發(fā)布時(shí)間：2018-05-01 22:12

  本文選題：胃食管反流病 + 治未病��； 參考：《廣州中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的在文獻(xiàn)研究的基礎(chǔ)上,通過(guò)德?tīng)柗品ê蛯?zhuān)家會(huì)議法,從胃食管反流病的中醫(yī)認(rèn)識(shí)、中醫(yī)治未病的內(nèi)容及胃食管反流病未病先防、既病防變、瘥后防復(fù)等階段的調(diào)攝治療措施等方面進(jìn)行咨詢(xún),制定胃食管反流病中醫(yī)治未病實(shí)踐方案。方法1.通過(guò)檢索《中華醫(yī)典》收集古代文獻(xiàn),檢索相關(guān)期刊論文(知網(wǎng))、維普數(shù)據(jù)庫(kù)、萬(wàn)方數(shù)據(jù)庫(kù)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)收集現(xiàn)代中文文獻(xiàn);檢索Cochrance Library、Pubmed等數(shù)據(jù)庫(kù)收集現(xiàn)代外文文獻(xiàn),對(duì)文獻(xiàn)進(jìn)行篩選分析,總結(jié)歸納胃食管反流病的中醫(yī)病名、病因病機(jī)、診斷標(biāo)準(zhǔn)、西醫(yī)發(fā)病機(jī)制、危險(xiǎn)因素、高危人群體質(zhì)特點(diǎn)、調(diào)攝措施、治療措施等,形成《胃食管反流病中醫(yī)治未病實(shí)踐方案》調(diào)查問(wèn)卷,通過(guò)德?tīng)柗品�、�?zhuān)家會(huì)議法對(duì)方案進(jìn)行咨詢(xún)、討論、修改和調(diào)整。2.采用病例調(diào)查法在廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院、廣東省中醫(yī)院、深圳市中醫(yī)院、首都醫(yī)科大學(xué)望京醫(yī)院、河南中醫(yī)學(xué)院第一附屬醫(yī)院等多家醫(yī)院收集100例胃食管反流病高危人群及胃食管反流病患者病歷資料,進(jìn)行指南與實(shí)踐程度一致性程度評(píng)價(jià)。結(jié)果1.共進(jìn)行了四輪專(zhuān)家咨詢(xún)和一次專(zhuān)家會(huì)議。參加第一輪咨詢(xún)的專(zhuān)家有12位,均為高級(jí)職稱(chēng),專(zhuān)家積極系數(shù)為75%;參加第二輪咨詢(xún)的專(zhuān)家有12位,均為高級(jí)職稱(chēng),專(zhuān)家積極系數(shù)為80%;參加第三輪咨詢(xún)的專(zhuān)家有11位,均為高級(jí)職稱(chēng),專(zhuān)家積極系數(shù)為73.33%;參加第四輪咨詢(xún)的專(zhuān)家有12位,均為高級(jí)職稱(chēng),專(zhuān)家積極系數(shù)為75%。各輪專(zhuān)家均有較強(qiáng)的地域代表性及學(xué)科代表性。參與專(zhuān)家會(huì)議的專(zhuān)家有4位,均為高級(jí)職稱(chēng),具有較高的權(quán)威性。經(jīng)過(guò)四輪咨詢(xún)及專(zhuān)家討論,確定方案內(nèi)容包括:中醫(yī)病名、中醫(yī)病因、中醫(yī)病機(jī)、中醫(yī)診斷標(biāo)準(zhǔn)、西醫(yī)發(fā)病機(jī)制、危險(xiǎn)因素、治未病措施及意義、高危人群體質(zhì)特點(diǎn)、改善生活方式(未病先防)、日常飲食、藥膳及花茶、穴位按摩、音樂(lè)療法、心理療法、改變生活方式(已病防變)、飲食宜忌、中藥治療、中成藥治療、特色療法、量表及心理輔導(dǎo)、瘥后防復(fù)。各條目均數(shù)在4.75-5.0之間,等級(jí)和在57-60之間,權(quán)威系數(shù)在0-0.13之間,變異系數(shù)為0.416,P0.001�？死拾秃障禂�(shù)為0.931,問(wèn)卷信度較好。2.一致性結(jié)果顯示,高危人群特點(diǎn)及疾病診斷標(biāo)準(zhǔn),一致率分別為35%、65%。對(duì)高危人群進(jìn)行改善生活方式及飲食調(diào)護(hù)的宣教方面一致率均為35%。穴位按摩、音樂(lè)療法、心理療法的一致率分別為10%、0、21%。已診斷為GERD患者干預(yù)措施中改變生活方式的一致率為65%,飲食調(diào)護(hù)、中藥治療、中成藥、中醫(yī)特色療法、量表及心理輔導(dǎo)的一致率分別為47%、54%、29%、17%、35%。結(jié)論運(yùn)用德?tīng)柗品ê蛯?zhuān)家會(huì)議法,形成《胃食管反流病中醫(yī)治未病實(shí)踐方案》。但受限于醫(yī)師、患者及外部環(huán)境,方案一致性較低,有待進(jìn)一步修改。
[Abstract]:Objective on the basis of literature study, through Delphi method and expert meeting method, from the Chinese medicine understanding of gastroesophageal reflux disease, the contents of TCM treatment and the prevention of gastroesophageal reflux disease before disease, both disease prevention and change prevention. In order to make the practical plan of treating gastroesophageal reflux disease by traditional Chinese medicine (TCM), we should consult the measures of adjusting and treating gastroesophageal reflux disease in the stage of recuperation and recuperation. Method 1. The ancient literature was collected by searching the Chinese Medical Dictionary, and the full text database of Chinese periodicals was searched (Zhiwang, Weipu, Wanfang, and Chinese Biomedical Literature Database). To search the Cochrance Library Pubmed database to collect modern foreign literature, to screen and analyze the literatures, to sum up the TCM disease names, etiology and pathogenesis, diagnostic criteria, pathogenesis of western medicine, risk factors and physical characteristics of high-risk population, and to sum up and summarize the TCM disease name, etiology and pathogenesis, pathogenesis of western medicine, risk factors, and physical characteristics of high-risk population. Through