent ion,2001:37-38.
[2]Jeffrey PK. Framework for program evaluation in public health[J].MMWR,1999, 48:9-13.
[3]Sylvie S,Aushra S. Handbook for process evaluation in noncommunicable disease prevent ion[M]. WHO,2000:1-11.
[4]Berel E,Veierodl MB, Bjelland M,et al. Outcome and process evaluation of a Norweigian school-randomized fruit and vegetable intervention:fruits and vegetables mak e the marks (FVMM)[J]. Health Educ R,2006,21:258-267.
[5]Rychetnik L, Hawe P, Waters E, et al. A glossary for evidence based public health[J].J Epidemiol Comm Heal th,2004,58:538-545.
[6]Judy MB, Marian H, Carrie DH, et al. Overview of format ive, process and outcome evaluation methods used in VERBTM campaign [J].AmJ Prev Med,2008,34: 222-229.
[7]刘森,洪志恒,詹思延.复杂干预的设计和评价[J].中华流行病学杂志,2010,31(12)：1410-1413.
[8]高峰燕,万霞,刘亨辉,等.过程评价及其在公共卫生领域的应用[J].中国慢性病预防与控制[J],2008,16(6)：650-652.
[9]谭先杰,郎景和,沈铿,等.《妇科常见恶性肿瘤诊断与治疗规范(草案)》的推广及执行情况分析[J].中华妇产科杂志,2001,36(4)：236-238.
[10]李倩.重庆地区《CO2PD诊治指南》临床执行情况现状调查[D].重庆：重庆医科大学,2010：8.
[11]李俊勇,刘民,周丽,等.医学科研项目实施过程评价指标的应用[J].中华医学科研管理杂志,2005,18(2)：95-96.
[12]刘民,蒋宁,王呈,等.医学科研项目实施过程评价指标体系的可靠性和真实性评价[J].中华医学科研骨理杂志,2006,19(5)：264-267.
[13]葛海萍,姜海萍.住院脑卒中患者康复训练执行情况调查[J].护理学杂志,2011,26 (7)：69-71.
[14]张璐莹.过程评价指标的制定与检测[J].中国卫生质量管理,2005,12(4)：67-69.
[15]杨茗,董碧蓉.临床医生如何评价和应用临床实践指南[J].循证医学,2008,8(4)：235-238.
[16]曾广基,澳大利亚临床诊疗指南的制订、实施与评估[J].现代医院,2009,9(1)：154-156.
[17]林豪杰,董继宏,金丽蓉,等(译).建立卒中医疗体系的建议——美国卒中协会特别工作组关于建立卒中体系的建议[J].国外医学脑血管疾病分册,2005,13(12)：883-894.
[18]Macleod MR,O'Collins T, Howells DW, et al. Pool ingo fanimal experimental data reveals influence of study design and publication bias[J]. Stroke,2004, 35(5):1203-8.
[19]苏志红,王桂敏,于红泽.欧洲卒中促进会对卒中处理的建议(2003更新版)[J].国外医学脑血管疾病分册,2004,12(2)：81.
[20]LaBresh KA. Quality of acute stroke care improvement framework for the Paul Coverdell National Acute Stroke Registry:facilitat ing policy and system change at the hospital level[J]. Am J Prev Med,2006,31 (6 Suppl 2):S246-50.
[21]Broderick JP. Over view of stroke care in the United States and beyond [J]. Am J Prev Med,2006,31(6 Suppl 2):S189-91.
[22]Lindsay MP, Kapra 1 MK, Gladstone D, et al. The Canadian Stroke Qual ity of Care Study:establishing indicators foroptimal acute stroke care[J]. CMAJ,2005, 172(3):363-5.
[23]Heuschmann PU, Berger K.International experience in stroke registries: German Stroke Registers Study Group[J].Am J Prev Med,2006,31(6 Suppl 2):S238-9.
[24]Kobayashi S. International experience in stroke registry: Japanese Stroke Data bank[J]. Am J Prev Med,2006,31(6 Suppl 2):S240-2.
[25]Lee BC, Roh JK. Internat ional experience in stroke registries:Korean Stroke Registry[J]. Am J Prev Med,2006,31 (6 Suppl 2):S243-5.
[26]李子孝,王伊龙,David Wang,等.美国卒中医疗质量登记和持续质量改进项目进展[Jl.Chin J Stroke,2011,6(12):988-992.
