中医全科医学诊疗模式的文献研究

发布时间：2018-06-30 05:07

本文选题：中医全科医学 + 诊疗模式　；参考：《北京中医药大学》2016年硕士论文

【摘要】：目的：首先以文献研究的方法探究中医全科医学的诊疗模式和社区诊疗模式,之后应用数理统计法对中医全科医学诊疗模式下中药联合针灸方法治疗脑卒中后抑郁症文献进行客观的疗效分析,以期为“以病定技术”的中医全科医学诊疗模式在社区中推广提供参考依据。方法：第一节：采用文献研究的方法对中医全科医学的诊疗模式进行探究,并探讨中、西医全科医学诊疗模式间的差异,对比二者间的优势与局限性。第二节：根据国际循证医学中心/Cochrane协作工作手册标准,使用计算机检索万方数据库(WF,1998-2016)、中国生物医学文献数据库(CBM,1979-2016)、中国知网全文期刊数据库(CNKI,1979-2016)、维普中文科技期刊数据库(VIP,1989-2016)。纳入有关中药联合针灸治疗脑卒中后抑郁症的随机对照试验(RCT)文献,将筛选出的文献按照Cochrane Review Handbook5.0质量评价标准,对RCT的随机方法、盲法的应用、分配隐藏的实施、样本量、治疗方法、统计方法、随访与失访等内容进行资料提取与质量评价。采用RevMan 5.3软件进行分析,评价中药联合针灸方法对PSD患者HAMD积分变化情况及有效率。结果：第一节：通过文献研究的方法探究中医全科医学的诊疗模式,结果显示辨体-辨病-辨证诊疗模式、中医特色家庭病床服务模式、“以病定技术”的中医适宜技术服务模式及中医干预社区精神疾病模式适合社区开展。通过探究发现,中医全科医学诊疗模式相较西医而言具有一定优势,在社区医疗活动发挥了积极作用。在社区推广中医全科医学诊疗模式是提高国民健康素质的一条基本路径,也是中国特色社会主义医疗事业发展的新亮点。第二节：针对不同的数据库分别制定检索策略,共检索出1229篇文献,查重排除858篇。通过阅读编目、摘要不符合要求的文献347篇,剩余24篇文献下载全文阅读进一步筛选,排除未标有“随机对照”或不符合本系统评价诊断、纳入标准的文献14篇,最终纳入10篇中药联合针灸治疗脑卒中后抑郁症的随机对照试验,对此10篇文献进行资料提取及文献质量评价。偏倚风险评估显示本研究纳入文献的质量普遍偏低,具有较高风险。10篇研究共提供病例总数738例,其中试验组369例、对照组369例,通过对纳入文献进行分析,得出以下结果：(1) HAMD积分变化比较：7篇文献异质性分析,I2=100%,P0.00001,显示研究具有异质性,选择随机效应模型,MD=5.26,95%CI [2.07,8.45], Z=3.22 (P=0.001),说明中药联合针灸治疗组与西药对照组改善HAMD积分有统计学差异,表明中药联合针灸治疗方法对于HAMD积分改善优于抗抑郁西药。(2)有效率比较：9篇文献异质性分析P=0.71,I2=0%,显示研究之间无异质性,选择固定效应模型,OR=2.93,95%CI[1.87,4.61],Z=4.66(P0.00001),说明治疗组与西药对照组治疗PSD有效率有统计学差异。表明在有效率方面,中药联合针灸疗法组对治疗PSD有效率优于抗抑郁西药。结论：-、辨体-辨病-辨证诊疗模式、中医特色家庭病床服务模式、“以病定技术”的中医适宜技术服务模式及中医干预社区精神疾病模式适合社区开展。二、“中药联合针灸”的中医适宜技术可有效治疗脑卒中后抑郁症。
[Abstract]:Objective: To explore the mode of diagnosis and treatment of general medicine in traditional Chinese medicine and the mode of community diagnosis and treatment by means of literature research, and then analyze the objective effect of the literature on the treatment of post-stroke depression with the combined acupuncture and moxibustion of traditional Chinese medicine under the general medical diagnosis and treatment mode of traditional Chinese medicine with the method of mathematical statistics. Diagnosis and treatment mode in the community to provide reference basis. Method: first section: the use of literature research methods to explore the diagnosis and treatment of traditional Chinese medicine, and discuss the differences between the western medicine general medical diagnosis and treatment mode, compare the advantages and limitations between the two. Second: according to the international evidence-based medical center /Cochrane cooperative work To make the manual standard, use the computer to retrieve the Wanfang database (WF, 1998-2016), the Chinese biomedical literature database (CBM, 1979-2016), the full text journal database (CNKI, 1979-2016), and the VIP Chinese sci-tech journal database (VIP, 1989-2016). The randomized controlled trial (RCT) on the combined acupuncture and moxibustion for the treatment of post-stroke depression (VIP, 1989-2016). In the literature, according to the Cochrane Review Handbook5.0 quality evaluation standard, the selected literature was used to extract and evaluate the random methods of RCT, the application of blind method, the implementation of the distribution, the sample size, the treatment method, the statistical method, the follow-up and the loss of visits. The RevMan 5.3 software was used to analyze and evaluate the combined acupuncture and moxibustion methods of Chinese medicine. PSD patients HAMD integral change