本文選題：兒童多動(dòng)癥　切入點(diǎn)：循證醫(yī)學(xué)　出處：《南京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:文獻(xiàn)研究結(jié)合Delphi法對(duì)兒童多動(dòng)癥的中醫(yī)兒科臨床指南進(jìn)行修訂,以期對(duì)中醫(yī)藥治療兒童多動(dòng)癥提供臨床指導(dǎo)。方法:在循證醫(yī)學(xué)的基礎(chǔ)上,采用文獻(xiàn)研究、Delphi法專家調(diào)查問(wèn)卷、專家論證會(huì)、同行征求意見(jiàn)、方法質(zhì)量學(xué)評(píng)價(jià)及臨床一致性評(píng)價(jià)相結(jié)合的方法修訂兒童多動(dòng)癥的中醫(yī)診療指南。文獻(xiàn)研究:檢索相關(guān)期刊論文(CNKI)、萬(wàn)方全文數(shù)據(jù)庫(kù)、中文科技期刊數(shù)據(jù)庫(kù)(維普)、中國(guó)優(yōu)秀博碩士學(xué)位論文全文數(shù)據(jù)庫(kù)、COCHRANE圖書館、Clinical Trial、NGC等,檢索年限從2000年1月到 2016年3月,選擇中醫(yī)治療及中西醫(yī)結(jié)合治療、預(yù)防類文獻(xiàn),嚴(yán)格按照文獻(xiàn)的納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn),對(duì)文獻(xiàn)進(jìn)行篩選評(píng)價(jià),對(duì)隨機(jī)臨床試驗(yàn)評(píng)價(jià)采用改良Jadad量表大于等于3分的文獻(xiàn)作為治療性建議的證據(jù),對(duì)非隨機(jī)臨床試驗(yàn)的評(píng)價(jià)采用MINORS條目評(píng)分總分大于等于13分的文獻(xiàn)作為治療性建議證據(jù),對(duì)Meta分析的文獻(xiàn),采用AMSTAR量表評(píng)分大于等于5分文獻(xiàn)為證據(jù),并對(duì)文獻(xiàn)進(jìn)行分析、總結(jié)、尋找規(guī)律,建立Excel數(shù)據(jù)庫(kù),并對(duì)各項(xiàng)指標(biāo)進(jìn)行頻數(shù)頻率的統(tǒng)計(jì)學(xué)分析,完成文獻(xiàn)研究總結(jié),編寫專家調(diào)查問(wèn)卷。Delphi法專家調(diào)查問(wèn)卷:在前期文獻(xiàn)研究的基礎(chǔ)上,編寫專家調(diào)查問(wèn)卷,基于Delphi法的原則,以電子郵件的方式向全國(guó)36位專家發(fā)放兩輪專家問(wèn)卷調(diào)查表,主要從均數(shù)(x)、等級(jí)和(S)及不重要百分比(R)、變異系數(shù)(CV)等指標(biāo)進(jìn)行評(píng)價(jià),對(duì)兩輪專家調(diào)查問(wèn)卷的結(jié)果進(jìn)行分析,匯總專家意見(jiàn)并結(jié)合文獻(xiàn)研究,確定指南初稿。專家論證會(huì):邀請(qǐng)相關(guān)專業(yè)的24位專家召開(kāi)了專家論證會(huì),工作組按專家論證會(huì)意見(jiàn)結(jié)合兩輪專家調(diào)查問(wèn)卷分析結(jié)果及文獻(xiàn)研究結(jié)果,修改指南初稿,形成了指南征求意見(jiàn)稿。同行征求意見(jiàn)、方法質(zhì)量學(xué)評(píng)價(jià)、臨床一致性評(píng)價(jià):項(xiàng)目工作組于2015年10月13～31日向36家單位的50位同行業(yè)專家發(fā)送征求意見(jiàn)稿,根據(jù)其提出的意見(jiàn)修改指南征求意見(jiàn)稿形成評(píng)價(jià)稿。兒科專家指導(dǎo)組于2015年12月13～30日組織中醫(yī)兒科學(xué),中西醫(yī)結(jié)合兒科學(xué)、溫病學(xué)的4位專家進(jìn)行指南方法學(xué)的質(zhì)量評(píng)價(jià)(AGREEⅡ工具)。并于2015年12月10日-2016年3月30日邀請(qǐng)12個(gè)三級(jí)甲等醫(yī)院開(kāi)展了 201例臨床一致性評(píng)價(jià),并根據(jù)專家質(zhì)量方法學(xué)評(píng)價(jià)和臨床一致性評(píng)價(jià)反饋的意見(jiàn),對(duì)評(píng)價(jià)稿又作了全面的整理、修改,2016年4月形成了指南審核稿。結(jié)果:結(jié)合兩輪專家調(diào)查問(wèn)卷、專家論證會(huì)、同行征求意見(jiàn)、方法質(zhì)量學(xué)評(píng)價(jià)及臨床一致性評(píng)價(jià),匯總專家意見(jiàn)對(duì)本次指南進(jìn)行修訂,最終完成了科學(xué)規(guī)范的兒童多動(dòng)癥的中醫(yī)臨床診療指南,對(duì)2012版的指南進(jìn)行了完善與更新。結(jié)論:在循證醫(yī)學(xué)的基礎(chǔ)上,采用改良Jadad量表、MINORS條目、AMSTAR量表對(duì)臨床治療性文獻(xiàn)進(jìn)行分析篩選評(píng)價(jià),對(duì)兒童多動(dòng)癥的標(biāo)準(zhǔn)化、規(guī)范化的循證實(shí)踐意義深遠(yuǎn)。與2012年的指南相比較,在病名、適用范圍、診斷標(biāo)準(zhǔn)及辨證分型方面都進(jìn)行了調(diào)整與更新,并且新增了預(yù)防和調(diào)護(hù)的內(nèi)容。在兒童多動(dòng)癥的中藥復(fù)方用藥規(guī)律方面,發(fā)現(xiàn)中醫(yī)治療兒童多動(dòng)癥以補(bǔ)虛、安神、清熱、平肝為主,兼以健脾為主要治法。
[Abstract]:Objective: to research the Delphi method combined with TCM pediatrics clinical guidelines of children with ADHD were revised, in order to provide clinical guidance for the treatment of children with ADHD medicine. Methods: Based on evidence-based medicine, using literature research method, Delphi expert questionnaire, expert on card, peer comments, guidelines for TCM diagnosis and treatment methods quality evaluation and clinical evaluation of the combination of the consistency of the revision of children with ADHD. Literature research: Chinese retrieval Journal Full-text Database (CNKI), Wanfang database, Chinese journal database (D & P), Chinese master theses full-text database, COCHRANE library, Clinical Trial, NGC and so on, the retrieval period from January 2000 to March 2016, selection of combined treatment of traditional Chinese medicine treatment and prevention of traditional Chinese medicine and Western medicine, literature, in