[27]王拥军.建立有效的卒中医疗质量测评及改进体系[J].中华内科杂志2011,50(3)：185-186.
[28]LaBresh KA. Quality of acute stroke care improvement framework for the Paul Coverdell National Acute Stroke Registry:facilitat ing policy and system change at the hospital level[J]. Am J Prev Med,2006,31 (6 Suppl 2):S246-50.
[29].David Wang,王拥军.美国卒中医疗质量及其历史、现状和挑战[J].中国卒中杂志,2011,6(12)：993-1000.
[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体系质量评价研究[J].中国卫生质量管理,2010,17(1)：11-15.
[31]王伊龙,王拥军,赵性泉,等,建立中国卒中医疗服务、持续质量改进平台与组织化卒中体系[J].中国医院,2010,14(5)：9-11.
[32]王拥军.组织化卒中医疗的概念及国内外特征[J].中国临床康复,2003,7(1)：6-7.
[33]王拥军.改变传统医疗模式,发展组织化卒中医疗体系[J].中国全科医学,2004,7(2)：69-70.
[34]Sinha S, Warburton EA. The evolution of stroke uni ts-towards a more intensive approach [J]. QJM,2000,93:633-638.
[35]Stroke unit trialists collaboraton. Organized inpatient (Stroke Unit) care for stroke[J]. The cochrane database of systematic reviews,2000:4.
[36]Seenan P,Long M, Langhorne P. Stroke units in their natural habitat: systematic review of observational studies[J].Stroke,2007,38:1886-1892.
[37]王伊龙,王拥军,赵性泉,等,建立中国卒中医疗服务、持续质量改进平台与组织化卒中体系[J].中国医院,2010,14(5)：9-11.
[38]招远褀.基于急性缺血中风临床路径组织化卒中管理的构建与实践[D].广州：广州中医药大学,2011：50.
[1]Haynes RB. Compliance in Health Care[M]. Baltimore: John Hopkins Press,1979: 118.
[2]沈爱宗,张善堂,刘斌,等.990篇病人治疗依从性文献计量学分析[J].疾病控制杂志,2005,9(2)：177-179.
[3]田少雷.药物临床试验与GCP[M].北京：北京大学出版社,2003：51.
[4]许卫华,梁伟雄,王奇,等.临床研究者低依从的表现、原因及对策[J].中药新药与临床药理,2009,20(3)：288-290.
[5]汪朝晖,杨忠奇,杜彦萍,等.谈药物临床试验中研究者依从性的管理[J].江西中医学院学报,2009,21(1)：20-22.
[6]张弦,张阳,赵衍红.由新药临床试验中的依从性问题引发的思考[J].医学与哲学(临床决策论坛版),2009,30(12)：69-70.
[7]Shumaker SA, Dugan E, Bowen DJ. Enhancing adherence in randomized controlled clinical trials [J]. Control Cl in Trials,2000,21 (5 Supp 1):S226-S232.
[8]范大超.评估及提高受试者依从性的方法[J].中国处方药,2010,4(97)：70-71.
[9]林岩.影响和提高缺血性脑卒中二级预防依从性的研究[D].上海：上海交通大学硕士学位论文,2009：3-10.
[10]支英杰,谢雁鸣.浅析临床研究中影响患者依从性问题的因素与对策[J].中医杂志,2010,S1：215-216.
[11]许卫华,王奇,梁伟雄.问卷或量表在病人依从性测量中的应用[J].中国慢性病预防与控制,2007,15(4)：403-405.
[12]Sherbourne CD, Hays RD, Ordway L, et al. Antecedents of adherence to medical recommendations:Results from the Medical Outcomes Study[J].J Behav Med, 1992,15:447-468.
[13]Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-report measure of medicat ion adherence[J].Med Care,1986,24:67-74.
[14]Morisky DE, Ang A, Kr ousel Wood M, et al. Predict ive val idi ty of a medication adherence measure in an outpatient setting. J Clin Hypertens, 2008,10(5):348-354.
[15]李粉玲,王英蓉,郑绮雯,等.血脂异常患者健康知识与治疗依从性的调查分析[J].齐齐哈尔医学院学报,2011,32(1)：123-125.
[16]孟令海,李迥,尚淑玲,等.526例缺血性脑卒中患者二级预防中他汀类调脂药依从性研究[J].医药导报,2012,31(7)：149.
