骨质疏松症(骨痿)的中医临床路径研究
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摘要
骨质疏松症(骨痿)是老年性骨代谢疾病,国内尚未制定出较为完整的骨质疏松症(骨痿)专业中医临床路径,为适应现代中医学发展的需要,广州中医药大学第三附属医院联合浙江中医药大学附属第二医院、上海中医药大学附属曙光医院、广西骨伤医院、常德市第一中医院等中医医疗单位在《临床路径管理指导原则》下,结合就诊中医医院患者的诊断标准、证候诊断,制定进入路径标准,优化门诊及住院治疗时间、规范中医证候学及检查项目,依据证候诊断脾肾阳虚型、肝肾阴虚型、气滞血瘀型三种证型,辨证给予治疗方案,并配合外治及物理等疗法,观察患者临床疼痛改善情况,最后进行安全性指标评价,以完成路径标准。希望通过临床试用,对中医的临床路径实用性、可行性进行探讨,并对其进行完善。
Osteoporosis(flaccidity of bones) is a senile bone metabolic disease. There is no professional clinical pathway of osteoporosis in Chinese medicine in our country. In order to adapt to the development of modern TCM, the inclusion criteria, optimized outdoor clinic and the duration of indoor treatment, and unified items of the examination have been classified in the third medical college of Guangzhou University of Chinese Medicine, Zhejiang Chinese Medical University Second Affiliated Hospital, Shanghai Chinese Medical University Affiliated Shuguang Hospital, Guangxi Orthopedic Hospital, and Changde First Chinese Medicine Hospital according to the Clinical Pathway Management Guidelines. Three patterns of syndrome including yang deficiency of spleen and kidney, yin deficiency of liver and kidney, and qi stagnation and blood stasis are differentiated in accordance with TCM symptoms of the patients, conducting diagnosis and treatment based on overall analysis of symptoms and signs,it also need external treatment and physiotherapy. The relieve of pain in the patients is observed. The safety index is evaluated in order to complete the standard of clinical pathway. By clinical trials, the feasibility and practicality of the clinical pathway of Chinese medicine may be explored and improved gradually.
Osteoporosis(flaccidity of bones) is a senile bone metabolic disease. There is no professional clinical pathway of osteoporosis in Chinese medicine in our country. In order to adapt to the development of modern TCM, the inclusion criteria, optimized outdoor clinic and the duration of indoor treatment, and unified items of the examination have been classified in the third medical college of Guangzhou University of Chinese Medicine, Zhejiang Chinese Medical University Second Affiliated Hospital, Shanghai Chinese Medical University Affiliated Shuguang Hospital, Guangxi Orthopedic Hospital, and Changde First Chinese Medicine Hospital according to the Clinical Pathway Management Guidelines. Three patterns of syndrome including yang deficiency of spleen and kidney, yin deficiency of liver and kidney, and qi stagnation and blood stasis are differentiated in accordance with TCM symptoms of the patients, conducting diagnosis and treatment based on overall analysis of symptoms and signs,it also need external treatment and physiotherapy. The relieve of pain in the patients is observed. The safety index is evaluated in order to complete the standard of clinical pathway. By clinical trials, the feasibility and practicality of the clinical pathway of Chinese medicine may be explored and improved gradually.
引文
[1] 原发性骨质疏松症诊疗指南(2017)[J]. 中国全科医学, 2017(32): 3963-3982.Chinese Society of Osteoporosis and Bone Mineral Research. Guidelines for the diagnosis and treatment of primary(2017)[J]. Chinese General Practice, 2017(in Chinese).
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[3] Si L, Winzenberg T M, Jiang Q, Chen M, Palmer A J. Projection of osteoporosis-related fractures and costs in China: 2010-2050[J]. Osteoporos Int, 2015, 26(7): 1929-1937.
[4] Stefano N M, Filho N C. Activity-based costing in services: literature bibliometric review[J]. Springerplus, 2013, 2(1): 80.
[5] 程义玲,陈迎春. 临床路径在单病种付费方式中的应用研究[J]. 医学与社会, 2012(03): 50-52.Cheng Yiling et al. Application Research of the Cclinical Pathway in Single Disease Payment[J]. Medicine and Society, 2012(03): 50-52 (in Chinese).
[6] 张敏州,程康林,乔志强,等. 中医临床路径构建思路与方法[J]. 中国医院管理, 2005(03): 37-39.Zhang Minzhou, Cheng KangIin, Qiao Zhiqiang,et al. The Ways and Methods of Constructing Clinical Pathway of Traditional Chinese Medicine[J]. Chinese Hospital Management, 2005,25(3):37-39 (in Chinese).
[7] 谢晴宇,孟庆刚,王永炎. 中医临床路径实践模式的思考[J]. 北京中医药大学学报, 2013(01): 5-9.XIE Qingyu, MENG Qinggang, WANG Yongyan. Practical mode of clinical pathway of Chinese medicine[J]. Journal of Beijing University of Traditional Chinese Medicine, 2013(01): 5-9 (in Chinese).
