出血性中风证候要素诊断量表条目筛选的研究

发布时间：2018-08-17 13:09

【摘要】：目的:中医证候标准化、客观化研究的一项重要内容就是证候诊断量表的研究。量表条目的筛选是量表编制过程中的一个重要环节。本研究通过专家咨询问卷的方法,参照德尔菲法(Delphi),从而获取专家认为对于出血性中风临床常见证候要素及具有诊断意义的四诊信息,筛选专家经验辨证量表条目,并结合应用统计方法分析临床四诊信息,进一步探讨将专家经验与临床信息相结合,筛选出血性中风证候要素诊断量表条目,以期构建出血性中风证候要素诊断量表,奠定基础。方法:研究主要分为两个阶段,第一阶段,建立出血性中风证候要素诊断量表维度及相应条目池。参照德尔菲法,通过两轮专家问卷的方式咨询专家意见,获取专家经验,筛选出对于出血性中风证候相关要素及其具有诊断意义的四诊信息(条目),从重要性角度筛选条目;第二部分,基于临床信息筛选出血性中风证候要素诊断量表条目,进一步验证专家经验筛选结果。利用前瞻性、多中心、大样本采集的出血性中风临床四诊信息,通过卡方检验、因子分析法、聚类分析等方法临床四诊信息,获得对证候要素诊断具有意义的四诊信息,在验证专家经验筛选结果的同时,将两部分的研究结果共有的四诊信息作为出血性中风证候要素诊断量表条目池。结果:基于专家经验与临床信息筛选的出血性中风证候要素诊断量表内风证条目有:两手握固、口噤不开、健忘、头重痛、头晕目眩、苔黄厚腻、脉弦、目偏不瞬、头掣痛、舌体颤抖、48小时达到高峰、苔厚腻、口苦基于专家经验与临床信息筛选的出血性中风证候要素诊断量表内火证条目有:满面通红、壮热、目赤、躁扰不宁、舌红绛、渴喜冷饮、头灼痛、舌红、脉数、口臭、面红、苔黄厚基于专家经验与临床信息筛选的出血性中风证候要素诊断量表痰证条目有:咳痰、苔厚腻、昏睡、喉中痰鸣、苔白腻、神情呆滞、嗜睡、苔黄厚腻、腻苔、反应迟钝、昏聩、头重、舌胖大、脉滑、痰色黄、头昏、厚苔、表情淡漠、浮肿、脉濡基于专家经验与临床信息筛选的出血性中风证候要素诊断量表瘀证条目有:头刺痛、痛有定处、舌有瘀斑或瘀点、舌下脉络青紫、舌青紫、肌肤甲错、皮肤紫斑、面色黧黑、爪甲青紫、口唇青黑、脉结、脉涩、舌下脉络曲张、面色晦暗、肢痛麻木基于专家经验与临床信息筛选的出血性中风证候要素诊断量表气虚证条目有:自汗、少气懒言、脉弱、面白、二便失禁、呼吸微弱、口唇淡白、舌淡、肢体萎软、面色萎黄、表情淡漠、纳呆、便溏、齿痕舌、脉微基于专家经验与临床信息筛选的出血性中风证候要素诊断量表阴虚证条目有:舌光红无苔、盗汗、潮热、低热、苔少、舌干、咽干、手足蠕动、舌痿、两目干涩、剥脱苔、脉细、口干、手足心热结论:1证候要素是构成“证候”的最小单元,通过“降维”、“降阶”,简化了中医辨证的多维性和复杂性,为中医辨证量表的研究提供了模式范例。2辨证论治体系就是古代医家在临床实践过程中不断形成和完善的,是中医的精髓,而古代文献是对这一“精髓“最完成的承载,为中医证候的研究提供了宝贵的资源。因此基于古代进行证候的研究,是建立中医证候诊断标准的必要前提。参照德尔菲法是获取专家经验的有效方法,能够从重要性角度为辨证量表提供条目,是进一步筛选证候辨证量表条目、建立中医证候诊断标准的有效途径之一。3初步认为通过文献研究、临床流行病学调查、统计分析及临床验证,出血性中风证候要素诊断量表的条目池的建立要将专家经验与临床四诊信息通过现代的数理统计分析方法将二者结果融合,互相支撑,互相为用,最终筛选出重要性高、独立性强、敏感性强与临床可操作性的量表条目,为证候规范化研究提供规范的可供借鉴的研究思路与方法
[Abstract]:Objective: To study the standardization and objectification of TCM syndromes, an important part of which is the study of the syndrome diagnosis scale.The selection of the items of the scale is an important link in the preparation of the scale.This study is based on the Delphi method and consulted by the experts to obtain the common clinical symptoms of hemorrhagic apoplexy. Elements and diagnostic information of the four diagnostic scales were screened, and the items of the Expert Experience Differentiation Scale were analyzed with statistical methods. The items of the Diagnostic Scale of Hemorrhagic Apoplexy Syndrome Elements were screened by combining expert experience with clinical information in order to construct the Diagnostic Scale of Hemorrhagic Apoplexy Syndrome Elements. Methods: The study was divided into two stages. In the first stage, the dimension and item pool of the diagnostic scale of Hemorrhagic Apoplexy Syndrome elements were established. Information (items) were screened from an important point of view; in the second part, based on clinical information, the items of the Diagnostic Scale for Hemorrhagic Stroke Syndrome Elements were screened to further validate the results of expert experience screening. Methods Four diagnostic information was obtained from the clinical four diagnostic information, and the four diagnostic information was used as the item pool of the diagnostic scale for hemorrhagic stroke. The items of wind syndrome in the diagnostic scale include: holding hands firmly, opening mouth, forgetfulness, severe headache, dizziness and dizziness, thick and greasy fur, pulse strings, unsteady eyes, headache, tongue trembling, peaking in 48 hours, thick and