[17]张瑛,苗玲,林岩等.缺血性卒中患者抗栓药依从性研究[J].国际脑血管病杂志,2007,15(4)：262-264.
[18]张君,李国信,张锡玮.谈新药临床试验中受试者和研究者依从性问题[J].辽宁中医杂志,2005,32(8)：854-855.
[19]沈新,汪雁.提高老年患者药物临床试验依从性的研究[J].护理管理,2012,29(5)：41-43.
[20]李永昆,肖义泽,杨晓琼.社区高血压患者管理依从性评估[J].中国当代医药,2010,17(32)：133-134.
[21]蔡军红,刘沙林,彭海燕,等.影响脑梗死病人早期功能锻炼依从性的相关因素及对策[J].护士进修杂志,2008,23(6)：529-531.
[22]Haynes RB. Interventions for helping patients to follow prescriptions for medications. Cochne Database of Systematic Reviews,2002,2:CD0000111.
[1]任丽.中医综合疗法治疗急性缺血性中风病的系统评价[D].山东：山东中医药大学,2009.
[2]Gubitz G, Sandercock P. Acute ischemic stroke [J]. BMJ,2000,320:692.
[3]Sinha S, Warburton EA. The evolution of stroke units towards a more intensive approach [J]. QJM,2000,93:633-638.
[4]Indredavik B, Fjartoft H, Ekeberg G, et al. Benefit of an extended stroke unit service with early supported discharge:A randomized, controlled trial [J]. Stroke,2000,31(12):2989-2994.
[5]郭蕾,王永炎,张志斌,等.关于证候概念的诠释[J].北京中医药大学学报,2003,26(2)：5-8.
[6]刘强.中风病急性期证候与基础病及神经功能缺损相关性研究[D].北京：北京中医药大学,2005.
[7]王建华,王永炎.出血性中风、缺血性中风急性期证候演变规律的研究[J].中国中医急症,2001,10(4)：215-217.
[8]刘淼,洪志恒,詹思延.复杂干预的设计和评价[J].中华流行病学杂志2010,31(12)：1410-1413.
[9]孙振球.医学统计学(第二版)[J].北京：人民卫生出版社,2005,7：493-522.
[10]中国中医科学院.中医循证临床实践指南(中医内科)[J].北京：中国中医药出版社,2011,1：283-310.
[11]中华中医药学会中医内科常见病诊疗指南(中医病症部分)[J]北京：中国中医药出版社,2008,7：56-62.
[12]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J],中华神经科杂志,2010,43(2)：1-8.
[13]高颖,马斌,刘强,等.缺血性中风证候要素诊断量表编制及方法学探讨[J].中医杂志,2011,52(24)：2097-2101.
[14]高颖,马斌,刘强,等.《缺血性中风证候要素诊断量表》临床验证[J].中医杂志,2012,53(1)：23-25.
[15]Su Y, Zhang X, Zeng J, et al.New-onset constipation at acute stage after first stroke: incidence, risk factors, and impact on the stroke outcome[J]. Stoke,2009,40(4):1304.
[16]Van Putten MJ, Peters JM, Mulder SM, et al. A brain symmetry index (BSI) for online EEG monitoring in carotid endarterectomy. Clin Neurophysiol, 2004,115(5):1189-1194.
[17]辛喜艳.中风病虚实证候演变及脑电特征与预后的关系研究[D].北京：北京中医药大学,2012：34.
[18]中华医学会神经病学分会.中国脑血管病防治指南[M].北京：人民卫生出版社,2007：34.
[19]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体系质量评价研究[J].中国卫生质量管理,2010,17(1)：11-15.
[20]林蓓蕾,张振香,孙玉梅.脑卒中患者功能锻炼依从性及其影响因素的研究现状[J].中国慢性病预防与控制,2011,19(5)：1.
[21]黄芳.脑卒中偏瘫患者康复依从性的影响因素及对策[J].神经病学与神经康复学杂志,2009,6(3)：194-196.
[22]赵小平,谭耀坤,黄芳艳.影响脑卒中患者出院后健康转归的原因[J].中国临床康复,2004,8(4)：631.
[23]唐颖,石跃林.脑卒中偏瘫患者早期康复训练依从性相关因素分析[J].中国康复理论与实践,2007,13(1)：69-70.
