基于案例推理的中医医案效果择优要点分析及其解决方法  

Analysis on Key Points of Effect Selection of Traditional Chinese Medicine Medical Records and Its Solutions Based on Case-based Reasoning

作　　者：杨方燕 刘晓玉 王瑞坤 雷聪 张乃文 石康乐 孟庆刚[1] YANG Fangyan;LIU Xiaoyu;WANG Ruikun;LEI Cong;ZHANG Naiwen;SHI Kangle;MENG Qinggang(Beijing University of Chinese Medicine,Beijing 100029,China;Fangshan Hospital,Beijing University of Chinese Medicine,Beijing 102400,China;Heilongjiang University of Chinese Medicine,Harbin 150040,Heilongjiang,China;University of Chinese Academy of Sciences,Beijing 100049,China)

机构地区：[1]北京中医药大学,北京100029 [2]北京中医药大学房山医院,北京102400 [3]黑龙江中医药大学,黑龙江哈尔滨150040 [4]中国科学院大学,北京100049

出　　处：《中华中医药学刊》2022年第2期51-55,共5页Chinese Archives of Traditional Chinese Medicine

基　　金：国家自然科学基金(81973980);中国科学院大学优秀青年教师科研能力提升项目(E0E48979)。

摘　　要：中医医案是对医家临证经验的记录,能够反映医家学术观点,指导临床实践与决策。中医临床诊疗过程中,面对临床问题,医生往往结合既往经验,筛选可比医案,对比多个治疗方案的效果,形成备选方案集合与排序,最终结合实际情况选择解决方案,这个过程可以定义为中医医案效果择优。但是,医案效果择优的结果受到"医家经验的丰富性程度和医者思维习惯"的局限,如何突破这种限制,将案例推理"相似的问题有相似的解"的核心思想融入到中医医案效果择优的方法学研究中来。提出基于案例推理的中医医案效果择优,需要结合各类医案的特点,依次通过案例表征、案例检索、案例重用、案例修正分别实现"临床问题表征、界定可比医案、形成备选方案集合与排序、有效治疗方案的修正应用",以实现"中医医案效果择优"的规范化、流程化操作。此外,需要通过建立反馈机制,在临床实践中检验、提高模型的信效度。Traditional Chinese medical record is a record of doctors’clinical experience,which can reflect doctors’academic views and guide clinical practice and decision-making.In the process of clinical diagnosis and treatment of traditional Chinese medicine and when facing clinical problems,doctors often screen comparable medical cases in combination with previous experience,compare the effects of multiple treatment schemes,form a collection and ranking of alternative schemes,and finally select solutions in combination with the actual situation.This process can be defined as the effect selection of traditional Chinese medical cases.The effect selection of traditional Chinese medical records based on case-based reasoning needs to be combined with the characteristics of various medical records,and"clinical problem representation,definition of comparable medical records,formation and ranking of alternative schemes,and correction and application of effective treatment schemes"should be realized through case representation,case retrieval,case reuse and case correction in order to realize the standardization and application of"effect selection of traditional Chinese medical records".In addition,we need to establish a feedback mechanism to test and improve the reliability and validity of the model in clinical practice.

关 键 词：中医医案研究 效果择优 临床问题 可比性 效果评价 案例推理 辅助决策 

分 类 号：R2-03[医药卫生—中医学]