基于自发呈报网络的中医临床实践指南推广模式研究

中医临床实践指南的制定-应用-评价本为一体,目前由于指南信息不通畅,执行情况的反馈信息后滞和不足,严重影响了中医临床实践指南的制修订工作。据此,笔者在《中医药标准化网站》建设中,研究中医临床实践指南推广模式,构建良好的指南发布平台和执行情况反馈平台,以期为指南的制修订奠定基础。     

Development of clinical practice guidelines in 11 common diseases with Chinese medicine interventions in China

Objective:To analyze the clinical practice guideline(CPG) development on 11 common diseases with Chinese medicine(CM) interventions in China.Methods:The CPGs of 11 common diseases which could be treated effectively with CM had been published between 1980 and 2010 in China.The 11 diseases include coronary heart disease(angina pectoris),hypertension,chronic gastritis,rheumatoid arthritis,cerebral infarction,migraine,diabetes,primary osteoporosis,insomnia,common cold,and IgA nephropathy.The issuing organization,date of publication,development methods,and citation rate of the CPGs were analyzed.According to the development method,each guideline was categorized as consensus-based(CB),evidence-based(EB), or consensus based with no explicit consideration of evidence-based(CB-EB).Results:Thirty-three CPGs on the 11 common diseases were found:20 guidelines were classified as CB,13 as CB-EB and none as EB.Fifteen CPGs were issued by the China Association of Chinese Medicine,8 by professional working groups,and 4 by the State Administration of Traditional Chinese Medicine.Six guidelines were published between 1980 and 1990,9 between 1991 and 2000,and 18 between 2001 and 2010.Fifty-eight percent of these guidelines have not been amended timely.Only 54.5%(18/33) of the 33 guidelines were cited by other researchers and 45.5% (15/33) percent had never been cited.Conclusions:Most CPGs developed for 11 common diseases with CM approaches in China are consensus,and their citation rates are relatively low.The results suggest that more EB CPG or CPG strictly based on expert consensus could be developed,and great efforts should be made for future CM CPG application.     

1508例高血压病患者中医证候分布调查研究

目的:通过流行病学调查方法分析高血压病的中医证类分布和证素分布规律。方法:对1508例高血压病患者进行横断面调查,采用Epidate3.0软件作为数据录入软件。统计分析软件采用SAS9.0进行。结果:高血压病的中医证类分布痰瘀互结900例,占59.68%;阴阳失调544例,占36.07%;瘀血阻络228例,占15.12%;气阴亏虚184例,占12.20%;肾阳亏虚131例,占8.69%。高血压病的中医证素分布血瘀76.13%,痰71.09%,阴虚69.30%,阳虚54.64%,气虚37.93%,内火7.56%。结论:随着生活方式的改变,高血压病中医证候发生改变,痰瘀互结,阴阳失调是高血压病的重要病因病机,高血压病实证以痰瘀互结为主,虚证以肾阴阳失调为主,其病位在肾和心。     

中医临床实践指南制定过程中存在的问题及对策

通过对国际循证性临床实践指南制定程序与方法的研究,结合中医临床实践指南制定的现状,指出作为指南制定基础的相关临床研究匮乏以及指南制定的程序与方法欠规范是目前中医临床实践指南制定中存在的主要问题。针对指南制定的程序与方法欠规范的具体情况提出建议,以期为中医相关临床实践指南的制定提供方法学参考,并为建立符合中医特点的、具有示范意义的指南/专家共识制定模式进行有益探索。     

高血压病与痰瘀互结及五脏相关的理论探讨

为了探讨高血压病发生与痰瘀互结的关系及其与五脏的相关性,文章对历代文献中关于痰、瘀与眩晕、头痛,及五脏与眩晕、头痛的论述进行分析、研究,发现痰、瘀与眩晕、头痛的发生关系密切,眩晕、头痛的发生与五脏相关,并且痰、瘀与五脏功能失调相关。痰能致眩、致头痛,瘀也能致眩、致头痛,五脏功能失调可以产生痰、瘀,五脏病变可引发眩晕、头痛。因此,高血压病眩晕、头痛的发生与五脏病变有着直接或间接的联系,在临床治疗高血病时要注意其与五脏的关联。通过临床实践,进一步证实高血压病的发生与心、肾的关系最为密切。历代文献虽有痰瘀互结致病的论述,但未发现痰瘀互结致眩晕、头痛的明确认识,而在临床上痰瘀互结是高血压病发生的重要病理因素,应引起重视。     

补肾降压方对高血压病肾精亏虚、痰瘀互结证作用机理的研究

本课题97例高血压病患者均来自广州荔湾区中医医院及广州市中医医院，补肾降压水煎剂组67例，对照组30例，住院病例不少于2／3。根据诊断标准、纳入病例标准、排除病例标准进行选择，符合条件者入选。针对2003年12月-2006年10月门诊和住院患者，采用随机单盲的方法分组，随机分为治疗组和对照组。     

沈氏女科临证思辨及诊治技巧

沈氏女科始于明代,传承650余年,绵延至今已21代。沈氏女科的优势特色是整体观、恒动观、开放观、综合观;临证的指导思想是中西医要配合、传统和现代要链接、线性和非线性相结合、实体本体论和关系本体论并重、混沌无序与清晰有序要区分;临床强调脏腑辨证,但要根据病情、病证灵活结合三焦辨证、六经辨证综合应用。临证处方要掌握几大原则:勿用有毒之品、固护脾胃之气、巧用引经药物、注意寒热反佐、给邪出路排毒,提高临床疗效。     

关于促进中医药标准化发展的几点建议

中医药标准化建设是中医药事业发展的必然需求,中医药标准化工作在"十一五"期间取得了卓有成效的进展,但也存在一些困难和问题。"十二五"是中医药标准化发展的重要战略期。本文通过对中医药标准化现状进行分析,提出若干建议,以期能够为促进中医药标准化建设发挥些微作用。