[24]葛海萍,姜海萍.住院脑卒中患者康复训练执行情况调查[J].护理学杂志,2011,26(7)：1.
[25]蔡军红,刘沙林,彭海燕,等.影响脑梗死病人早期功能锻炼依从性的相关因素及对策[J].护士进修杂志,2008,23(6)：1.
[26]夏萍,庄岩,卢传坚,陈达灿.我国医疗质量多维综合评价方法的循证评价[J].中国循证医学杂志,2011,11(2)：226-230.
[27]田凤调.秩和比法的应用[M].北京：人民卫生出版社,2002,9.
[2]李勇.益气活血振颓汤治疗缺血性中风偏瘫57例[J].浙江中医杂志,2002,3(9)：384.
[3]刘华.益气活血法治疗缺血性中风临床和药理研究10年回顾与展望[J].现代中西医结合杂志,2000,9(13)：1217.
[4]邹忆怀.王永炎教授运用化痰通腑治疗急性期中风的经验探讨[J].北京中医药大学学报,1999,22(4)：68.
[5]胡跃强,胡国恒等.清热化瘀颗粒治疗急性缺血性中风的临床研究[J].山东中医药大学学报,2004,28(1)：31-33.
[6]张根明,孙塑伦,高颖等.扶正护脑法治疗缺血性中风急性期的临床研究[J].北京中医药大学学报,2003,10(3)：7-10.
[7]冯学功.缺血性中风恢复期补肾培元、化痰祛瘀、散风通络治法初探[J].中医药学报,2001,29(3)：4-6.
[8]支惠萍,刘云等.益肾通络胶囊治疗缺血性中风疗效观察[J].上海中医药杂志,2000,34(5)：19-20.
[9]郭新峰,赖世隆.清开灵注射液治疗急性中风的Meta分析[J].广州中医药大学学报,2000,17(1)：9.
[10]李可建.清开灵注射液治疗缺血性中风急性期随机对照试验的系统评价[J].中华实用中西医杂志2006,19(8)：855-857.
[11]李可建.丹参制剂治疗缺血性中风急性期随机对照试验的系统评价[J].中医药学刊,2006,24(9)：1640-1642.
[12]李可建.刺五加注射液治疗缺血性中风急性期随机对照试验的系统评价[J].中成药,2006,28(10)：1458-1461.
[13]李可建.三七制剂治疗缺血性中风急性期随机对照试验的系统评价[J].临床荟萃,2007,22(1)：1-5.
[14]李可建.参麦注射液治疗缺血性中风急性期随机对照试验的系统评价[J].中医药学报,2006,34(4)：4-7.
[15]李可建.生脉注射液治疗缺血性中风急性期随机对照试验的系统评价[J].辽宁中医杂志,2006,33(8)：936-937.
[16]李可建.葛根素治疗缺血性中风急性期随机对照试验的系统评价[J].山东中医药大学学报,2006,30(2)：120-124.
[17]李可建.疏血通注射液治疗缺血性脑卒中急性期随机对照试验的系统评价[J].中国综合临床,2007,23(1)：7-10.
[18]李可建.银杏叶制剂治疗缺血性中风急性期随机对照试验的系统评价[J].中医药导报,2006,12(11)：1-5.
[19]李可建.灯盏花制剂治疗缺血性中风急性期随机对照试验的系统评价[J].中国医药导刊,2006,8(1)：41-44.
[20]李可建.脉络宁注射液治疗缺血性中风急性随机对照试验的系统评价[J].中华中医药杂志,2006,21(8)：471-474.
[21]马丽虹,李茂峰,李可建.红花注射液治疗缺血性中风急性期随机对照试验的系统评价[J].山东中医杂志,2006,25(9)：590-592.
[22]李可建.川芎嗪注射液治疗缺血性中风急性期随机对照实验的系统评价[J].时珍国医国药,2006,17(10)：1874-1876.
[23]李可建.补阳还五汤及其中成药治疗缺血性中风急性期随机对照试验的系统评价[J].2006,28(1)：58-62.
[24]李可建.黄芪注射液治疗缺血性中风急性期随机对照实验的系统评价[J].中医药通报,2006,5(6)：46-50.
[25]张伯礼,王玉来,高颖等.中风病急性期综合治疗方案研究与评价—附522例临床研究报告[J].中国危重病急救医学2005,17(5)：259-263.
