出血性中風(fēng)證候要素診斷量表條目篩選的研究
發(fā)布時間：2018-08-17 13:09
【摘要】：目的:中醫(yī)證候標(biāo)準(zhǔn)化、客觀化研究的一項重要內(nèi)容就是證候診斷量表的研究。量表條目的篩選是量表編制過程中的一個重要環(huán)節(jié)。本研究通過專家咨詢問卷的方法,參照德爾菲法(Delphi),從而獲取專家認(rèn)為對于出血性中風(fēng)臨床常見證候要素及具有診斷意義的四診信息,篩選專家經(jīng)驗辨證量表條目,并結(jié)合應(yīng)用統(tǒng)計方法分析臨床四診信息,進(jìn)一步探討將專家經(jīng)驗與臨床信息相結(jié)合,篩選出血性中風(fēng)證候要素診斷量表條目,以期構(gòu)建出血性中風(fēng)證候要素診斷量表,奠定基礎(chǔ)。方法:研究主要分為兩個階段,第一階段,建立出血性中風(fēng)證候要素診斷量表維度及相應(yīng)條目池。參照德爾菲法,通過兩輪專家問卷的方式咨詢專家意見,獲取專家經(jīng)驗,篩選出對于出血性中風(fēng)證候相關(guān)要素及其具有診斷意義的四診信息(條目),從重要性角度篩選條目;第二部分,基于臨床信息篩選出血性中風(fēng)證候要素診斷量表條目,進(jìn)一步驗證專家經(jīng)驗篩選結(jié)果。利用前瞻性、多中心、大樣本采集的出血性中風(fēng)臨床四診信息,通過卡方檢驗、因子分析法、聚類分析等方法臨床四診信息,獲得對證候要素診斷具有意義的四診信息,在驗證專家經(jīng)驗篩選結(jié)果的同時,將兩部分的研究結(jié)果共有的四診信息作為出血性中風(fēng)證候要素診斷量表條目池。結(jié)果:基于專家經(jīng)驗與臨床信息篩選的出血性中風(fēng)證候要素診斷量表內(nèi)風(fēng)證條目有:兩手握固、口噤不開、健忘、頭重痛、頭暈?zāi)垦�、苔黃厚膩、脈弦、目偏不瞬、頭掣痛、舌體顫抖、48小時達(dá)到高峰、苔厚膩、口苦基于專家經(jīng)驗與臨床信息篩選的出血性中風(fēng)證候要素診斷量表內(nèi)火證條目有:滿面通紅、壯熱、目赤、躁擾不寧、舌紅絳、渴喜冷飲、頭灼痛、舌紅、脈數(shù)、口臭、面紅、苔黃厚基于專家經(jīng)驗與臨床信息篩選的出血性中風(fēng)證候要素診斷量表痰證條目有:咳痰、苔厚膩、昏睡、喉中痰鳴、苔白膩、神情呆滯、嗜睡、苔黃厚膩、膩苔、反應(yīng)遲鈍、昏聵、頭重、舌胖大、脈滑、痰色黃、頭昏、厚苔、表情淡漠、浮腫、脈濡基于專家經(jīng)驗與臨床信息篩選的出血性中風(fēng)證候要素診斷量表瘀證條目有:頭刺痛、痛有定處、舌有瘀斑或瘀點(diǎn)、舌下脈絡(luò)青紫、舌青紫、肌膚甲錯、皮膚紫斑、面色黧黑、爪甲青紫、口唇青黑、脈結(jié)、脈澀、舌下脈絡(luò)曲張、面色晦暗、肢痛麻木基于專家經(jīng)驗與臨床信息篩選的出血性中風(fēng)證候要素診斷量表氣虛證條目有:自汗、少氣懶言、脈弱、面白、二便失禁、呼吸微弱、口唇淡白、舌淡、肢體萎軟、面色萎黃、表情淡漠、納呆、便溏、齒痕舌、脈微基于專家經(jīng)驗與臨床信息篩選的出血性中風(fēng)證候要素診斷量表陰虛證條目有:舌光紅無苔、盜汗、潮熱、低熱、苔少、舌干、咽干、手足蠕動、舌痿、兩目干澀、剝脫苔、脈細(xì)、口干、手足心熱結(jié)論:1證候要素是構(gòu)成“證候”的最小單元,通過“降維”、“降階”,簡化了中醫(yī)辨證的多維性和復(fù)雜性,為中醫(yī)辨證量表的研究提供了模式范例。2辨證論治體系就是古代醫(yī)家在臨床實踐過程中不斷形成和完善的,是中醫(yī)的精髓,而古代文獻(xiàn)是對這一“精髓“最完成的承載,為中醫(yī)證候的研究提供了寶貴的資源。因此基于古代進(jìn)行證候的研究,是建立中醫(yī)證候診斷標(biāo)準(zhǔn)的必要前提。參照德爾菲法是獲取專家經(jīng)驗的有效方法,能夠從重要性角度為辨證量表提供條目,是進(jìn)一步篩選證候辨證量表條目、建立中醫(yī)證候診斷標(biāo)準(zhǔn)的有效途徑之一。3初步認(rèn)為通過文獻(xiàn)研究、臨床流行病學(xué)調(diào)查、統(tǒng)計分析及臨床驗證,出血性中風(fēng)證候要素診斷量表的條目池的建立要將專家經(jīng)驗與臨床四診信息通過現(xiàn)代的數(shù)理統(tǒng)計分析方法將二者結(jié)果融合,互相支撐,互相為用,最終篩選出重要性高、獨(dú)立性強(qiáng)、敏感性強(qiáng)與臨床可操作性的量表條目,為證候規(guī)范化研究提供規(guī)范的可供借鑒的研究思路與方法
[Abstract]:Objective: To study the standardization and objectification of TCM syndromes, an important part of which is the study of the syndrome diagnosis scale.The selection of the items of the scale is an important link in the preparation of the scale.This study is based on the Delphi method and consulted by the experts to obtain the common clinical symptoms of hemorrhagic apoplexy. Elements and diagnostic information of the four diagnostic scales were screened, and the items of the Expert Experience Differentiation Scale were analyzed with statistical methods. The items of the Diagnostic Scale of Hemorrhagic Apoplexy Syndrome Elements were screened by combining expert experience with clinical information in order to construct the Diagnostic Scale of Hemorrhagic Apoplexy Syndrome Elements. Methods: The study was divided into two stages. In the first stage, the dimension and item pool of the diagnostic scale of Hemorrhagic Apoplexy Syndrome elements were established. Information (items) were screened from an important point of view; in the second part, based on clinical information, the items of the Diagnostic Scale for Hemorrhagic Stroke Syndrome Elements were screened to further validate the results of expert experience screening. Methods Four diagnostic information was obtained from the clinical four diagnostic information, and the four diagnostic information was used as the item