本文選題：中醫(yī)皮膚科 + 操作規(guī)范��； 參考：《北京中醫(yī)藥大學》2017年碩士論文

【摘要】：目的通過文獻研究、專家共識會、專家咨詢問卷以及臨床驗證等多個途徑,初步建立標準編制的框架、原則與內(nèi)容,形成中醫(yī)皮膚科診療技術(shù)操作規(guī)范(火針療法、拔罐療法、放血療法、中藥換藥)草案,用于指導上述技術(shù)在中醫(yī)皮膚科的臨床應(yīng)用,提高臨床療效。方法通過文獻研究的方法,檢索了近30余年(1979年～2015年)四種療法治療皮膚科疾病的文獻,通過文獻的納入、排除標準對檢索的文獻進行篩選,對最終納入的文獻進行分類、分析,總結(jié)歸納出具體操作步驟與方法,建立標準的內(nèi)容并形成標準草案一稿。在文獻研究的基礎(chǔ)上,通過專家共識會議、專家咨詢問卷的發(fā)放,在全國范圍內(nèi)廣泛征求相關(guān)領(lǐng)域?qū)＜业囊庖?經(jīng)過不斷修改形成標準草案二稿、三稿。最后通過臨床工作人員的實際操作驗證標準的可行性,通過對反饋意見的整理與系統(tǒng)分析,對于標準的具體條目進行逐一修改,綜合采納各領(lǐng)域?qū)＜乙庖?最終形成中醫(yī)皮膚科診療技術(shù)操作規(guī)范(火針療法、拔罐療法、放血療法、中藥換藥)草案。結(jié)果在草案起草階段,通過對納入文獻的總結(jié)與分析,將四項操作的具體內(nèi)容如術(shù)語和定義、操作步驟與方法、適應(yīng)證、注意事項、禁忌等方面進行規(guī)范,參照國家對于標準的編寫原則與要求,完成標準的初稿。在意見征求階段共進行了兩輪的專家咨詢,通過多種途徑、多種形式(包括了專家共識會議、專家問卷咨詢)進行廣泛咨詢,參與調(diào)查的人員共計49人次,所在地區(qū)覆蓋全國15個省、直轄市,共涉及20余家臨床單位與科研院所,本研究中共發(fā)放問卷55份,回收49份,總回收率為89.09%,且專家反饋時限較短,說明專家積極性較高,結(jié)果的可信性較高。兩輪的問卷調(diào)查在建議修改欄共收集到建議198條,其中火針療法73條,拔罐療法61條,放血療法28條,中藥換藥36條。通過意見匯總與分析,對收集到的所有意見進行采納、部分采納以及不采納。在臨床驗證階段,通過對4家三級甲等醫(yī)院共計21人次的臨床驗證以驗證其在臨床的符合度。經(jīng)過意見統(tǒng)計與分析可知,四項操作規(guī)范中所有條目一致率都在80%以上,因此本標準基本符合臨床實際操作。結(jié)論本標準是基于文獻研究與專家共識的臨床標準,并且經(jīng)過臨床驗證其可行性,具有一定的科學性、嚴謹性與臨床適用性。本標準適用范圍較廣,如中醫(yī)皮膚科、針灸科以及其他臨床工作人員,在實際診療皮膚科疾病時都可以將其作為指導與參考,以便提高臨床療效。本研究為中醫(yī)皮膚科的診療操作規(guī)范最終形成行業(yè)標準提供了方法學的探索與研究基礎(chǔ)。
[Abstract]:Objective to establish the framework, principles and contents of the standard based on literature research, expert consensus meeting, expert consultation questionnaire and clinical verification, and to form the technical standard of dermatology of traditional Chinese medicine (fire needle therapy, cupping therapy). Bloodletting therapy, traditional Chinese medicine change) draft, used to guide the above-mentioned techniques in the clinical application of traditional Chinese medicine dermatology, improve the clinical efficacy. Methods the literature of four kinds of therapies for treating dermatological diseases for more than 30 years (1979 ~ 2015) was retrieved by literature research. The literature was screened by the inclusion of literature and exclusion criteria, and the literature included in the literature was classified. Analyze, sum up the concrete operation steps and methods, establish the content of the standard and form a draft of the standard. On the basis of literature research, through expert consensus meeting and expert consultation questionnaire, the opinions of experts in relevant fields are widely sought in the whole country, and the second and third drafts of the standard are constantly revised and formed. Finally, through the practical operation of the clinical staff to verify the feasibility of the standard, through the feedback collation and systematic analysis, the specific items of the standard are revised one by one, and the expert opinions in various fields are comprehensively adopted. Finally, it forms the draft of technical operation of dermatology of traditional Chinese medicine (fire needle therapy, cupping therapy, bloodletting therapy, traditional Chinese medicine changing medicine). Results during the drafting stage of the draft, the contents of the four operations, such as terms and definitions, operational steps and methods, indications, precautions, taboos and so on, were standardized through the summary and analysis of the included documents. The first draft of the standard is completed with reference to the country's principles and requirements for the preparation of the standard. During the consultation phase, two rounds of expert consultation were conducted, and extensive consultations were conducted in various forms (including expert consensus meetings, expert questionnaire consultations) through a variety of channels, with a total of 49 participants participating in the survey. The area covers 15 provinces and municipalities in China, involving more than 20 clinical units and scientific research institutes. In this study, 55 questionnaires were distributed, 49 were recovered, the total recovery rate was 89.09, and the time limit for expert feedback was relatively short, indicating that the experts were highly motivated. The results have higher credibility. A total of 198 recommendations were collected from two rounds of questionnaire survey, including 73 items of fire acupuncture therapy, 61 items of cupping therapy, 28 items of bloodletting therapy and 36 items of traditional Chinese medicine. Through opinion summary and analysis, all views collected are adopted, partially accepted and not accepted. In the phase of clinical verification, 21 patients in 4 Grade 3A hospitals were tested. According to the opinion statistics and analysis, the consistency rate of all items in the four operational specifications is above 80%, so this standard basically accords with the clinical practice. Conclusion this standard is based on literature research and experts' consensus, and its feasibility is proved to be scientific, rigorous and applicable. This standard is applicable to a wide range, such as traditional Chinese medicine dermatology, acupuncture and other clinical staff, in the actual diagnosis and treatment of dermatologic diseases can be used as a guide and reference, in order to improve the clinical efficacy. This study provides a methodological exploration and research basis for the standard of diagnosis and treatment of traditional Chinese medicine dermatology.
【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R275

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