[26]Zhang SH, Liu M, Asplund K, et al. Acupuncture for Acute Stroke[J]. Chochrane Database Syst Rev,2005, (2):CD003317.
[27]石学敏.以针灸治疗为中心的中风诊疗体系[J].江苏中医,1999,20(8)：3.
[28]李慧,梁伟雄,郭新峰.醒脑开窍针法治疗中风的Meta分析[J].广州中医药大学学报,2004,21(3)：215.
[29]Lei H, A i SC, Wen L,et al.Clinical Report on Improvement of Mobility of Affected Shoulder Joint Caused by Acute Cerebral Infarction Treated with Acupuncture and Massage [J]. World Journal of Acupuncture Moxibustion,2008, (1):29-32.
[30]吴振国,梅荣军.推拿关节综合治疗缺血性中风下肢肌张力增高30例[J].针灸临床杂志,2011,(05)：43-45.
[31]邹忆怀,王永炎.复方通络液外洗治疗中风病后“手胀”的探讨[J].中国全科医学,1998,1(1)：33-34.
[32]邹忆怀,李宗衡,张华等.王永炎教授“松”与“静”的观点在偏瘫康复中的应用[J].中国医药学报,2004,19(9)：540-541
[33]曾庆云.中西医综合康复方案对缺血性脑卒中早期偏瘫的影响的对比研究[D].山东中医药大学,2006.
[34]周东海,杜长海等.综合疗法治疗急性期缺血性中风病818例临床研究[J].北京中医,2004,23(1)：10-13.
[35]王建华,解庆凡,王永炎等.中风病急性期中医康复的研究[J].中国中医急症,2006,15(4)：337-338.
[36]张伯礼,王玉来,高颖等.中风病急性期综合治疗方案研究与评价—附522例临床 研究报告[J].中国危重病急救医学2005,17(5)：259-263.
[37]任丽.中医综合疗法治疗急性缺血性中风病的系统评价[D],山东中医药大学,2009.
[38]蔡业峰,付于,郭建文等.中医药治疗急性缺血中风的多中心随机对照研究[J].中药材,2007,30(9)：1192-1195.
[39]王拥军.组织化卒中医疗的概念及国内外特征[J].中国临床康复,2003,7(1)：6-7.
[40]王拥军.改变传统医疗模式,发展组织化卒中医疗体系[J].中国全科医学,2004,7(2)：69-70.
[41]GubitzG, SandercockP. Acute ischemic stroke[J]. BMJ,2000,320:692.
[42]Sinha S, Warburton EA. The evolution of stroke units towards a more intensive approach[J]. QJM,2000,93:633-638.
[43]Indredavik B, Fjartoft H, Ekeberg G, et al. Benefit of an extended stroke unit service with early supported discharge:A randomized, controlled trial [J].Stroke,2000,31(12):2989-2994.
[44]黄燕,汤湘江,黄培新.关于建设中西医结合卒中单元的探讨[J].中国临床康复,2003,7(31)：4283-4283.
[45]白小欣,黄胜平,李铁林,等.中西医结合脑卒中治疗新模式的探讨[J].医学与哲学.2006,2(5)：70-71.
[46]张春红,卞金玲,石学敏.石氏脑卒中单元促进脑卒中患者全面康复的效应[J].中国临床康复,2006,10(7)：140-141.
[47]石学敏.脑血管病与中风单元[J].天津中医药,2005,22(1)：1-3.
[48]郭琳.从醒脑开窍针法到石氏中风单元建设[J].中国针灸,2005,25(8)：581.
[49]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[D].辽宁中医药大学,2010.
[1]Goldies M, Gabrille S, Michael S, et al. Introduction to program evaluation for comprehensive tobacco control programs [M]. Atlanta (GA):Centers for disease control and prevent ion,2001:37-38.
[2]Jeffrey PK. Framework for program evaluation in public health[J].MMWR,1999, 48:9-13.
[3]Sylvie S,Aushra S. Handbook for process evaluation in noncommunicable disease prevent ion[M]. WHO,2000:1-11.
[4]Berel E,Veierodl MB, Bjelland M,et al. Outcome and process evaluation of a Norweigian school-randomized fruit and vegetable intervention:fruits and vegetables mak e the marks (FVMM)[J]. Health Educ R,2006,21:258-267.
