心系病证量表的初步编制及考评

发布时间：2018-08-27 17:53

【摘要】：目的：基于证素辨证原理建立心系病证量表,为心系常见病如心悸、胸痹、不寐等病的临床疗效评价提供一个客观化、标准化的测量工具,量化中医药疗效,为中医治疗疾病提供有效证据,以减少中医症状评定的主观性和不确定性,可通过本量表测评比较不同治疗方案、同一治疗方案前后的患者的量表测评结果,从而判断治疗方案对疾病的干预效果,以帮助选择更为优越的个体化治疗方案。为患者了解身体健康状况提供参考工具。为心系辨证提供客观规范收集辨证资料,并为中医临床心系病证辨证做出一些指导、参考。方法：1.依据文献调研,依据证素辨证原理进行证素拆分,归纳总结证型中包含证素心的证候,对症状进行术语规范,形成条目池。2.运用德尔菲专家咨询法进行三轮专家咨询,形成初量表。3.收集临床病例进行预调查,采用困难度分析法、反应特征法、相关系数法对进行条目客观筛选,优化心系病证量表。4.临床调研,进行初步心系量表信度、效度、反应度及可行性考评。结果：1.通过文献回顾、教材梳理、标准收集对心系病证证候规范化,经频数统计,形成具有264个条目的条目池。2.经过三轮德尔菲专家咨询,均数、满分比、变异系数的均数分别为3.87、0.34、0.24,均具有较高的集中程度。协调程度系数为0.452,三轮专家咨询问卷的回收率达到100%,无专家自动退出,专家的积极程度高。3.专家权威程度取决专家对条目做出的判断依据和对条目熟悉程度。是根据熟悉程度及判断依据计算专家权威程度,常用权威系数代表权威程度,权威系数等于熟悉程度系数(Cs)与判断依据系数(Ca)的算术平均值。三轮专家咨询的权威系数分别为0.75、0.79、0.80,均大于0.7,说明具有良好的权威性。结论：初步编制的心系病量表具有较好的信度、效度,对心系病证的辨证及临床疗效评价有一定的指导作用,但临床应用价值有待大规模临床流行病学的调查分析,仍需不断的研究和完善。
[Abstract]:Objective: to establish the syndrome scale of heart system disease based on the principle of syndrome differentiation, so as to provide an objective and standardized measuring tool for the evaluation of clinical curative effect of common heart diseases such as palpitation, chest obstruction and insomnia, and to quantify the curative effect of traditional Chinese medicine. To provide effective evidence for TCM treatment of diseases and to reduce subjectivity and uncertainty in the evaluation of TCM symptoms, this scale can be used to evaluate and compare the results of patients with different treatment schemes and before and after the same treatment plan. In order to help select more superior individualized treatment, we can judge the intervention effect of the treatment plan to the disease. To provide a reference tool for patients to understand their health status. To provide objective and standard data for syndrome differentiation of heart system, and to provide some guidance and reference for TCM clinical syndrome differentiation of heart system. Method 1: 1. According to the literature investigation, according to the principle of syndrome element differentiation, the syndromes were split, the syndrome types including syndromes were summarized, the symptoms were standardized by terms, and the item pool was formed. 2. Using Delphi expert consultation method to carry out three rounds of expert consultation, forming initial scale. 3. The clinical cases were collected for pre-investigation, and the methods of difficulty degree analysis, response characteristics and correlation coefficient were used to screen the items objectively, and to optimize the scale of heart disease. 4. The reliability, validity, response and feasibility of the preliminary cardiac scale were evaluated. The result is 1: 1. Through literature review, teaching materials combing, standard collection of heart disease syndrome and syndrome standardization, through frequency statistics, formed a 264 entries of entries pool. 2. After three rounds of Delphi expert consultation, the mean, full score ratio and coefficient of variation were 3.87 ~ 0.34 ~ 0.24, respectively. The coefficient of coordination degree is 0.452, the recovery rate of three rounds of expert consultation questionnaire reaches 100, no expert automatically quit, and the positive degree of expert is high. 3. The degree of expert authority depends on the expert's judgment and familiarity with the item. The authority coefficient is equal to the arithmetic average of familiarity coefficient (Cs) and judgment basis coefficient (Ca). The authority coefficient of three rounds of expert consultation is 0.75U 0.79U 0.80, all of them are greater than 0.70.This shows that the expert consultation has good authoritativeness. Conclusion: the preliminary scale has good reliability and validity. It can guide the differentiation of symptoms and signs and the evaluation of clinical curative effect, but the clinical application value needs to be investigated and analyzed on a large scale of clinical epidemiology. Still need constant research and consummation.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R256.2

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