本文選題：中醫(yī)全科醫(yī)學(xué) + 診療模式　； 參考：《北京中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的：首先以文獻(xiàn)研究的方法探究中醫(yī)全科醫(yī)學(xué)的診療模式和社區(qū)診療模式,之后應(yīng)用數(shù)理統(tǒng)計(jì)法對中醫(yī)全科醫(yī)學(xué)診療模式下中藥聯(lián)合針灸方法治療腦卒中后抑郁癥文獻(xiàn)進(jìn)行客觀的療效分析,以期為“以病定技術(shù)”的中醫(yī)全科醫(yī)學(xué)診療模式在社區(qū)中推廣提供參考依據(jù)。方法：第一節(jié)：采用文獻(xiàn)研究的方法對中醫(yī)全科醫(yī)學(xué)的診療模式進(jìn)行探究,并探討中、西醫(yī)全科醫(yī)學(xué)診療模式間的差異,對比二者間的優(yōu)勢與局限性。第二節(jié)：根據(jù)國際循證醫(yī)學(xué)中心/Cochrane協(xié)作工作手冊標(biāo)準(zhǔn),使用計(jì)算機(jī)檢索萬方數(shù)據(jù)庫(WF,1998-2016)、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(CBM,1979-2016)、中國知網(wǎng)全文期刊數(shù)據(jù)庫(CNKI,1979-2016)、維普中文科技期刊數(shù)據(jù)庫(VIP,1989-2016)。納入有關(guān)中藥聯(lián)合針灸治療腦卒中后抑郁癥的隨機(jī)對照試驗(yàn)(RCT)文獻(xiàn),將篩選出的文獻(xiàn)按照Cochrane Review Handbook5.0質(zhì)量評價(jià)標(biāo)準(zhǔn),對RCT的隨機(jī)方法、盲法的應(yīng)用、分配隱藏的實(shí)施、樣本量、治療方法、統(tǒng)計(jì)方法、隨訪與失訪等內(nèi)容進(jìn)行資料提取與質(zhì)量評價(jià)。采用RevMan 5.3軟件進(jìn)行分析,評價(jià)中藥聯(lián)合針灸方法對PSD患者HAMD積分變化情況及有效率。結(jié)果：第一節(jié)：通過文獻(xiàn)研究的方法探究中醫(yī)全科醫(yī)學(xué)的診療模式,結(jié)果顯示辨體-辨病-辨證診療模式、中醫(yī)特色家庭病床服務(wù)模式、“以病定技術(shù)”的中醫(yī)適宜技術(shù)服務(wù)模式及中醫(yī)干預(yù)社區(qū)精神疾病模式適合社區(qū)開展。通過探究發(fā)現(xiàn),中醫(yī)全科醫(yī)學(xué)診療模式相較西醫(yī)而言具有一定優(yōu)勢,在社區(qū)醫(yī)療活動發(fā)揮了積極作用。在社區(qū)推廣中醫(yī)全科醫(yī)學(xué)診療模式是提高國民健康素質(zhì)的一條基本路徑,也是中國特色社會主義醫(yī)療事業(yè)發(fā)展的新亮點(diǎn)。第二節(jié)：針對不同的數(shù)據(jù)庫分別制定檢索策略,共檢索出1229篇文獻(xiàn),查重排除858篇。通過閱讀編目、摘要不符合要求的文獻(xiàn)347篇,剩余24篇文獻(xiàn)下載全文閱讀進(jìn)一步篩選,排除未標(biāo)有“隨機(jī)對照”或不符合本系統(tǒng)評價(jià)診斷、納入標(biāo)準(zhǔn)的文獻(xiàn)14篇,最終納入10篇中藥聯(lián)合針灸治療腦卒中后抑郁癥的隨機(jī)對照試驗(yàn),對此10篇文獻(xiàn)進(jìn)行資料提取及文獻(xiàn)質(zhì)量評價(jià)。偏倚風(fēng)險(xiǎn)評估顯示本研究納入文獻(xiàn)的質(zhì)量普遍偏低,具有較高風(fēng)險(xiǎn)。10篇研究共提供病例總數(shù)738例,其中試驗(yàn)組369例、對照組369例,通過對納入文獻(xiàn)進(jìn)行分析,得出以下結(jié)果：(1) HAMD積分變化比較：7篇文獻(xiàn)異質(zhì)性分析,I2=100%,P0.00001,顯示研究具有異質(zhì)性,選擇隨機(jī)效應(yīng)模型,MD=5.26,95%CI [2.07,8.45], Z=3.22 (P=0.001),說明中藥聯(lián)合針灸治療組與西藥對照組改善HAMD積分有統(tǒng)計(jì)學(xué)差異,表明中藥聯(lián)合針灸治療方法對于HAMD積分改善優(yōu)于抗抑郁西藥。(2)有效率比較：9篇文獻(xiàn)異質(zhì)性分析P=0.71,I2=0%,顯示研究之間無異質(zhì)性,選擇固定效應(yīng)模型,OR=2.93,95%CI[1.87,4.61],Z=4.66(P0.00001),說明治療組與西藥對照組治療PSD有效率有統(tǒng)計(jì)學(xué)差異。表明在有效率方面,中藥聯(lián)合針灸療法組對治療PSD有效率優(yōu)于抗抑郁西藥。結(jié)論：-、辨體-辨病-辨證診療模式、中醫(yī)特色家庭病床服務(wù)模式、“以病定技術(shù)”的中醫(yī)適宜技術(shù)服務(wù)模式及中醫(yī)干預(yù)社區(qū)精神疾病模式適合社區(qū)開展。二、“中藥聯(lián)合針灸”的中醫(yī)適宜技術(shù)可有效治療腦卒中后抑郁癥。
[Abstract]:Objective: To explore the mode of diagnosis and treatment of general medicine in traditional Chinese medicine and the mode of community diagnosis and treatment by means of literature research, and then analyze the objective effect of the literature on the treatment of post-stroke depression with the combined acupuncture and moxibustion of traditional Chinese medicine under the general medical diagnosis and treatment mode of traditional Chinese medicine with the method of mathematical statistics. Diagnosis and treatment mode in the community to provide reference basis. Method: first section: the use of literature research methods to explore the diagnosis and treatment of traditional Chinese medicine, and discuss the differences between the western medicine general medical diagnosis and treatment mode, compare the advantages and limitations between the two. Second: according to the international evidence-based medical center /Cochrane cooperative work To make the manual standard, use the computer to retrieve the Wanfang database (WF, 1998-2016), the Chinese biomedical literature database (CBM, 1979-2016), the full text journal database (CNKI, 1979-2016), and the VIP Chinese sci-tech journal database (VIP, 1989-2016). The randomized controlled trial (RCT) on the combined acupuncture and moxibustion for the treatment of post-stroke depression (VIP, 1989-2016). In the literature, according to the Cochrane Review Handbook5.0 