[8] 高飞,李少冬. 中医临床路径应用研究进展[J]. 中国医院, 2016(09): 78-80.GAO Fei, LI Shaodong. Progress on the application research of TCM clinical pathway[J]. Chinese Hospitals, 2016,20(9):78-80 (in Chinese).
[9] 王丽颖,赵学尧,宇文亚,等. 中医诊疗指南与中医临床路径、中医诊疗方案的比较[J]. 中医杂志, 2015(24): 2112-2115.WANG Liying, ZHAO Xueyao, YU Wenya, et al. Comparison of Clinical Practice Guidelines with Clinical Pathways and Diagnosis & Treatment Schemes in Chinese Medicine[J]. Journal of Traditional Chinese Medicine, 2015(24): 2112-2115 (in Chinese).
[10] 国家卫生和计划生育委员会. 关于印发《临床路径管理指导原则(试行)》的通知[Z]. 2009-10-13(http://www.nhfpc.gov.cn/zwgk/lclj/201306/1067154511a3495285d805592586159b.shtml) National health and family planning commission of the People’s Republic of China. Notice on the issuance of guidelines for the management of clinical pathways (trial)[Z]. 2009-10-13(http://www. nhfpc.gov.cn/zwgk/lclj/201306/1067154511a3495285d805592586159b.shtml) (in Chinese).
[11] 徐国柱,蔡志基.镇痛药临床评价方法研究[J].中国新药杂志,1995,4:20-22+57.Xu Guozhu,Cai Zhiji.Clinical Evaluation of Analgesics[J].Chin J New Drugs,1995,4:20-22+57(in Chinese).
[2] Yoshimura N, Muraki S, Nakamura K, Tanaka S. Epidemiology of the locomotive syndrome: The research on osteoarthritis/osteoporosis against disability study 2005-2015[J]. Mod Rheumatol, 2017, 27(1): 1-7.
[3] Si L, Winzenberg T M, Jiang Q, Chen M, Palmer A J. Projection of osteoporosis-related fractures and costs in China: 2010-2050[J]. Osteoporos Int, 2015, 26(7): 1929-1937.
[4] Stefano N M, Filho N C. Activity-based costing in services: literature bibliometric review[J]. Springerplus, 2013, 2(1): 80.
[5] 程义玲,陈迎春. 临床路径在单病种付费方式中的应用研究[J]. 医学与社会, 2012(03): 50-52.Cheng Yiling et al. Application Research of the Cclinical Pathway in Single Disease Payment[J]. Medicine and Society, 2012(03): 50-52 (in Chinese).
[6] 张敏州,程康林,乔志强,等. 中医临床路径构建思路与方法[J]. 中国医院管理, 2005(03): 37-39.Zhang Minzhou, Cheng KangIin, Qiao Zhiqiang,et al. The Ways and Methods of Constructing Clinical Pathway of Traditional Chinese Medicine[J]. Chinese Hospital Management, 2005,25(3):37-39 (in Chinese).
[7] 谢晴宇,孟庆刚,王永炎. 中医临床路径实践模式的思考[J]. 北京中医药大学学报, 2013(01): 5-9.XIE Qingyu, MENG Qinggang, WANG Yongyan. Practical mode of clinical pathway of Chinese medicine[J]. Journal of Beijing University of Traditional Chinese Medicine, 2013(01): 5-9 (in Chinese).
[8] 高飞,李少冬. 中医临床路径应用研究进展[J]. 中国医院, 2016(09): 78-80.GAO Fei, LI Shaodong. Progress on the application research of TCM clinical pathway[J]. Chinese Hospitals, 2016,20(9):78-80 (in Chinese).
[9] 王丽颖,赵学尧,宇文亚,等. 中医诊疗指南与中医临床路径、中医诊疗方案的比较[J]. 中医杂志, 2015(24): 2112-2115.WANG Liying, ZHAO Xueyao, YU Wenya, et al. Comparison of Clinical Practice Guidelines with Clinical Pathways and Diagnosis & Treatment Schemes in Chinese Medicine[J]. Journal of Traditional Chinese Medicine, 2015(24): 2112-2115 (in Chinese).
[10] 国家卫生和计划生育委员会. 关于印发《临床路径管理指导原则(试行)》的通知[Z]. 2009-10-13(http://www.nhfpc.gov.cn/zwgk/lclj/201306/1067154511a3495285d805592586159b.shtml) National health and family planning commission of the People’s Republic of China. Notice on the issuance of guidelines for the management of clinical pathways (trial)[Z]. 2009-10-13(http://www. nhfpc.gov.cn/zwgk/lclj/201306/1067154511a3495285d805592586159b.shtml) (in Chinese).
[11] 徐国柱,蔡志基.镇痛药临床评价方法研究[J].中国新药杂志,1995,4:20-22+57.Xu Guozhu,Cai Zhiji.Clinical Evaluation of Analgesics[J].Chin J New Drugs,1995,4:20-22+57(in Chinese).