[5]Rychetnik L, Hawe P, Waters E, et al. A glossary for evidence based public health[J].J Epidemiol Comm Heal th,2004,58:538-545.
[6]Judy MB, Marian H, Carrie DH, et al. Overview of format ive, process and outcome evaluation methods used in VERBTM campaign [J].AmJ Prev Med,2008,34: 222-229.
[7]刘森,洪志恒,詹思延.复杂干预的设计和评价[J].中华流行病学杂志,2010,31(12)：1410-1413.
[8]高峰燕,万霞,刘亨辉,等.过程评价及其在公共卫生领域的应用[J].中国慢性病预防与控制[J],2008,16(6)：650-652.
[9]谭先杰,郎景和,沈铿,等.《妇科常见恶性肿瘤诊断与治疗规范(草案)》的推广及执行情况分析[J].中华妇产科杂志,2001,36(4)：236-238.
[10]李倩.重庆地区《CO2PD诊治指南》临床执行情况现状调查[D].重庆：重庆医科大学,2010：8.
[11]李俊勇,刘民,周丽,等.医学科研项目实施过程评价指标的应用[J].中华医学科研管理杂志,2005,18(2)：95-96.
[12]刘民,蒋宁,王呈,等.医学科研项目实施过程评价指标体系的可靠性和真实性评价[J].中华医学科研骨理杂志,2006,19(5)：264-267.
[13]葛海萍,姜海萍.住院脑卒中患者康复训练执行情况调查[J].护理学杂志,2011,26 (7)：69-71.
[14]张璐莹.过程评价指标的制定与检测[J].中国卫生质量管理,2005,12(4)：67-69.
[15]杨茗,董碧蓉.临床医生如何评价和应用临床实践指南[J].循证医学,2008,8(4)：235-238.
[16]曾广基,澳大利亚临床诊疗指南的制订、实施与评估[J].现代医院,2009,9(1)：154-156.
[17]林豪杰,董继宏,金丽蓉,等(译).建立卒中医疗体系的建议——美国卒中协会特别工作组关于建立卒中体系的建议[J].国外医学脑血管疾病分册,2005,13(12)：883-894.
[18]Macleod MR,O'Collins T, Howells DW, et al. Pool ingo fanimal experimental data reveals influence of study design and publication bias[J]. Stroke,2004, 35(5):1203-8.
[19]苏志红,王桂敏,于红泽.欧洲卒中促进会对卒中处理的建议(2003更新版)[J].国外医学脑血管疾病分册,2004,12(2)：81.
[20]LaBresh KA. Quality of acute stroke care improvement framework for the Paul Coverdell National Acute Stroke Registry:facilitat ing policy and system change at the hospital level[J]. Am J Prev Med,2006,31 (6 Suppl 2):S246-50.
[21]Broderick JP. Over view of stroke care in the United States and beyond [J]. Am J Prev Med,2006,31(6 Suppl 2):S189-91.
[22]Lindsay MP, Kapra 1 MK, Gladstone D, et al. The Canadian Stroke Qual ity of Care Study:establishing indicators foroptimal acute stroke care[J]. CMAJ,2005, 172(3):363-5.
[23]Heuschmann PU, Berger K.International experience in stroke registries: German Stroke Registers Study Group[J].Am J Prev Med,2006,31(6 Suppl 2):S238-9.
[24]Kobayashi S. International experience in stroke registry: Japanese Stroke Data bank[J]. Am J Prev Med,2006,31(6 Suppl 2):S240-2.
[25]Lee BC, Roh JK. Internat ional experience in stroke registries:Korean Stroke Registry[J]. Am J Prev Med,2006,31 (6 Suppl 2):S243-5.
[26]李子孝,王伊龙,David Wang,等.美国卒中医疗质量登记和持续质量改进项目进展[Jl.Chin J Stroke,2011,6(12):988-992.
[27]王拥军.建立有效的卒中医疗质量测评及改进体系[J].中华内科杂志2011,50(3)：185-186.
[28]LaBresh KA. Quality of acute stroke care improvement framework for the Paul Coverdell National Acute Stroke Registry:facilitat ing policy and system change at the hospital level[J]. Am J Prev Med,2006,31 (6 Suppl 2):S246-50.
[29].David Wang,王拥军.美国卒中医疗质量及其历史、现状和挑战[J].中国卒中杂志,2011,6(12)：993-1000.
