基于改良德尔菲法与层次分析法的儿童脑性瘫痪中医辨证研究  

Study on traditional Chinese medicine syndrome differentiation of cerebral palsy in children based on modified Delphi method and analytic hierarchy process

作　　者：张健[1,2] 赵澎 牛岩[1] 辛庆刚[1] 徐刚 陈淑娟[1] 盛倩倩[1] ZHANG Jian;ZHAO Peng;NIU Yan;XIN Qinggang;XU Gang;CHEN Shujuan;SHENG Qianqian(Department of Rehabilitation,Tianjin Children's Hospital,Tianjin,300134,China;Graduate School,Tianjin University of Traditional Chinese Medicine,Tianjin,301617,China)

机构地区：[1]天津市儿童医院康复科,天津300134 [2]天津中医药大学研究生院,天津301617

出　　处：《中医儿科杂志》2024年第6期112-119,共8页Journal of Pediatrics of Traditional Chinese Medicine

基　　金：天津市卫健委中医药重点领域课题(20170010)。

摘　　要：目的采用改良德尔菲(Delphi)法与层次分析(AHP)法进行儿童脑性瘫痪(CP)的中医辨证分型及相关证候条目研究。方法检索2005年7月1日至2022年9月30日中国知网、维普、万方、Pubmed数据库中的文献,筛选中西医对CP的诊疗思路、临床症状及体征的指南、临床观察及专家经验类文献,进行前期文献整合,通过课题组系统评价和专家会议讨论,将出现频数>20次的证型纳入条目池,初步确定脾虚肝亢、痰瘀阻滞、阴虚风动3种中医证型,并制定《脑性瘫痪中医证型辨证条目认可度》咨询问卷,开展3轮德尔菲专家调查,确定CP中医辨证分型的条目指标,从均数、等级和、变异系数以及不重要百分比等多个角度,对问卷调查结果进行评价,并结合专家给予的评价进行条目修改。结合AHP计算证候群的比重作为条目权重,初步构建CP中医辨证分型专家共识。结果共纳入分析文献183篇,筛选出3个中医证型,构建33个条目:脾虚肝亢证11条,痰瘀阻滞证12条,阴虚风动证10条。共邀请了60名国内著名专家进行问卷调查,专家权威程度得分为17.9分,第1轮、第2轮的专家积极参与率分别达到100.00%,96.67%。第3轮专家讨论后整体各谐系数为0.348,根据各条目的均值以及变异系数,结合临床经验,对条目进行适当删减后,最终确定辨证条目。AHP得到CP一级指标的比重排序为:脾虚肝亢证>痰瘀阻滞证>阴虚风动证;二级指标的比重由各证型权重相对重要性进行排序。结论基于Delphi法与AHP法初步形成儿童CP中医辨证模式,该模式包括每个证型的主要指标和次要指标,有助于临床医师把握辨证要点。Objective To conduct a study on the syndrome differentiation and related syndrome items of cerebral palsy in children using the modified Delphi method and analytic hierarchy process(AHP).Methods We searched the literature in CNKI,VIP,Wanfang,and PubMed databases from July 1,2005,to September 30,2022,focusing on diagnostic and treatment approaches,clinical symptoms,and signs of cerebral palsy in both traditional Chinese medicine(TCM)and Western medicine,guidelines,clinical observations,and expert experience.After preliminary literature integration,systematic evaluation by the research team,and expert panel discussion,items with a frequency greater than 20 were included in the item pool.Three preliminary TCM syndromes were identified:spleen deficiency with liver hyperactivity,phlegm and blood stasis obstruction,and yin deficiency with wind agitation.A consultation questionnaire,Recognition of Syndrome Differentiation Items for Cerebral Palsy in Traditional Chinese Medicine,was developed and subjected to three rounds of Delphi expert surveys to determine the syndrome differentiation indicators.The survey results were evaluated from multiple angles,including mean values,rank sums,coefficients of variation,and percentages of items deemed unimportant.Items were revised based on expert evaluations.AHP was used to calculate the weights of syndrome clusters,thereby preliminarily establishing an expert consensus on TCM syndrome differentiation of cerebral palsy.Results A total of 183 articles were included in the analysis,leading to the identification of three TCM syndromes with 33 items:11 items for spleen deficiency with liver hyperactivity syndrome,12 items for phlegm and blood stasis obstruction syndrome,and 10 items for yin deficiency with wind agitation syndrome.Sixty renowned domestic experts were invited to participate in the questionnaire survey,with an expert authority score of 17.9.The response rates for the first and second rounds of the survey were 95.24%and 75.00%,respectively.The overall coordination coeffic

关 键 词：脑性瘫痪 辨证论治 德尔菲法 层次分析法 专家问卷 

分 类 号：R255.6[医药卫生—中医内科学]