strict accordance with the inclusion criteria and exclusion criteria, screening evaluation of literature The price of randomized clinical trials evaluated by modified Jadad scale is greater than or equal to 3 points for the treatment of literature suggests that the evidence, evaluation of non randomized clinical trials using MINORS entry score of greater than or equal to 13 of the literature for the treatment of evidence, analysis of the Meta document, the AMSTAR score of greater than or equal to 5 documents as evidence, and the literature analysis, summary, find the law, establish the Excel database, and the indicators for statistical analysis of frequency, complete the research and preparation of.Delphi expert questionnaire method expert questionnaire: Based on the previous literatures, written expert questionnaire, Delphi method based on the principle of two rounds of expert questionnaire issued to the 36 experts by e-mail, mainly from the mean level (x), and (S) and a significant percentage (R), the coefficient of variation (CV) and other indicators Evaluation of two rounds of expert questionnaire results of the analysis, summary of expert opinion and combined with literature research, determine the draft guide. Experts will invite 24 experts convened the relevant professional experts will work according to the group of experts will combined with two rounds of expert analysis results and the results of questionnaire, revised draft guidelines the guide, form draft. Peer comments, the evaluation methods of quality, clinical evaluation of consistency: the project working group 50 on 13~31 October 2015 36 units of the same industry experts send draft, according to the views of the revised draft guidelines form evaluation draft. Pediatric expert group in December 2015 13~30, organization of Pediatrics of traditional Chinese medicine, pediatrics of traditional Chinese and Western medicine, quality evaluation methodology guide 4 experts of seasonal febrile disease (AGREE II tool) and in 2015. In December 10th March 30th -2016 invited 12 three hospitals to carry out clinical evaluation of consistency in 201 cases, and according to the expert feedback methodology of quality evaluation and clinical evaluation of consistency of opinion, evaluation and release a comprehensive collation, modify, April 2016 formed the audit guidelines draft. Results: the combination of two rounds of expert questionnaire and experts will peer comments, and evaluate the consistency of quality evaluation methods, summary of expert opinions to revise the guidelines, the final completion of the clinical diagnosis and treatment of scientific and standardized ADHD refers to the south, the 2012 edition of the guide to the improvement and update. Conclusion: Based on evidence-based medicine by using the modified Jadad scale, AMSTAR scale, MINORS entry, analyzed the selection and evaluation of clinical literature, standardization of children with ADHD, standardized evidence-based practice in 2012 and have far-reaching significance. Compared with the guidelines, for in the name of disease, scope, diagnostic criteria and TCM syndrome classification have been adjusted and updated, and added the prophylaxis and nursing content. The regularity of Chinese compound prescription Chinese medicine treatment of children with ADHD, found that children with ADHD with tonic, sedative, heat, calming the liver and the spleen. As the main treatment.

【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R277.7

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