基于叙事循证医学对中医临床疗效评价问题的解决策略  

Narrative evidence-based medicine:a strategy for evaluation of clinical efficacy of Chinese medicine

作　　者：陈秋平 邵明义[2,3] 毕倩 赵瑞霞 吕兰青[1] 崔鸿雁 CHEN Qiu-ping;SHAO Ming-yi;BI Qian;ZHAO Rui-xia;LYU Lan-qing;CUI Hong-yan(Henan University of Chinese Medicine,Zhengzhou 450000,China;the First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,China;Henan Evidence-based Medicine Center of Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]河南中医药大学,河南郑州450000 [2]河南中医药大学第一附属医院,河南郑州45000 [3]河南中医药循证医学中心,河南郑州450000

出　　处：《中国中药杂志》2022年第2期557-561,共5页China Journal of Chinese Materia Medica

基　　金：国家自然科学基金面上项目(81574101);河南省中医药科学研究专项(2019ZYZD03);河南省科技厅科技攻关项目(202102310169)。

摘　　要：中医临床诊治疾病的过程中积累了大量经验,疗效得到大众的认可,但是进入近现代以来,评价临床疗效的指标不单是依靠患者症状的改变,更多开始依靠现代科学证据,而中医临床的疗效评价常以患者疾病的主要特征指标和患者症状或病机的变化作为临床疗效评价标准,缺乏现代医学所公认的标准,疗效评价客观性的不确定、疾病疗效评价指标不统一等问题制约了中医临床的发展。将叙事医学和循证医学相融合,引入中医临床疗效评价,二者各有其特点:循证医学从临床问题出发将临床技能与当前可得最佳证据相结合,叙事医学是具有叙事能力的医学实践,强调患者的感受、意愿和价值取向。在循证叙事医学模式的基础上,以参与式行动诊疗方式为范式,构建符合中医诊疗特色的临床疗效评价体系,既能充分体现中医的诊疗特色、尊重患者的价值观,又能取得普适性强的临床证据。有助于提高医生对疾病的诊治水平、改善医患关系、提升患者生命质量和决策意识,最终完善中医临床疗效评价新模式。Rich experience of clinical diagnosis and treatment has been accumulated in the developmental history of Chinese medicine,and the efficacy has been increasingly accepted by the public.However,the evaluation of clinical efficacy is currently based more on scientific evidence instead of merely the changes of patient symptoms.In Chinese medicine,the changes of major disease indicators,patient symptoms,and pathogenesis are the major criteria for the evaluation of clinical efficacy.The lack of well-accepted and uniform criteria and the uncertainty of subjective evaluation limit the development of clinical Chinese medicine.Evidence-based medicine combines clinical skills with the current best evidence.Narrative medicine,utilizing people′s narratives in clinical practice,emphasizes patient feelings,willingness,and value orientation.The introduction of both evidence-based medicine and narrative medicine into the evaluation of clinical efficacy refers to the construction of the clinical efficacy evaluation system in a paradigm of participatory diagnosis and treatment.It can fully reflect the characteristics of Chinese medicine,respect the values of patients,and achieve universal clinical evidence.Therefore,it helps to improve the diagnosis and treatment,the relationship between doctors and patients,patients′life quality and decision-making awareness,and finally the new evaluation model of clinical efficacy of Chinese medicine.

关 键 词：中医疗效评价 叙事医学 循证医学 医患共建诊疗模式 真实世界研究 

分 类 号：R24[医药卫生—中医临床基础]