慢性阻塞性肺疾病急性加重期证候诊断的专家问卷调查分析  

An expert analysis of diagnostic criteria for traditional Chinese medicine syndromes of chronic obstructive pulmonary disease at acute exacerbation stage

作　　者：王至婉[1] 李建生[1] 余学庆[1] 李素云[1] 

机构地区：[1]河南中医学院老年医学研究所,河南中医学院第一附属医院,郑州450008

出　　处：《中国危重病急救医学》2011年第9期518-523,共6页Chinese Critical Care Medicine

基　　金：国家自然科学基金资助项目（30772797）;河南省高校新世纪优秀人才支持计划（2006HANCET-05）

摘　　要：目的探讨慢性阻塞性肺疾病急性加重期（AECOPD）常见证候及其特征。方法采用德尔菲法编制AECOPD中医证候特征专家咨询问卷表，向全国30位专家发送。对回收资料进行均数、变异系数和满分比的统计描述及χ2=检验。以均数≥3．00、变异系数〈30％且满分比≥10％作为临床常见中医证候；证候主症指标以同时满足均数≥4．00且变异系数〈30％为标准，次症指标以同时满足均数≥3．00且变异系数〈30％为标准。结果回收有效问卷29份。专家积极系数为96．67％，权威系数为0．835，协调系数为0．359（χ2=463．15，P=0．001）。AECOPD风寒束肺证均数4．12、变异系数21．50％，满分比34．48％．夕h寒内饮证分别为4．39、14．32％、48．28％；风热犯肺证分别为3．54、30．77％、6．90％；痰热壅肺证分别为4．85、9．23％、89．66％；痰湿阻肺证分别为4．36、15．57％、48．28％；表寒里热证分别4．59、16．27％、65．52％；痰瘀阻肺证分别为4．54、12．70％、55．17％；肺脾气虚证分别为3．25、27．30％、13．79％；肺肾气虚证分别为3．32、27．24％、13．79％；肺肾气阴两虚证分别为3．29、28．98％、24．14％；肺肾阴虚证分别为2．98、32．71％、3．45％。兼证有血瘀证和腑实证，其中血瘀证分别为4．67、10．29％、62．07％；腑实证分别为3．07、30．01％、6．90％。结论AECOPD有7个常见证候，即风寒束肺证、外寒内饮证、痰热壅肺证、痰湿阻肺证、肺脾气虚证、肺肾气虚证、肺肾气阴两虚证和1个兼证（血瘀证）；血瘀证贯穿于各个证候之中。Objective To investigate the common syndromes, clinical symptoms and characteristics of chronic obstructive pulmonary disease at acute exacerbation stage （AECOPD）. Methods Delphi method was used to organize the AECOPD expert questionnaire. This questionnaire was distributed to 30 selected experts of respiratory diseases. The resulting data were statistically analyzed by Chi-square test and statistical description such as mean, coefficient of variation and ratio of full marks. Common syndrome： mean≥3.00, coefficient of variation 〈 30% and ratio of full marks≥ 10% and common clinical symptoms： for major symptoms present, the index mean≥4.00 and coefficient of variation 3% and for minor symptom, index mean≥3.00 and coefficient of variation 〈30% were used as criteria. Results Twenty-nine valid expert questionnaires were received. The coefficient of positivity was 96.67%, of authority was 0. 835 and of coordination equals 0. 359 （X2= 463.15, P= 0. 001）. The mean, coefficient of variation and ratio of full marks for AECOPD syndrome of wind and cold invasion of lung （风寒束肺证） were 4.12, 21.50%, and 34.48%, respectively. Those for syndrome of exogenous cold evil and fluid-retention （外寒内饮证） were 4.39, 14.32%, 48.28%; those for syndrome of wind and heat invasion of lung （风热犯肺证） were 3.54, 30.77 %, 6.90% ; those for syndrome of phlegm-heat obstruction of the lung （痰热壅肺证） were 4.85, 9. 23%, 89.66% those for syndrome of pulmonary stagnation of phlegm （痰湿阻肺证） were 4- 36, 15.57%, 48.28% ; those for syndrome of external cold and internal heat （表寒里热证） were 4.59, 16.27G, 65. 52% those for syndrome of retention of phlegm and blood stasis in the lung （痰瘀阻肺证） were 4.54, 12.70%, 55.17%; those for syndrome of qi deficiency of the lung and spleen （肺脾气虚证） were 3.25, 27.30%, 13.79% those for syndrome of qi deficiency of the lung and kidney （肺肾气虚证） were 3.32, 27.24%, 13.79%; those for syndrome

关 键 词：肺疾病 阻塞性 慢性 急性加重期 证候 德尔菲法 

分 类 号：R259[医药卫生—中西医结合]