中医皮肤科诊疗技术操作规范（火针、拔罐、放血、中药换药）的研制

发布时间：2018-04-26 03:20

本文选题：中医皮肤科 + 操作规范　；参考：《北京中医药大学》2017年硕士论文

【摘要】：目的通过文献研究、专家共识会、专家咨询问卷以及临床验证等多个途径,初步建立标准编制的框架、原则与内容,形成中医皮肤科诊疗技术操作规范(火针疗法、拔罐疗法、放血疗法、中药换药)草案,用于指导上述技术在中医皮肤科的临床应用,提高临床疗效。方法通过文献研究的方法,检索了近30余年(1979年～2015年)四种疗法治疗皮肤科疾病的文献,通过文献的纳入、排除标准对检索的文献进行筛选,对最终纳入的文献进行分类、分析,总结归纳出具体操作步骤与方法,建立标准的内容并形成标准草案一稿。在文献研究的基础上,通过专家共识会议、专家咨询问卷的发放,在全国范围内广泛征求相关领域专家的意见,经过不断修改形成标准草案二稿、三稿。最后通过临床工作人员的实际操作验证标准的可行性,通过对反馈意见的整理与系统分析,对于标准的具体条目进行逐一修改,综合采纳各领域专家意见,最终形成中医皮肤科诊疗技术操作规范(火针疗法、拔罐疗法、放血疗法、中药换药)草案。结果在草案起草阶段,通过对纳入文献的总结与分析,将四项操作的具体内容如术语和定义、操作步骤与方法、适应证、注意事项、禁忌等方面进行规范,参照国家对于标准的编写原则与要求,完成标准的初稿。在意见征求阶段共进行了两轮的专家咨询,通过多种途径、多种形式(包括了专家共识会议、专家问卷咨询)进行广泛咨询,参与调查的人员共计49人次,所在地区覆盖全国15个省、直辖市,共涉及20余家临床单位与科研院所,本研究中共发放问卷55份,回收49份,总回收率为89.09%,且专家反馈时限较短,说明专家积极性较高,结果的可信性较高。两轮的问卷调查在建议修改栏共收集到建议198条,其中火针疗法73条,拔罐疗法61条,放血疗法28条,中药换药36条。通过意见汇总与分析,对收集到的所有意见进行采纳、部分采纳以及不采纳。在临床验证阶段,通过对4家三级甲等医院共计21人次的临床验证以验证其在临床的符合度。经过意见统计与分析可知,四项操作规范中所有条目一致率都在80%以上,因此本标准基本符合临床实际操作。结论本标准是基于文献研究与专家共识的临床标准,并且经过临床验证其可行性,具有一定的科学性、严谨性与临床适用性。本标准适用范围较广,如中医皮肤科、针灸科以及其他临床工作人员,在实际诊疗皮肤科疾病时都可以将其作为指导与参考,以便提高临床疗效。本研究为中医皮肤科的诊疗操作规范最终形成行业标准提供了方法学的探索与研究基础。
[Abstract]:Objective to establish the framework, principles and contents of the standard based on literature research, expert consensus meeting, expert consultation questionnaire and clinical verification, and to form the technical standard of dermatology of traditional Chinese medicine (fire needle therapy, cupping therapy). Bloodletting therapy, traditional Chinese medicine change) draft, used to guide the above-mentioned techniques in the clinical application of traditional Chinese medicine dermatology, improve the clinical efficacy. Methods the literature of four kinds of therapies for treating dermatological diseases for more than 30 years (1979 ~ 2015) was retrieved by literature research. The literature was screened by the inclusion of literature and exclusion criteria, and the literature included in the literature was classified. Analyze, sum up the concrete operation steps and methods, establish the content of the standard and form a draft of the standard. On the basis of literature research, through expert consensus meeting and expert consultation questionnaire, the opinions of experts in relevant fields are widely sought in the whole country, and the second and third drafts of the standard are constantly revised and formed. Finally, through the practical operation of the clinical staff to verify the feasibility of the standard, through the feedback collation and systematic analysis, the specific items of the standard are revised one by one, and the expert opinions in various fields are comprehensively adopted. Finally, it forms the draft of technical operation of dermatology of traditional Chinese medicine (fire needle therapy, cupping therapy, bloodletting therapy, traditional Chinese medicine changing medicine). Results during the drafting stage of the draft, the contents of the four operations, such as terms and definitions, operational steps and methods, indications, precautions, taboos and so on, were standardized through the summary and analysis of the included documents. The first draft of the standard is completed with reference to the country's principles and requirements for the preparation of the standard. During the consultation phase, two rounds of expert consultation were conducted, and extensive consultations were conducted in various forms (including expert consensus meetings, expert questionnaire consultations) through a variety of channels, with a total of 49 participants participating in the survey. The area covers 15 provinces and municipalities in China, involving more than 20 clinical units and scientific research institutes. In this study, 55 questionnaires were distributed, 49 were recovered, the total recovery rate was 89.09, and the time limit for expert feedback was relatively short, indicating that the experts were highly motivated. The results have higher credibility. A total of 198 recommendations were collected from two rounds of questionnaire survey, including 73 items of fire acupuncture therapy, 61 items of cupping therapy, 28 items of bloodletting therapy and 36 items of traditional Chinese medicine. Through opinion summary and analysis, all views collected are adopted, partially accepted and not accepted. In the phase of clinical verification, 21 patients in 4 Grade 3A hospitals were tested. According to the opinion statistics and analysis, the consistency rate of all items in the four operational specifications is above 80%, so this standard basically accords with the clinical practice. Conclusion this standard is based on literature research and experts' consensus, and its feasibility is proved to be scientific, rigorous and applicable. This standard is applicable to a wide range, such as traditional Chinese medicine dermatology, acupuncture and other clinical staff, in the actual diagnosis and treatment of dermatologic diseases can be used as a guide and reference, in order to improve the clinical efficacy. This study provides a methodological exploration and research basis for the standard of diagnosis and treatment of traditional Chinese medicine dermatology.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R275

【参考文献】