儿童多动症中医诊疗指南的修订研究

发布时间：2018-03-20 14:31

本文选题：儿童多动症　切入点：循证医学　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:文献研究结合Delphi法对儿童多动症的中医儿科临床指南进行修订,以期对中医药治疗儿童多动症提供临床指导。方法:在循证医学的基础上,采用文献研究、Delphi法专家调查问卷、专家论证会、同行征求意见、方法质量学评价及临床一致性评价相结合的方法修订儿童多动症的中医诊疗指南。文献研究:检索相关期刊论文(CNKI)、万方全文数据库、中文科技期刊数据库(维普)、中国优秀博硕士学位论文全文数据库、COCHRANE图书馆、Clinical Trial、NGC等,检索年限从2000年1月到 2016年3月,选择中医治疗及中西医结合治疗、预防类文献,严格按照文献的纳入标准和排除标准,对文献进行筛选评价,对随机临床试验评价采用改良Jadad量表大于等于3分的文献作为治疗性建议的证据,对非随机临床试验的评价采用MINORS条目评分总分大于等于13分的文献作为治疗性建议证据,对Meta分析的文献,采用AMSTAR量表评分大于等于5分文献为证据,并对文献进行分析、总结、寻找规律,建立Excel数据库,并对各项指标进行频数频率的统计学分析,完成文献研究总结,编写专家调查问卷。Delphi法专家调查问卷:在前期文献研究的基础上,编写专家调查问卷,基于Delphi法的原则,以电子邮件的方式向全国36位专家发放两轮专家问卷调查表,主要从均数(x)、等级和(S)及不重要百分比(R)、变异系数(CV)等指标进行评价,对两轮专家调查问卷的结果进行分析,汇总专家意见并结合文献研究,确定指南初稿。专家论证会:邀请相关专业的24位专家召开了专家论证会,工作组按专家论证会意见结合两轮专家调查问卷分析结果及文献研究结果,修改指南初稿,形成了指南征求意见稿。同行征求意见、方法质量学评价、临床一致性评价:项目工作组于2015年10月13～31日向36家单位的50位同行业专家发送征求意见稿,根据其提出的意见修改指南征求意见稿形成评价稿。儿科专家指导组于2015年12月13～30日组织中医儿科学,中西医结合儿科学、温病学的4位专家进行指南方法学的质量评价(AGREEⅡ工具)。并于2015年12月10日-2016年3月30日邀请12个三级甲等医院开展了 201例临床一致性评价,并根据专家质量方法学评价和临床一致性评价反馈的意见,对评价稿又作了全面的整理、修改,2016年4月形成了指南审核稿。结果:结合两轮专家调查问卷、专家论证会、同行征求意见、方法质量学评价及临床一致性评价,汇总专家意见对本次指南进行修订,最终完成了科学规范的儿童多动症的中医临床诊疗指南,对2012版的指南进行了完善与更新。结论:在循证医学的基础上,采用改良Jadad量表、MINORS条目、AMSTAR量表对临床治疗性文献进行分析筛选评价,对儿童多动症的标准化、规范化的循证实践意义深远。与2012年的指南相比较,在病名、适用范围、诊断标准及辨证分型方面都进行了调整与更新,并且新增了预防和调护的内容。在儿童多动症的中药复方用药规律方面,发现中医治疗儿童多动症以补虚、安神、清热、平肝为主,兼以健脾为主要治法。
[Abstract]:Objective: to research the Delphi method combined with TCM pediatrics clinical guidelines of children with ADHD were revised, in order to provide clinical guidance for the treatment of children with ADHD medicine. Methods: Based on evidence-based medicine, using literature research method, Delphi expert questionnaire, expert on card, peer comments, guidelines for TCM diagnosis and treatment methods quality evaluation and clinical evaluation of the combination of the consistency of the revision of children with ADHD. Literature research: Chinese retrieval Journal Full-text Database (CNKI), Wanfang database, Chinese journal database (D & P), Chinese master theses full-text database, COCHRANE library, Clinical Trial, NGC and so on, the retrieval period from January 2000 to March 2016, selection of combined treatment of traditional Chinese medicine treatment and prevention of traditional Chinese medicine and Western medicine, literature, in strict accordance with the inclusion criteria and exclusion criteria, screening evaluation of literature The price of randomized clinical trials evaluated by modified Jadad scale is greater than or equal to 3 points for the treatment of literature suggests that the evidence, evaluation of non randomized clinical trials using MINORS entry score of greater than or equal to 13 of the literature for the treatment of evidence, analysis of the Meta document, the AMSTAR score of greater than or equal to 5 documents as evidence, and the literature analysis, summary, find the law, establish the Excel database, and the indicators for statistical analysis of frequency, complete the research and preparation of.Delphi expert questionnaire method expert questionnaire: Based on the previous literatures, written expert questionnaire, Delphi method based on the principle of two rounds of expert questionnaire issued to the 36 experts by e-mail, mainly from the mean level (x), and (S) and a significant percentage (R), the coefficient of variation (CV) and other indicators Evaluation of two rounds of expert questionnaire results of the analysis, summary of expert opinion and combined with literature research, determine the draft guide. Experts will invite 24 experts convened the relevant professional experts will work according to the group of experts will combined with two rounds of expert analysis results and the results of questionnaire, revised draft guidelines the guide, form draft. Peer comments, the evaluation methods of quality, clinical evaluation of consistency: the project working group 50 on 13~31 October 2015 36 units of the same industry experts send draft, according to the views of the revised draft guidelines form evaluation draft. Pediatric expert group in December 2015 13~30, organization of Pediatrics of traditional Chinese medicine, pediatrics of traditional Chinese and Western medicine, quality evaluation methodology guide 4 experts of seasonal febrile disease (AGREE II tool) and in 2015. In December 10th March 30th -2016 invited 12 three hospitals to carry out clinical evaluation of consistency in 201 cases, and according to the expert feedback methodology of quality evaluation and clinical evaluation of consistency of opinion, evaluation and release a comprehensive collation, modify, April 2016 formed the audit guidelines draft. Results: the combination of two rounds of expert questionnaire and experts will peer comments, and evaluate the consistency of quality evaluation methods, summary of expert opinions to revise the guidelines, the final completion of the clinical diagnosis and treatment of scientific and standardized ADHD refers to the south, the 2012 edition of the guide to the improvement and update. Conclusion: Based on evidence-based medicine by using the modified Jadad scale, AMSTAR scale, MINORS entry, analyzed the selection and evaluation of clinical literature, standardization of children with ADHD, standardized evidence-based practice in 2012 and have far-reaching significance. Compared with the guidelines, for in the name of disease, scope, diagnostic criteria and TCM syndrome classification have been adjusted and updated, and added the prophylaxis and nursing content. The regularity of Chinese compound prescription Chinese medicine treatment of children with ADHD, found that children with ADHD with tonic, sedative, heat, calming the liver and the spleen. As the main treatment.

【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.7

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