pool of the diagnostic scale for hemorrhagic stroke. The items of wind syndrome in the diagnostic scale include: holding hands firmly, opening mouth, forgetfulness, severe headache, dizziness and dizziness, thick and greasy fur, pulse strings, unsteady eyes, headache, tongue trembling, peaking in 48 hours, thick and greasy fur, and bitter mouth. The items of fire syndrome in the diagnostic scale of hemorrhagic stroke syndrome based on expert experience and clinical information are: full face red, strong and strong. Fever, red eyes, restlessness, red tongue, thirst for cold drinks, burning headache, red tongue, pulse number, halitosis, flushing, thick fur based on expert experience and clinical information screening factors of hemorrhagic stroke syndrome diagnosis scale phlegm items are: sputum, thick fur, sleepy, sputum in the throat, white greasy fur, sluggish expression, sleepiness, thick fur, greasy, greasy fur, sluggish, sluggish, dull, dizzy, dull, dizzy, dizzy, and thick fur, greasy fur, greasy, greasy fur, greasy, greasy, Head weight, tongue fat, smooth pulse, phlegm yellow, dizziness, thick fur, indifferent expression, edema, pulse based on expert experience and clinical information screening of hemorrhagic stroke syndrome factors diagnosis scale blood stasis syndrome items are: headache, pain has a fixed place, tongue bruise or ecchymosis, sublingual veins cyanosis, tongue cyanosis, skin nail fault, skin purple spots, dark complexion, nail cyanosis, purple, skin purple. The diagnostic scale for Hemorrhagic Apoplexy Syndrome Based on expert experience and clinical information includes: spontaneous sweating, hypoventia, inertia, pulse weakness, paleness, incontinence, faint breathing, pale lips, pale tongue, weakness of limbs, yellowness of complexion, indifference, apathy, acceptance, etc. Diarrhea, dental scar tongue, pulse micro-based on expert experience and clinical information screening of Hemorrhagic Apoplexy Syndrome Elements of Yin deficiency scale entries are: red tongue, night sweat, hot flashes, low fever, less fur, dry tongue, pharynx, hand and foot peristalsis, tongue flaccidity, dry eyes, peeling off fur, fine pulse, dry mouth, hand and foot warm conclusion: 1 syndrome elements are composed of the most "syndrome" The small unit simplifies the multi-dimensionality and complexity of TCM syndrome differentiation by "reducing dimensionality" and "reducing order", and provides a model for the study of TCM syndrome differentiation scale. It provides valuable resources for the study of TCM syndromes. Therefore, the study of TCM syndromes based on ancient times is a necessary prerequisite for establishing the diagnostic criteria of TCM syndromes. One of the effective ways to diagnose TCM syndromes.3 It is preliminarily considered that through literature research, clinical epidemiological investigation, statistical analysis and clinical validation, the establishment of item pool of the Diagnostic Scale of Hemorrhagic Apoplexy Syndrome Elements should integrate the expert experience with the four clinical diagnostic information through modern mathematical statistical analysis method to fuse the two results. Supporting and serving each other, we can finally select the items of the scale with high importance, independence, sensitivity and clinical maneuverability, and provide normative research ideas and methods for the standardization of syndrome research.
