应用Delphi法制订注意缺陷多动障碍中医诊疗指南的研究

发布时间：2018-02-26 02:32

本文关键词： 注意缺陷多动障碍 Delphi法诊疗指南　出处：《北京中医药大学》2012年硕士论文　论文类型：学位论文

【摘要】：[目的] 1、应用Delphi法,制订注意缺陷多动障碍中医诊疗指南；2、了解和印证Delphi法在制订中医诊疗指南方面的作用和利弊,进一步完善此方法。 [方法] 通过充分查阅古今文献,根据Jadad评分量表筛选符合标准的文献,应用Delphi法从诊断、辨证分型、治疗、方药、预防护理等方面设计第1轮专家调查问卷,寄发给40名副高职称以上的儿科专家,1个月后收回试卷,并对问卷各选项评分进行统计。根据统计的原理,均数(M)1.5,满分比(K)0.5,变异系数(CV)0.5的指标保留,不被多数专家认可的指标可删除。在综合考量专家的意见后,设计第2轮调查问卷,并重复以上方法统计分析结果。2轮问卷调查结束后,初步拟定注意缺陷多动障碍的中医诊疗指南,召开专家研讨会讨论分析注意缺陷多动障碍的中医诊疗指南的最终定稿。 [结果] 经过文献检索、专家讨论、两轮问卷调查、最终定稿等多个环节,第1轮专家积极率为90%,第2轮为100%。在定义、临床症状、辨证论治、治法治则方面,选择专家评分高,集中率高,协调系数高的项目,并根据专家提出的建议进行酌情筛选,最终制订了注意缺陷多动障碍的中医诊疗指南。 1、ADHD的描述性定义为：“注意缺陷多动障碍是一种较常见的儿童时期行为障碍性疾病。临床以活动过多,注意力不集中,冲动任性,自控能力差,动作不协调和四肢精细动作能力弱,甚而出现社会适应障碍和学习困难,但智力正常或基本正常为特征。”需要与多发性抽动症,儿童精神分裂症进行鉴别诊断。 2、ADHD分为五个证型,分别辨证论治,综合治疗。肝肾阴虚证,治法：滋养肝肾、平肝潜阳,主方：杞菊地黄丸加减。心脾两虚证,治法：养心安神、健脾益气,主方：归脾汤合甘麦大枣汤加减。痰火扰心证,治法：清热泻火、化痰宁心,主方：黄连温胆汤加减。脾虚肝旺证,治法：健脾平肝、疏肝解郁,主方：逍遥散加减。肾虚肝旺证,治法：滋肾平肝,主方：知柏地黄丸加减。同时本病还可结合针灸、耳穴疗法等治疗。特别要注意对患儿进行教育引导,心理治疗,行为矫治及感觉统合训练治疗。 [结论] 通过系统的调研、问卷、探讨,最终制订了适用于18周岁以下注意缺陷多动障碍的中医诊疗指南,其中涵盖了中医的诊断、辨证、治疗方法等。并证明了Delphi法在制订注意缺陷多动障碍中医诊疗指南中的重要作用。
[Abstract]:[purpose]. 1. Using Delphi method to make the guidelines for the diagnosis and treatment of attention deficit hyperactivity disorder (2), to understand and confirm the role, advantages and disadvantages of Delphi method in the development of TCM diagnosis and treatment guidelines, and to further improve this method. [methods]. According to the Jadad scoring scale, the first round of expert questionnaire was designed from the aspects of diagnosis, syndrome differentiation, treatment, prescription and preventive nursing. They were sent to 40 pediatricians with non-senior professional titles. After one month, the test papers were collected, and the scores of the various options were counted. According to the principle of statistics, the average score was 1.5, the full score was 0.5, and the coefficient of variation was kept at CV0. 5. Indicators that are not recognized by most experts can be deleted. After considering the opinions of the experts, the second round of questionnaires is designed, and the results of the statistical analysis of the above methods are repeated after the completion of the second round of questionnaires. The guidelines for the diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) were preliminarily drawn up, and an expert seminar was held to discuss the finalization of the guidelines for the diagnosis and treatment of attention deficit hyperactivity disorder (ADHD). [results]. After literature retrieval, expert discussion, two rounds of questionnaire investigation, final decision and so on, the positive rate of experts in the first round is 90 and the second round is 100. In terms of definition, clinical symptoms, treatment based on syndrome differentiation and treatment principles, the selection of experts has a high score. The items with high concentration rate and high coordination coefficient were selected according to the suggestion of experts and the guidelines for diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) were developed. The descriptive definition of ADHD is: "attention deficit hyperactivity disorder (ADHD) is a common behavioral disorder in childhood. Discoordination of movement and weak fine movement of limbs, even social adaptation disorder and learning difficulties, but normal or basic normal intelligence are the characteristics. "it is necessary to make differential diagnosis with multiple tic disorder and schizophrenia in children." (2) ADHD is divided into five syndromes: syndrome differentiation and comprehensive treatment. Liver and kidney yin deficiency syndrome, treatment method: nourishing liver and kidney, calming liver and latent yang, main prescription: Qi Ju Di Huang Wan plus or minus. Heart and spleen deficiency syndrome, treatment method: nourishing heart and tranquilizing spirit, invigorating spleen and benefiting qi, The main prescription: Gui Pi Tang he Gan Mai Da Jujube decoction. Phlegm and Fire disturbing Heart Syndrome, treatment method: clearing away Heat and reducing Fire, dispelling phlegm and calming Heart, main prescription: Huanglian Wendan decoction subtracts. Spleen deficiency and liver flourishing Syndrome, treatment method: invigorating spleen and soothing liver, soothing liver and relieving stagnation of liver, Main prescription: Xiaoyao San plus or minus. Kidney deficiency and liver flourishing syndrome, treatment method: nourishing kidney and calming liver, main prescription: Zhibai Dihuang pills plus or minus. At the same time, this disease can be combined with acupuncture, ear point therapy and so on. Special attention should be paid to educational guidance and psychological treatment for children. Behavior correction and sensory integration training. [conclusion]. Through systematic investigation, questionnaire and discussion, we have finally developed a Chinese medicine diagnosis and treatment guide for attention deficit hyperactivity disorder under the age of 18, which covers the diagnosis and syndrome differentiation of traditional Chinese medicine. The important role of Delphi method in the development of attention deficit hyperactivity disorder (ADHD) in TCM diagnosis and treatment was proved.
【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】：2012
【分类号】：R749.94

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