and efficiency. Results: first section: through the literature research method to explore the traditional Chinese medicine diagnosis and treatment mode, the results show that the differentiation and differentiation of disease diagnosis and treatment mode, the traditional Chinese medicine family sickbed service mode, "disease setting technology" suitable technology service mode of traditional Chinese medicine and traditional Chinese medicine intervention community spirit The mode of disease is suitable for the community to carry out. Through the exploration, it has been found that the medical diagnosis and treatment mode of the general medicine of traditional Chinese medicine has some advantages compared with the western medicine, and has played an active role in the community medical activities. The new highlight of the exhibition. Second: a total of 1229 documents were retrieved for different databases, 858 articles were retrieved and 858 articles were retrieved. Through reading cataloguing, 347 articles were not conformed to the requirements, and the remaining 24 documents downloaded full text for further screening, excluding the "random control" or not conforming to the system evaluation diagnosis. 14 articles were included in the standard literature, and a randomized controlled trial of 10 Chinese medicine combined with acupuncture and moxibustion for post-stroke depression was included. The data were extracted and the literature quality was evaluated in 10 articles. The bias risk assessment showed that the quality of the literature included in this study was generally low. A total of 738 cases with high risk of.10 were provided. 369 cases and 369 cases in the control group were analyzed to get the following results: (1) HAMD integral change comparison: 7 literature heterogeneity analysis, I2=100%, P0.00001, showing the heterogeneity of the study, the choice of random effect model, MD=5.26,95%CI [2.07,8.45], Z=3.22 (P=0.001), indicating the combination of acupuncture treatment group with Western medicine and Western medicine. The improvement of HAMD scores in the group was statistically different, indicating that the combination of traditional Chinese medicine and acupuncture treatment improved the HAMD score better than the antidepressant western medicine. (2) the efficiency was compared: 9 literature heterogeneity analysis P=0.71, I2=0%, showing no heterogeneity between the studies, the selection of the fixed effect model, OR= 2.93,95%CI[1.87,4.61], Z=4.66 (P0.00001), indicating the treatment group and the West. The effective rate of PSD in the drug control group was statistically different. It showed that in the efficiency, the efficiency of the combined acupuncture and moxibustion group was better than the antidepressant western medicine. Conclusion: the pattern of differentiation and differentiation, the pattern of differentiation and differentiation, the family sickbed service mode of traditional Chinese medicine, the suitable technology service mode of TCM with the disease setting technology and the intervention society of traditional Chinese medicine. Two, the appropriate technology of Chinese medicine combined with acupuncture can effectively treat post-stroke depression.
【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】：2016
【分类号】：R242

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