【學(xué)位授予單位】：長春中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R277.7
本文編號：2187731
[Abstract]:Objective: To study the standardization and objectification of TCM syndromes, an important part of which is the study of the syndrome diagnosis scale.The selection of the items of the scale is an important link in the preparation of the scale.This study is based on the Delphi method and consulted by the experts to obtain the common clinical symptoms of hemorrhagic apoplexy. Elements and diagnostic information of the four diagnostic scales were screened, and the items of the Expert Experience Differentiation Scale were analyzed with statistical methods. The items of the Diagnostic Scale of Hemorrhagic Apoplexy Syndrome Elements were screened by combining expert experience with clinical information in order to construct the Diagnostic Scale of Hemorrhagic Apoplexy Syndrome Elements. Methods: The study was divided into two stages. In the first stage, the dimension and item pool of the diagnostic scale of Hemorrhagic Apoplexy Syndrome elements were established. Information (items) were screened from an important point of view; in the second part, based on clinical information, the items of the Diagnostic Scale for Hemorrhagic Stroke Syndrome Elements were screened to further validate the results of expert experience screening. Methods Four diagnostic information was obtained from the clinical four diagnostic information, and the four diagnostic information was used as the item pool of the diagnostic scale for hemorrhagic stroke. The items of wind syndrome in the diagnostic scale include: holding hands firmly, opening mouth, forgetfulness, severe headache, dizziness and dizziness, thick and greasy fur, pulse strings, unsteady eyes, headache, tongue trembling, peaking in 48 hours, thick and greasy fur, and bitter mouth. The items of fire syndrome in the diagnostic scale of hemorrhagic stroke syndrome based on expert experience and clinical information are: full face red, strong and strong. Fever, red eyes, restlessness, red tongue, thirst for cold drinks, burning headache, red tongue, pulse number, halitosis, flushing, thick fur based on expert experience and clinical information screening factors of hemorrhagic stroke syndrome diagnosis scale phlegm items are: sputum, thick fur, sleepy, sputum in the throat, white greasy fur, sluggish expression, sleepiness, thick fur, greasy, greasy fur, sluggish, sluggish, dull, dizzy, dull, dizzy, dizzy, and thick fur, greasy fur, greasy, greasy fur, greasy, greasy, Head weight, tongue fat, smooth pulse, phlegm yellow, dizziness, thick fur, indifferent expression, edema, pulse based on expert experience and clinical information screening of hemorrhagic stroke syndrome factors diagnosis scale blood stasis syndrome items are: headache, pain has a fixed place, tongue bruise or ecchymosis, sublingual veins cyanosis, tongue cyanosis, skin nail fault, skin purple spots, dark complexion, nail cyanosis, purple, skin purple. The diagnostic scale for Hemorrhagic Apoplexy Syndrome Based on expert experience and clinical information includes: spontaneous sweating, hypoventia, inertia, pulse weakness, paleness, incontinence, faint breathing, pale lips, pale tongue, weakness of limbs, yellowness of complexion, indifference, apathy, acceptance, etc. Diarrhea, dental scar tongue, pulse micro-based on expert experience and clinical information screening of Hemorrhagic Apoplexy Syndrome Elements of Yin deficiency scale entries are: red tongue, night sweat, hot flashes, low fever, less fur, dry tongue, pharynx, hand and foot peristalsis, tongue flaccidity, dry eyes, peeling off fur, fine pulse, dry mouth, hand and foot warm conclusion: 1 syndrome elements are composed of the most "syndrome" The small unit simplifies the multi-dimensionality and complexity of TCM syndrome differentiation by "reducing dimensionality" and "reducing order", and provides a model for the study of TCM syndrome differentiation scale. It provides valuable resources for the study of TCM syndromes. Therefore, the study of TCM syndromes based on ancient times is a necessary prerequisite for establishing the diagnostic criteria of TCM syndromes. One of the effective ways to diagnose TCM syndromes.3 It is preliminarily considered that through literature research, clinical epidemiological investigation, statistical analysis and clinical validation, the establishment of item pool of the Diagnostic Scale of Hemorrhagic Apoplexy Syndrome Elements should integrate the expert experience with the four clinical diagnostic information through modern mathematical statistical analysis method to fuse the two results. Supporting and serving each other, we can finally select the items of the scale with high importance, independence, sensitivity and clinical maneuverability, and provide normative research ideas and methods for the standardization of syndrome research.
【學(xué)位授予單位】：長春中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R277.7
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