[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体系质量评价研究[J].中国卫生质量管理,2010,17(1)：11-15.
[31]王伊龙,王拥军,赵性泉,等,建立中国卒中医疗服务、持续质量改进平台与组织化卒中体系[J].中国医院,2010,14(5)：9-11.
[32]王拥军.组织化卒中医疗的概念及国内外特征[J].中国临床康复,2003,7(1)：6-7.
[33]王拥军.改变传统医疗模式,发展组织化卒中医疗体系[J].中国全科医学,2004,7(2)：69-70.
[34]Sinha S, Warburton EA. The evolution of stroke uni ts-towards a more intensive approach [J]. QJM,2000,93:633-638.
[35]Stroke unit trialists collaboraton. Organized inpatient (Stroke Unit) care for stroke[J]. The cochrane database of systematic reviews,2000:4.
[36]Seenan P,Long M, Langhorne P. Stroke units in their natural habitat: systematic review of observational studies[J].Stroke,2007,38:1886-1892.
[37]王伊龙,王拥军,赵性泉,等,建立中国卒中医疗服务、持续质量改进平台与组织化卒中体系[J].中国医院,2010,14(5)：9-11.
[38]招远褀.基于急性缺血中风临床路径组织化卒中管理的构建与实践[D].广州：广州中医药大学,2011：50.
[1]Haynes RB. Compliance in Health Care[M]. Baltimore: John Hopkins Press,1979: 118.
[2]沈爱宗,张善堂,刘斌,等.990篇病人治疗依从性文献计量学分析[J].疾病控制杂志,2005,9(2)：177-179.
[3]田少雷.药物临床试验与GCP[M].北京：北京大学出版社,2003：51.
[4]许卫华,梁伟雄,王奇,等.临床研究者低依从的表现、原因及对策[J].中药新药与临床药理,2009,20(3)：288-290.
[5]汪朝晖,杨忠奇,杜彦萍,等.谈药物临床试验中研究者依从性的管理[J].江西中医学院学报,2009,21(1)：20-22.
[6]张弦,张阳,赵衍红.由新药临床试验中的依从性问题引发的思考[J].医学与哲学(临床决策论坛版),2009,30(12)：69-70.
[7]Shumaker SA, Dugan E, Bowen DJ. Enhancing adherence in randomized controlled clinical trials [J]. Control Cl in Trials,2000,21 (5 Supp 1):S226-S232.
[8]范大超.评估及提高受试者依从性的方法[J].中国处方药,2010,4(97)：70-71.
[9]林岩.影响和提高缺血性脑卒中二级预防依从性的研究[D].上海：上海交通大学硕士学位论文,2009：3-10.
[10]支英杰,谢雁鸣.浅析临床研究中影响患者依从性问题的因素与对策[J].中医杂志,2010,S1：215-216.
[11]许卫华,王奇,梁伟雄.问卷或量表在病人依从性测量中的应用[J].中国慢性病预防与控制,2007,15(4)：403-405.
[12]Sherbourne CD, Hays RD, Ordway L, et al. Antecedents of adherence to medical recommendations:Results from the Medical Outcomes Study[J].J Behav Med, 1992,15:447-468.
[13]Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-report measure of medicat ion adherence[J].Med Care,1986,24:67-74.
[14]Morisky DE, Ang A, Kr ousel Wood M, et al. Predict ive val idi ty of a medication adherence measure in an outpatient setting. J Clin Hypertens, 2008,10(5):348-354.
[15]李粉玲,王英蓉,郑绮雯,等.血脂异常患者健康知识与治疗依从性的调查分析[J].齐齐哈尔医学院学报,2011,32(1)：123-125.
[16]孟令海,李迥,尚淑玲,等.526例缺血性脑卒中患者二级预防中他汀类调脂药依从性研究[J].医药导报,2012,31(7)：149.
[17]张瑛,苗玲,林岩等.缺血性卒中患者抗栓药依从性研究[J].国际脑血管病杂志,2007,15(4)：262-264.
[18]张君,李国信,张锡玮.谈新药临床试验中受试者和研究者依从性问题[J].辽宁中医杂志,2005,32(8)：854-855.
[19]沈新,汪雁.提高老年患者药物临床试验依从性的研究[J].护理管理,2012,29(5)：41-43.
[20]李永昆,肖义泽,杨晓琼.社区高血压患者管理依从性评估[J].中国当代医药,2010,17(32)：133-134.
