基于肾病集群构建慢性肾衰竭标准化诊疗路径  

Construction of a standardized diagnosis and treatment pathway for chronic renal failure based on kidney disease clusters

作　　者：周珊珊 张春花 郁丽丹 胡亮 于欣 ZHOU Shanshan;ZHANG Chunhua;YU Lidan;HU Liang;YU Xin(Department of Nephrology,Weihai Hospital of Traditional Chinese Medicine of Shandong Province,Weihai,Shandong,264200)

机构地区：[1]山东省威海市中医院肾病科,山东威海264200

出　　处：《实用临床医药杂志》2025年第6期94-98,共5页Journal of Clinical Medicine in Practice

基　　金：山东省中医药科技项目(Q-2023053)。

摘　　要：目的基于肾病集群构建慢性肾衰竭(CRF)标准化诊疗路径,为CRF的中医诊疗提供参考。方法通过肾病集群构建CRF中医诊疗方案,通过文献研究构建CRF标准化诊疗路径的初步框架,并对26名专家进行3轮德尔菲法专家咨询,分析专家积极程度、权威程度、专家意见协调程度、重要性赋值、变异系数,最终形成CRF标准化诊疗路径。结果第1轮、第2轮和第3轮专家咨询的积极系数(Caj)分别为1.000、0.923和1.000,专家权威系数(Cr)分别为0.895、0.910和0.923,总体Kendall′s W系数分别为0.233、0.248和0.293(P<0.001)。最终形成的CRF标准化诊疗路径包括4个一级指标、19个二级指标、77个三级指标,重要性赋值均数为4.42~4.87,变异系数为0.072~0.126。结论基于肾病集群构建的CRF标准化诊疗路径具有较高的科学性和可靠性,导向明确,简洁易行,对CRF的中医诊疗具有较高的指导意义。Objective To establish a standardized diagnostic and treatment pathway for chronic renal failure(CRF)based on a nephrology cluster,providing a reference for the traditional Chinese medicine(TCM)diagnosis and treatment of CRF.Methods A TCM diagnostic and treatment protocol for CRF was developed through cluster construction.A preliminary framework for the standardized diagnostic and treatment pathway of CRF was constructed through literature research.Three rounds of Delphi expert consultation were conducted among 26 experts.The experts′enthusiasm,authority,coordination of opinions,importance ratings,and coefficient of variation were analyzed to ultimately form the standardized diagnostic and treatment pathway for CRF.Results The active coefficients(Caj)for the first,second,and third rounds of expert consultation were 1.000,0.923,and 1.000,respectively.The expert authority coefficients(Cr)were 0.895,0.910,and 0.923,respectively.The overall Kendall's W coefficients were 0.233,0.248,and 0.293(P<0.001).The final standardized diagnostic and treatment pathway for CRF included 4 primary indicators,19 secondary indicators,and 77 tertiary indicators,with mean importance ratings ranging from 4.42 to 4.87 and coefficients of variation ranging from 0.072 to 0.126.Conclusion The standardized diagnostic and treatment pathway for CRF established based on a nephrology cluster is highly scientific and reliable,with clear guidance and ease in implementation,providing good guidance for the TCM diagnosis and treatment of CRF.

关 键 词：慢性肾衰竭 肾病集群 德尔菲法 专家咨询 诊疗路径 重要性赋值 变异系数 

分 类 号：R692.5[医药卫生—泌尿科学] R242[医药卫生—外科学] R2-03[医药卫生—临床医学]