基于德尔菲法探讨中医痰证辨证依据  

Assessing for syndrome Differentiation Basis of Phlegm Syndrome Based on Delphi Method

作　　者：谢蓉[1] 彭丹虹 王燕萍[2] 刘晓琪[2] 连新福[1] 李先涛[2] XIE Rong PENG Danhong WANG Yanping LIU Xiaoqi LIAN Xinfu LI Xiantao(Department of Neurology, Zhuhai Hosptial, Guangdong Provincial Hospital of TCM, Zhuhai 519015, Guangdong, China Basic Medical College of Guangzhou University of Chinese Medicine, Guangzhou510006, Guangdong, China)

机构地区：[1]广东省中医院珠海医院神经内科,广东珠海519015 [2]广州中医药大学基础医学院,广东广州510006

出　　处：《辽宁中医杂志》2017年第1期16-20,I0001,共6页Liaoning Journal of Traditional Chinese Medicine

基　　金：国家重点基础研究发展计划("973"计划)(2014CB542901)

摘　　要：目的:明确中医痰证的辨证依据。方法:在文献系统评价的基础上,制定《中医痰证的辨证依据专家咨询问卷》,采用德尔菲法专家咨询方法,经过两轮专家咨询,明确痰证的辨证依据。结果:基于文献系统评价的结果,经多次小范围集体讨论,保留16条条目,初步拟定《中医痰证德尔菲法专家咨询问卷》。在全国范围内,先后开展了两轮德尔菲法专家咨询,共咨询了93位专家。两轮咨询问卷的回收率及其专家对每个问题的应答率,均为100%。两轮咨询问卷总的信度与效度分别为0.885和63.187%,提示所拟定的问卷的稳定性及有效性尚可。对两次咨询问卷的均数、满分频率、等级和及变异系数进行分析,如果某一条目有3项及其以上排秩均在后30%,即删除该条目。经统计分析,其中呕恶、舌淡、脉濡3个条目均排在30%之后,考虑删除这3条。所保留的中医痰证的辨证依据的条目初步确定为胸闷/胸痛、痰多、痞满、体胖、纳呆、头重、眩晕、肢体困重、倦怠乏力、嗜睡,苔腻、脉滑、脉弦13个条目。结论:初步探索基于德尔菲法专家咨询明确证候依据,建立证候诊断标准专家共识的研究模式。但该模式还需要进一步临床实践验证,从敏感度和特异度等方面评价其效应。Objective ： To clarify syndrome differentiation basis of phlegm syndrome. Methods ： On the basis of the literature eval- uation system, expert consultation questionnaire for phlegm syndrome differentiation of TCM was formulated. It preliminarilyfound out the differentiation basis of phlegm syndrome by using expert consultation based on Delphi method. Results ： Based on the results of systematic literature reviews and several small group discussion, 16 items were retained, forming Delphi expert consultation questionnaire for differentiation basis of phlegm syndrome. Two rounds of Delphi expert consultation has launched nationwide. A total of 93 experts were participated. The recovery rate and each question response rate were 100% in two expert consultation questionnaires. The reliability and validity of two rounds of consultation total were 0. 885% and 63. 187% , which suggested that stability and validity of the questionnaire were acceptable. The consistency of two rounds of expert consultation questionnaire indicated that there was no significant difference （P 〉 0.05）. The consistency of judgment made by the experts in the two rounds of consultation was acceptable. Mean size, mark frequency, sum of ranks and coefficient of variation for each entry were analyzed statistically. An entry was deleted if it had three or more indexes at the end 30% of the rank. Three entries were deleted which were vomiting, pale tongue, pulse moisten. Thirteen entries of differentiation basis of phlegm syndrome in coronary heart disease were retained. They werechest tightness/pain, excessive phlegm, abdominal distention and fullness, obesity,loss of appetite, sensation of head, dizziness, sensation of body, fatigue, lethargy, greasy coating, slippery pulseand stringy pulse. Conclusion ： Exploring the research model that Delphi method expert consultation determines differentiation basis of syndrome for expert consensus. But it needs further clinical practice from sensitivity and specificity to evaluate.

关 键 词：痰证 辨证依据 德尔菲 专家问卷 

分 类 号：R255.8[医药卫生—中医内科学]