不同医生辨证与针刺处方差异的临床研究

发布时间：2018-11-01 14:32

【摘要】：目的探索不同临床医生临床辨证与针刺处方中存在的差异性。方法以癌症化疗后出现恶心、呕吐患者为研究对象,拟对其进行针刺治疗。分别由两名不同医生对同一患者进行独立的四诊辨证,并拟定具体的针刺方案,包括选穴、针刺深度、手法强度、补泻手法、留针时间。对辨证一致性进行Kappa检验,比较不同医生针刺方案的差异。结果两名医生的辨证结果一致性很低(一致率38.5%,k=0.22),但对于穴位的选择基本一致,以中脘、天枢(双侧)、内关(双侧)、足三里(双侧)为主穴,选穴结果差异无统计学意义(χ~2=8.746,P=0.724)。两名医生针刺方案的手法强度、针刺深度、留针时间、补泻手法差异均有统计学意义(P0.05)。结论针对癌症化疗后恶心、呕吐患者,不同医生辨证结果一致性低,但对穴位选择影响不大,差异体现在针刺手法的不同。
[Abstract]:Objective to explore the differences between clinical syndrome differentiation and acupuncture prescriptions among different clinicians. Methods patients with nausea and vomiting after cancer chemotherapy were treated with acupuncture. By two different doctors to the same patient by the independent four diagnosis differentiation, and draw up specific acupuncture program, including point selection, acupuncture depth, manual strength, reinforcing and reducing manipulation, needle retention time. The consistency of syndrome differentiation was tested by Kappa, and the difference of acupuncture schemes among different doctors was compared. Results the results of the two doctors' syndrome differentiation were very low (the consistent rate was 38.5%), but the selection of acupoints was basically the same. The main points were Zhongwan, Tianshu (bilateral), Neiguan (bilateral) and Zusanli (bilateral). There was no significant difference in the results of acupoint selection (蠂 ~ 2 ~ 2 ~ (8.746) P ~ (0. 724). The difference of manipulation intensity, depth of acupuncture, time of retention of needle, reinforcing and reducing manipulation between the two doctors were statistically significant (P0.05). Conclusion for the patients with nausea and vomiting after cancer chemotherapy, the differentiation results of different doctors have low consistency, but have little effect on the choice of acupoints, the difference is reflected in the difference of acupuncture manipulation.
【作者单位】：北京中医药大学循证医学中心;中国中医科学研究院西苑医院;
【基金】：北京市科技新星计划(Z111102054511086) 国家自然科学基金(30901929) 教育部新世纪优秀人才支持计划(NCET-10-0271)
【分类号】：R246.5

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