the Delphi method and the expert meeting method, the project was consulted, discussed, revised and adjusted by the questionnaire of the practical plan of TCM treatment of gastroesophageal reflux disease. Cases were investigated in the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine, Guangdong traditional Chinese Medicine Hospital, Shenzhen traditional Chinese Medicine Hospital, and Wangjing Hospital of Capital Medical University. The medical records of 100 patients with gastroesophageal reflux disease (GERD) and gastroesophageal reflux disease (GERD) were collected in many hospitals such as the first affiliated Hospital of Henan College of traditional Chinese Medicine and so on. Result 1. Four rounds of expert advice and one expert meeting were conducted. Twelve experts participated in the first round of consultation, all with senior professional titles, and the positive coefficient of experts was 750.12 experts participated in the second round of consultations, all of whom were senior titles, and the expert positive coefficient was 80. The number of experts participating in the third round of consultations was 11. There are 12 experts participating in the fourth round of consultation, all of them are senior titles, and the positive coefficient of experts is 753.33. Each round of experts has a strong geographical representation and discipline representation. There are 4 experts who participate in the expert meeting, all of them are senior titles and have high authority. After four rounds of consultation and expert discussions, it was determined that the contents of the scheme include: TCM disease name, TCM etiology, TCM pathogenesis, TCM diagnostic criteria, Western medicine pathogenesis, risk factors, treatment measures and significance, and physical characteristics of high-risk groups. Improve lifestyle (prevent illness before illness, daily diet, medicine meal and scented tea, acupoint massage, music therapy, psychotherapy, change life style (disease prevention, diet should avoid, Chinese medicine treatment, traditional Chinese medicine treatment, characteristic therapy, Scale and psychological counseling, recuperation after recuperation. The average of each item is between 4.75-5.0, the rank and the coefficient of authority are between 0-0.13, and the coefficient of variation is 0.416p0.001. The Cronbach coefficient was 0.931, and the questionnaire reliability was better. 2. The concordant results showed that the consistent rates of the characteristics of high-risk population and the diagnostic criteria of disease were 35% and 65% respectively. The consistent rate of improving lifestyle and diet care for high-risk population was 35. The consistent rates of acupoint massage, music therapy and psychotherapy were 100.21. The consistent rate of lifestyle change in the intervention measures of patients with GERD was 65, the consistent rate of diet regulation and nursing, traditional Chinese medicine treatment, traditional Chinese medicine, traditional Chinese medicine characteristic therapy, scale and psychological counseling were 470.54 and 292917173535, respectively. Conclusion the method of Delphi and expert meeting was used to form the practical plan of TCM treatment of gastroesophageal reflux disease. However, limited by physicians, patients and the external environment, the protocol is less consistent and needs further modification.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R259

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