[21]蔡军红,刘沙林,彭海燕,等.影响脑梗死病人早期功能锻炼依从性的相关因素及对策[J].护士进修杂志,2008,23(6)：529-531.
[22]Haynes RB. Interventions for helping patients to follow prescriptions for medications. Cochne Database of Systematic Reviews,2002,2:CD0000111.
[1]任丽.中医综合疗法治疗急性缺血性中风病的系统评价[D].山东：山东中医药大学,2009.
[2]Gubitz G, Sandercock P. Acute ischemic stroke [J]. BMJ,2000,320:692.
[3]Sinha S, Warburton EA. The evolution of stroke units towards a more intensive approach [J]. QJM,2000,93:633-638.
[4]Indredavik B, Fjartoft H, Ekeberg G, et al. Benefit of an extended stroke unit service with early supported discharge:A randomized, controlled trial [J]. Stroke,2000,31(12):2989-2994.
[5]郭蕾,王永炎,张志斌,等.关于证候概念的诠释[J].北京中医药大学学报,2003,26(2)：5-8.
[6]刘强.中风病急性期证候与基础病及神经功能缺损相关性研究[D].北京：北京中医药大学,2005.
[7]王建华,王永炎.出血性中风、缺血性中风急性期证候演变规律的研究[J].中国中医急症,2001,10(4)：215-217.
[8]刘淼,洪志恒,詹思延.复杂干预的设计和评价[J].中华流行病学杂志2010,31(12)：1410-1413.
[9]孙振球.医学统计学(第二版)[J].北京：人民卫生出版社,2005,7：493-522.
[10]中国中医科学院.中医循证临床实践指南(中医内科)[J].北京：中国中医药出版社,2011,1：283-310.
[11]中华中医药学会中医内科常见病诊疗指南(中医病症部分)[J]北京：中国中医药出版社,2008,7：56-62.
[12]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J],中华神经科杂志,2010,43(2)：1-8.
[13]高颖,马斌,刘强,等.缺血性中风证候要素诊断量表编制及方法学探讨[J].中医杂志,2011,52(24)：2097-2101.
[14]高颖,马斌,刘强,等.《缺血性中风证候要素诊断量表》临床验证[J].中医杂志,2012,53(1)：23-25.
[15]Su Y, Zhang X, Zeng J, et al.New-onset constipation at acute stage after first stroke: incidence, risk factors, and impact on the stroke outcome[J]. Stoke,2009,40(4):1304.
[16]Van Putten MJ, Peters JM, Mulder SM, et al. A brain symmetry index (BSI) for online EEG monitoring in carotid endarterectomy. Clin Neurophysiol, 2004,115(5):1189-1194.
[17]辛喜艳.中风病虚实证候演变及脑电特征与预后的关系研究[D].北京：北京中医药大学,2012：34.
[18]中华医学会神经病学分会.中国脑血管病防治指南[M].北京：人民卫生出版社,2007：34.
[19]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体系质量评价研究[J].中国卫生质量管理,2010,17(1)：11-15.
[20]林蓓蕾,张振香,孙玉梅.脑卒中患者功能锻炼依从性及其影响因素的研究现状[J].中国慢性病预防与控制,2011,19(5)：1.
[21]黄芳.脑卒中偏瘫患者康复依从性的影响因素及对策[J].神经病学与神经康复学杂志,2009,6(3)：194-196.
[22]赵小平,谭耀坤,黄芳艳.影响脑卒中患者出院后健康转归的原因[J].中国临床康复,2004,8(4)：631.
[23]唐颖,石跃林.脑卒中偏瘫患者早期康复训练依从性相关因素分析[J].中国康复理论与实践,2007,13(1)：69-70.
[24]葛海萍,姜海萍.住院脑卒中患者康复训练执行情况调查[J].护理学杂志,2011,26(7)：1.
[25]蔡军红,刘沙林,彭海燕,等.影响脑梗死病人早期功能锻炼依从性的相关因素及对策[J].护士进修杂志,2008,23(6)：1.
[26]夏萍,庄岩,卢传坚,陈达灿.我国医疗质量多维综合评价方法的循证评价[J].中国循证医学杂志,2011,11(2)：226-230.
[27]田凤调.秩和比法的应用[M].北京：人民卫生出版社,2002,9.