基于德尔菲法的柴胡加龙骨牡蛎汤治疗快速性心律失常合并焦虑状态方证研究  

Prescriptions and syndromes of Chaihu and Longgu Muli Decoction for treatment of tachyarrhythmia accompanied by anxiety state based on Delphi method

作　　者：刘刚[1,2] 李滟郦 闫奎坡 闫海峰[1] 张磊 杜明远 李一卓[1,2] 朱翠玲 LIU Cang;LI Yan-li;YAN Kui-po;YAN Hai-feng;ZHANG Lei;DU Ming-yuan;LI Yi-zhuo;ZHU Cui-ling(Cardiac Center,the First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450046,China;Collaborative Innovation Center of Prevention and Treatment of Major Diseases by Chinese and Western Medicine,Zhengzhou 450046,China)

机构地区：[1]河南中医药大学第一附属医院心脏中心,河南郑州450046 [2]中西医防治重大疾病河南省协同创新中心,河南郑州450046

出　　处：《中国中药杂志》2025年第6期1680-1687,共8页China Journal of Chinese Materia Medica

基　　金：河南省自然科学基金青年项目(232300421308);国家自然科学基金青年科学基金项目(82405290);国家中医药管理2022年度张仲景传承与创新专项(GZY-KJS-2022-044-2);河南省医学科技攻关计划省部共建青年项目(SBGJ202303044);河南省中医药科学研究专项(2022JDZX106)。

摘　　要：柴胡加龙骨牡蛎汤治疗快速性心律失常合并焦虑抑郁疗效显著,但临床应用缺乏规范性指导。首先,通过古今文献与临床病例收集,对柴胡加龙骨牡蛎汤进行考证,并对其治疗快速性心律失常合并焦虑的医案类、个人经验类文献及临床病例的基本信息、具体用药及四诊信息进行提取分析,初步得出其方证特征。然后,采用德尔菲法,依据纳入数据构建条目池,编写专家问卷,收集专家对条目的评分及修改意见,经统计分析筛选条目,再经小组讨论形成第二轮问卷,重复上述过程,筛选出柴胡加龙骨牡蛎汤治疗快速性心律失常合并焦虑状态方证表的最终条目,以指导临床选方用药。最后,提取出症状和体征71条,舌脉33条,主要证候特点为心悸、胸闷、急躁易怒等,与古代方证基本相符;通过频次、频率分析和工作小组讨论,筛选出71个条目,经筛选、修改并使用主次划分法后,确定了11条主要诊断条目与10条次要诊断条目。结果显示,柴胡加龙骨牡蛎汤治疗快速性心律失常合并焦虑状态主要方证条目为心悸、眠差、口苦、口干、烦躁易怒/焦虑不安/胆怯易惊、舌红、苔黄腻、脉数、工作/生活压力大、心电图/Holter示快速性心律失常、焦虑量表阳性;次要方证条目为胸闷、气短、身重乏力、汗出、纳差、大便秘结、苔白腻、脉弦、脉滑、脉结或代。Chaihu and Longgu Muli Decoction has demonstrated significant efficacy in the treatment of tachyarrhythmia accompanied by anxiety and depression.However,there is a lack of standardized guidelines for its clinical application.In this study,the Chaihu and Longgu Muli Decoction was investigated through extensive research on ancient and modern literature,as well as a collection of clinical medical records.The basic information,medication details,and diagnostic information from medical records,personal experience literature,and clinical cases in the treatment of tachyarrhythmia accompanied by anxiety were extracted and analyzed to preliminarily identify the prescription characteristics and syndrome patterns.Subsequently,the Delphi method was employed to construct an item pool based on the data obtained in the first step.An expert questionnaire was prepared to collect scores and revision opinions from experts regarding these items.After statistical analysis and group discussions,a second round of questionnaires was formed by screening out certain items.This process was repeated until a final item set for the treatment of tachyarrhythmia accompanied by anxiety with Chaihu and Longgu Muli Decoction was determined.These findings provided guidance for clinical prescription practices.By extracting 71 syndromes and signs,as well as 33 tongue and pulse characteristics,the main syndrome features included palpitations,chest tightness,irritability,etc.,which were basically consistent with the ancient syndromes.Through frequency analysis and group discussions,71 items were screened out.After screening,modification,and primary and secondary division,11 main diagnostic items and 10 secondary diagnostic items were determined.On this basis,the research team believes that Chaihu and Longgu Muli Decoction is mainly indicated for the following syndromes in the treatment of tachyarrhythmia accompanied by anxiety(palpitations,poor sleep,bitter taste,dry mouth,irritability/easily angered/anxiety/fearfulness/easily startled,red tongue with

关 键 词：柴胡加龙骨牡蛎汤 德尔菲法 方证研究 焦虑 快速性心律失常 

分 类 号：R259[医药卫生—中西医结合]