greasy fur, and bitter mouth. The items of fire syndrome in the diagnostic scale of hemorrhagic stroke syndrome based on expert experience and clinical information are: full face red, strong and strong. Fever, red eyes, restlessness, red tongue, thirst for cold drinks, burning headache, red tongue, pulse number, halitosis, flushing, thick fur based on expert experience and clinical information screening factors of hemorrhagic stroke syndrome diagnosis scale phlegm items are: sputum, thick fur, sleepy, sputum in the throat, white greasy fur, sluggish expression, sleepiness, thick fur, greasy, greasy fur, sluggish, sluggish, dull, dizzy, dull, dizzy, dizzy, and thick fur, greasy fur, greasy, greasy fur, greasy, greasy, Head weight, tongue fat, smooth pulse, phlegm yellow, dizziness, thick fur, indifferent expression, edema, pulse based on expert experience and clinical information screening of hemorrhagic stroke syndrome factors diagnosis scale blood stasis syndrome items are: headache, pain has a fixed place, tongue bruise or ecchymosis, sublingual veins cyanosis, tongue cyanosis, skin nail fault, skin purple spots, dark complexion, nail cyanosis, purple, skin purple. The diagnostic scale for Hemorrhagic Apoplexy Syndrome Based on expert experience and clinical information includes: spontaneous sweating, hypoventia, inertia, pulse weakness, paleness, incontinence, faint breathing, pale lips, pale tongue, weakness of limbs, yellowness of complexion, indifference, apathy, acceptance, etc. Diarrhea, dental scar tongue, pulse micro-based on expert experience and clinical information screening of Hemorrhagic Apoplexy Syndrome Elements of Yin deficiency scale entries are: red tongue, night sweat, hot flashes, low fever, less fur, dry tongue, pharynx, hand and foot peristalsis, tongue flaccidity, dry eyes, peeling off fur, fine pulse, dry mouth, hand and foot warm conclusion: 1 syndrome elements are composed of the most "syndrome" The small unit simplifies the multi-dimensionality and complexity of TCM syndrome differentiation by "reducing dimensionality" and "reducing order", and provides a model for the study of TCM syndrome differentiation scale. It provides valuable resources for the study of TCM syndromes. Therefore, the study of TCM syndromes based on ancient times is a necessary prerequisite for establishing the diagnostic criteria of TCM syndromes. One of the effective ways to diagnose TCM syndromes.3 It is preliminarily considered that through literature research, clinical epidemiological investigation, statistical analysis and clinical validation, the establishment of item pool of the Diagnostic Scale of Hemorrhagic Apoplexy Syndrome Elements should integrate the expert experience with the four clinical diagnostic information through modern mathematical statistical analysis method to fuse the two results. Supporting and serving each other, we can finally select the items of the scale with high importance, independence, sensitivity and clinical maneuverability, and provide normative research ideas and methods for the standardization of syndrome research.
【学位授予单位】：长春中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R277.7

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