quality evaluation standard, the selected literature was used to extract and evaluate the random methods of RCT, the application of blind method, the implementation of the distribution, the sample size, the treatment method, the statistical method, the follow-up and the loss of visits. The RevMan 5.3 software was used to analyze and evaluate the combined acupuncture and moxibustion methods of Chinese medicine. PSD patients HAMD integral change and efficiency. Results: first section: through the literature research method to explore the traditional Chinese medicine diagnosis and treatment mode, the results show that the differentiation and differentiation of disease diagnosis and treatment mode, the traditional Chinese medicine family sickbed service mode, "disease setting technology" suitable technology service mode of traditional Chinese medicine and traditional Chinese medicine intervention community spirit The mode of disease is suitable for the community to carry out. Through the exploration, it has been found that the medical diagnosis and treatment mode of the general medicine of traditional Chinese medicine has some advantages compared with the western medicine, and has played an active role in the community medical activities. The new highlight of the exhibition. Second: a total of 1229 documents were retrieved for different databases, 858 articles were retrieved and 858 articles were retrieved. Through reading cataloguing, 347 articles were not conformed to the requirements, and the remaining 24 documents downloaded full text for further screening, excluding the "random control" or not conforming to the system evaluation diagnosis. 14 articles were included in the standard literature, and a randomized controlled trial of 10 Chinese medicine combined with acupuncture and moxibustion for post-stroke depression was included. The data were extracted and the literature quality was evaluated in 10 articles. The bias risk assessment showed that the quality of the literature included in this study was generally low. A total of 738 cases with high risk of.10 were provided. 369 cases and 369 cases in the control group were analyzed to get the following results: (1) HAMD integral change comparison: 7 literature heterogeneity analysis, I2=100%, P0.00001, showing the heterogeneity of the study, the choice of random effect model, MD=5.26,95%CI [2.07,8.45], Z=3.22 (P=0.001), indicating the combination of acupuncture treatment group with Western medicine and Western medicine. The improvement of HAMD scores in the group was statistically different, indicating that the combination of traditional Chinese medicine and acupuncture treatment improved the HAMD score better than the antidepressant western medicine. (2) the efficiency was compared: 9 literature heterogeneity analysis P=0.71, I2=0%, showing no heterogeneity between the studies, the selection of the fixed effect model, OR= 2.93,95%CI[1.87,4.61], Z=4.66 (P0.00001), indicating the treatment group and the West. The effective rate of PSD in the drug control group was statistically different. It showed that in the efficiency, the efficiency of the combined acupuncture and moxibustion group was better than the antidepressant western medicine. Conclusion: the pattern of differentiation and differentiation, the pattern of differentiation and differentiation, the family sickbed service mode of traditional Chinese medicine, the suitable technology service mode of TCM with the disease setting technology and the intervention society of traditional Chinese medicine. Two, the appropriate technology of Chinese medicine combined with acupuncture can effectively treat post-stroke depression.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R242

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