胃食管反流病中医治未病实践方案制订

发布时间：2018-05-01 22:12

本文选题：胃食管反流病 + 治未病　；参考：《广州中医药大学》2017年硕士论文

【摘要】：目的在文献研究的基础上,通过德尔菲法和专家会议法,从胃食管反流病的中医认识、中医治未病的内容及胃食管反流病未病先防、既病防变、瘥后防复等阶段的调摄治疗措施等方面进行咨询,制定胃食管反流病中医治未病实践方案。方法1.通过检索《中华医典》收集古代文献,检索相关期刊论文(知网)、维普数据库、万方数据库、中国生物医学文献数据库收集现代中文文献;检索Cochrance Library、Pubmed等数据库收集现代外文文献,对文献进行筛选分析,总结归纳胃食管反流病的中医病名、病因病机、诊断标准、西医发病机制、危险因素、高危人群体质特点、调摄措施、治疗措施等,形成《胃食管反流病中医治未病实践方案》调查问卷,通过德尔菲法、专家会议法对方案进行咨询、讨论、修改和调整。2.采用病例调查法在广州中医药大学第一附属医院、广东省中医院、深圳市中医院、首都医科大学望京医院、河南中医学院第一附属医院等多家医院收集100例胃食管反流病高危人群及胃食管反流病患者病历资料,进行指南与实践程度一致性程度评价。结果1.共进行了四轮专家咨询和一次专家会议。参加第一轮咨询的专家有12位,均为高级职称,专家积极系数为75%;参加第二轮咨询的专家有12位,均为高级职称,专家积极系数为80%;参加第三轮咨询的专家有11位,均为高级职称,专家积极系数为73.33%;参加第四轮咨询的专家有12位,均为高级职称,专家积极系数为75%。各轮专家均有较强的地域代表性及学科代表性。参与专家会议的专家有4位,均为高级职称,具有较高的权威性。经过四轮咨询及专家讨论,确定方案内容包括:中医病名、中医病因、中医病机、中医诊断标准、西医发病机制、危险因素、治未病措施及意义、高危人群体质特点、改善生活方式(未病先防)、日常饮食、药膳及花茶、穴位按摩、音乐疗法、心理疗法、改变生活方式(已病防变)、饮食宜忌、中药治疗、中成药治疗、特色疗法、量表及心理辅导、瘥后防复。各条目均数在4.75-5.0之间,等级和在57-60之间,权威系数在0-0.13之间,变异系数为0.416,P0.001。克朗巴赫系数为0.931,问卷信度较好。2.一致性结果显示,高危人群特点及疾病诊断标准,一致率分别为35%、65%。对高危人群进行改善生活方式及饮食调护的宣教方面一致率均为35%。穴位按摩、音乐疗法、心理疗法的一致率分别为10%、0、21%。已诊断为GERD患者干预措施中改变生活方式的一致率为65%,饮食调护、中药治疗、中成药、中医特色疗法、量表及心理辅导的一致率分别为47%、54%、29%、17%、35%。结论运用德尔菲法和专家会议法,形成《胃食管反流病中医治未病实践方案》。但受限于医师、患者及外部环境,方案一致性较低,有待进一步修改。
[Abstract]:Objective on the basis of literature study, through Delphi method and expert meeting method, from the Chinese medicine understanding of gastroesophageal reflux disease, the contents of TCM treatment and the prevention of gastroesophageal reflux disease before disease, both disease prevention and change prevention. In order to make the practical plan of treating gastroesophageal reflux disease by traditional Chinese medicine (TCM), we should consult the measures of adjusting and treating gastroesophageal reflux disease in the stage of recuperation and recuperation. Method 1. The ancient literature was collected by searching the Chinese Medical Dictionary, and the full text database of Chinese periodicals was searched (Zhiwang, Weipu, Wanfang, and Chinese Biomedical Literature Database). To search the Cochrance Library Pubmed database to collect modern foreign literature, to screen and analyze the literatures, to sum up the TCM disease names, etiology and pathogenesis, diagnostic criteria, pathogenesis of western medicine, risk factors and physical characteristics of high-risk population, and to sum up and summarize the TCM disease name, etiology and pathogenesis, pathogenesis of western medicine, risk factors, and physical characteristics of high-risk population. Through the Delphi method and the expert meeting method, the project was consulted, discussed, revised and adjusted by the questionnaire of the practical plan of TCM treatment of gastroesophageal reflux disease. Cases were investigated in the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine, Guangdong traditional Chinese Medicine Hospital, Shenzhen traditional Chinese Medicine Hospital, and Wangjing Hospital of Capital Medical University. The medical records of 100 patients with gastroesophageal reflux disease (GERD) and gastroesophageal reflux disease (GERD) were collected in many hospitals such as the first affiliated Hospital of Henan College of traditional Chinese Medicine and so on. Result 1. Four rounds of expert advice and one expert meeting were conducted. Twelve experts participated in the first round of consultation, all with senior professional titles, and the positive coefficient of experts was 750.12 experts participated in the second round of consultations, all of whom were senior titles, and the expert positive coefficient was 80. The number of experts participating in the third round of consultations was 11. There are 12 experts participating in the fourth round of consultation, all of them are senior titles, and the positive coefficient of experts is 753.33. Each round of experts has a strong geographical representation and discipline representation. There are 4 experts who participate in the expert meeting, all of them are senior titles and have high authority. After four rounds of consultation and expert discussions, it was determined that the contents of the scheme include: TCM disease name, TCM etiology, TCM pathogenesis, TCM diagnostic criteria, Western medicine pathogenesis, risk factors, treatment measures and significance, and physical characteristics of high-risk groups. Improve lifestyle (prevent illness before illness, daily diet, medicine meal and scented tea, acupoint massage, music therapy, psychotherapy, change life style (disease prevention, diet should avoid, Chinese medicine treatment, traditional Chinese medicine treatment, characteristic therapy, Scale and psychological counseling, recuperation after recuperation. The average of each item is between 4.75-5.0, the rank and the coefficient of authority are between 0-0.13, and the coefficient of variation is 0.416p0.001. The Cronbach coefficient was 0.931, and the questionnaire reliability was better. 2. The concordant results showed that the consistent rates of the characteristics of high-risk population and the diagnostic criteria of disease were 35% and 65% respectively. The consistent rate of improving lifestyle and diet care for high-risk population was 35. The consistent rates of acupoint massage, music therapy and psychotherapy were 100.21. The consistent rate of lifestyle change in the intervention measures of patients with GERD was 65, the consistent rate of diet regulation and nursing, traditional Chinese medicine treatment, traditional Chinese medicine, traditional Chinese medicine characteristic therapy, scale and psychological counseling were 470.54 and 292917173535, respectively. Conclusion the method of Delphi and expert meeting was used to form the practical plan of TCM treatment of gastroesophageal reflux disease. However, limited by physicians, patients and the external environment, the protocol is less consistent and needs further modification.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

【参考文献】