【摘要】：目的：基于證素辨證原理建立心系病證量表,為心系常見病如心悸、胸痹、不寐等病的臨床療效評價提供一個客觀化、標準化的測量工具,量化中醫(yī)藥療效,為中醫(yī)治療疾病提供有效證據(jù),以減少中醫(yī)癥狀評定的主觀性和不確定性,可通過本量表測評比較不同治療方案、同一治療方案前后的患者的量表測評結果,從而判斷治療方案對疾病的干預效果,以幫助選擇更為優(yōu)越的個體化治療方案。為患者了解身體健康狀況提供參考工具。為心系辨證提供客觀規(guī)范收集辨證資料,并為中醫(yī)臨床心系病證辨證做出一些指導、參考。方法：1.依據(jù)文獻調研,依據(jù)證素辨證原理進行證素拆分,歸納總結證型中包含證素心的證候,對癥狀進行術語規(guī)范,形成條目池。2.運用德爾菲專家咨詢法進行三輪專家咨詢,形成初量表。3.收集臨床病例進行預調查,采用困難度分析法、反應特征法、相關系數(shù)法對進行條目客觀篩選,優(yōu)化心系病證量表。4.臨床調研,進行初步心系量表信度、效度、反應度及可行性考評。結果：1.通過文獻回顧、教材梳理、標準收集對心系病證證候規(guī)范化,經(jīng)頻數(shù)統(tǒng)計,形成具有264個條目的條目池。2.經(jīng)過三輪德爾菲專家咨詢,均數(shù)、滿分比、變異系數(shù)的均數(shù)分別為3.87、0.34、0.24,均具有較高的集中程度。協(xié)調程度系數(shù)為0.452,三輪專家咨詢問卷的回收率達到100%,無專家自動退出,專家的積極程度高。3.專家權威程度取決專家對條目做出的判斷依據(jù)和對條目熟悉程度。是根據(jù)熟悉程度及判斷依據(jù)計算專家權威程度,常用權威系數(shù)代表權威程度,權威系數(shù)等于熟悉程度系數(shù)(Cs)與判斷依據(jù)系數(shù)(Ca)的算術平均值。三輪專家咨詢的權威系數(shù)分別為0.75、0.79、0.80,均大于0.7,說明具有良好的權威性。結論：初步編制的心系病量表具有較好的信度、效度,對心系病證的辨證及臨床療效評價有一定的指導作用,但臨床應用價值有待大規(guī)模臨床流行病學的調查分析,仍需不斷的研究和完善。
[Abstract]:Objective: to establish the syndrome scale of heart system disease based on the principle of syndrome differentiation, so as to provide an objective and standardized measuring tool for the evaluation of clinical curative effect of common heart diseases such as palpitation, chest obstruction and insomnia, and to quantify the curative effect of traditional Chinese medicine. To provide effective evidence for TCM treatment of diseases and to reduce subjectivity and uncertainty in the evaluation of TCM symptoms, this scale can be used to evaluate and compare the results of patients with different treatment schemes and before and after the same treatment plan. In order to help select more superior individualized treatment, we can judge the intervention effect of the treatment plan to the disease. To provide a reference tool for patients to understand their health status. To provide objective and standard data for syndrome differentiation of heart system, and to provide some guidance and reference for TCM clinical syndrome differentiation of heart system. Method 1: 1. According to the literature investigation, according to the principle of syndrome element differentiation, the syndromes were split, the syndrome types including syndromes were summarized, the symptoms were standardized by terms, and the item pool was formed. 2. Using Delphi expert consultation method to carry out three rounds of expert consultation, forming initial scale. 3. The clinical cases were collected for pre-investigation, and the methods of difficulty degree analysis, response characteristics and correlation coefficient were used to screen the items objectively, and to optimize the scale of heart disease. 4. The reliability, validity, response and feasibility of the preliminary cardiac scale were evaluated. The result is 1: 1. Through literature review, teaching materials combing, standard collection of heart disease syndrome and syndrome standardization, through frequency statistics, formed a 264 entries of entries pool. 2. After three rounds of Delphi expert consultation, the mean, full score ratio and coefficient of variation were 3.87 ~ 0.34 ~ 0.24, respectively. The coefficient of coordination degree is 0.452, the recovery rate of three rounds of expert consultation questionnaire reaches 100, no expert automatically quit, and the positive degree of expert is high. 3. The degree of expert authority depends on the expert's judgment and familiarity with the item. The authority coefficient is equal to the arithmetic average of familiarity coefficient (Cs) and judgment basis coefficient (Ca). The authority coefficient of three rounds of expert consultation is 0.75U 0.79U 0.80, all of them are greater than 0.70.This shows that the expert consultation has good authoritativeness. Conclusion: the preliminary scale has good reliability and validity. It can guide the differentiation of symptoms and signs and the evaluation of clinical curative effect, but the clinical application value needs to be investigated and analyzed on a large scale of clinical epidemiology. Still need constant research and consummation.
【學位授予單位】：福建中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R256.2

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