循证医学模式指导下的针灸临床研究现状分析

循证医学作为一门新兴的医学方法学,对现今临床研究影响颇为深远。本文以针灸临床研究现今发展现状以及循证医学在针灸临床研究的应用为基础,提出应把循证医学的方法和针灸疗法的特点有机结合,使针灸临床研究设计尽可能地趋于完善,以开创针灸临床研究的新纪元。     

循证医学对高压氧医学发展的启示

1 循证医学 循证医学（evidence—based medicine，EBM）是以大规模随机对照临床试验（randomized controlled trial，RCT）方法及其结果的应用为特征的临床实践新模式，是以证据为基础的医学。循证医学的本质是一门方法学，它是一种获取临床医学信息、评价临床信息可靠性以及制定临床医学决策的基本方法。Davidsackea认为循证医学是“医师慎重、准确和明智地应用目前所能获得的最佳证据，为自己所面临的具体患者作出处理决策。循证医学是近十几年发展起来的一门新兴临床医学的分支学科。但在短短的十多年中已显示出了强大的生命力，循证医学的迅速兴起．是经验医学的继承和发展．它必将使临床理论思维模式、临床研究模式、临床决策模式发生深刻的变革，为临床的研究和实践提供更广阔的视野。必将在医学哲学和实践中发挥日益重要的作用。[第一段]     

循证医学对麻醉决策及临床研究的影响

循证医学(EBM)的出现使临床医学研究和临床实践发生了巨大的变化,由经验医学向EBM转变是这种变化的具体体现[1].从麻醉学科的角度来看,EBM改变了麻醉医生思考问题的方式,更新了麻醉与手术前评估的方法,并利用EBM的方法进行决策分析,以影响麻醉前后的各种决策;更重要的是循证医学理念深刻影响到麻醉临床课题的研究方向.现从以下几个方面阐述EBM对麻醉领域的影响.     

循证医学对放射科研究生培养中的启示

医学教育是医学人才培养的重要载体,现代医学模式的提出,体现了人类对医学更为理性和全面的认识,全面素质教育显得尤其重要。医学院校作为培养新世纪高级医学人才的基地,更有必要加强这一方面的工作。随着当代科技的进步、医学教育的发展,研究生教学工作日益受到重视。无庸讳言     

运用循证医学促进精神病学临床研究

近年来我国精神病学研究水平有了很大的提高,特别是实验室的研究发展较快.但在发展过程中也存在若干不足,与国际水平比较还有较大差距,需要加以重视.     

循证医学对骨科临床实践的启示与哲学反思

循证医学被定义为“慎重、准确和明智地应用当前最好的证据来确定患者的治疗措施”,而最好的证据主要来自于有效的随机对照临床试验。在骨科临床实践中遵行循证医学势在必行,但在循证医学的应用中存在一些误区,诸如过分强调普遍规律而忽视患者的个体差异,在践行循证医学的过程中理论与实践之间存在着一定的偏差等。因此,既要严格遵守循证医学的原则,又要避免生搬硬套、死板教条,否则可能会给患者造成严重的损害。     

循证医学对医学文献检索的影响

循证医学(evidence-based medicine，EBM)，即遵循证据的医学。其核心思想是，任何医疗决策都应建立在最新最佳的临床科学研究证据(current best evidence)的基础上。循证医学强调收集最佳证据，最佳证据是通过随机对照试验(RCT)、系统评价(systematic reviews)或Meta-分析后得出的。EBM创始人之一David Sackett在原有EBM概念的     

针灸治疗血管性痴呆常用治法的循证医学评价

目的 寻求针灸治疗血管性痴呆到目前为止确有疗效的可靠证据。方法 采用循证医学和临床流行病学评价文献质量的原则和方法，全面检索建国以来针灸治疗血管性痴呆的临床研究文献，对针灸治疗血管性痴呆的临床疗效进行分析评价。结果 针灸治疗最常用的干预措施依次为电针、毫针、激光针和穴位注射。结论 未检索到针灸治疗血管性痴呆的最可靠证据．为针灸临床疗效的评价与研究提供科学依据与研究方法。     

针灸临床防治性研究中对照组设立的探讨

1 我国针灸临床研究中对照组设立的现状及问题 随着循证医学(evidence-based medicine,EBM)在我国的引入和发展,针灸临床防治性研究的质量日趋受到重视。对照是医学研究中十分重要的一     

温针灸治疗腰椎间盘突出症的临床效果

目的温针灸治疗腰椎间盘突出症的临床效果。方法将64例血瘀型腰椎间盘突出症患者按照随机数字表法分为对照组和观察组,各32例。对照组给予常规针灸治疗,观察组取穴与对照组相同,给予温针灸。比较两组的治疗效果。结果观察组的治疗总有效率高于对照组(P<0.05)。治疗后,两组的VAS评分、IL-6、NO水平均降低,JOA下腰痛评分均升高,且观察组优于对照组(P<0.05)。结论温针灸治疗腰椎间盘突出症的效果显著,可改善患者的临床症状,减轻疼痛和炎症反应。     

The status and future of acupuncture clinical research

On November 8-9, 2007, the Society for Acupuncture Research (SAR) hosted an international conference to mark the tenth anniversary of the landmark National Institutes of Health Consensus Development Conference on Acupuncture. More than 300 acupuncture researchers, practitioners, students, funding agency personnel, and health policy analysts from 20 countries attended the SAR meeting held at the University of Maryland School of Medicine, Baltimore, MD. This paper summarizes important invited lectures in the area of clinical research. Specifically, included are: a review of the recently conducted German trials and observational studies on low-back pain (LBP), gonarthrosis, migraine, and tension-type headache (the Acupuncture Research Trials and the German Acupuncture Trials, plus observational studies); a systematic review of acupuncture treatment for knee osteoarthritis (OA); and an overview of acupuncture trials in neurologic conditions, LBP, women's health, psychiatric disorders, and functional bowel disorders. A summary of the use of acupuncture in cancer care is also provided. Researchers involved in the German trials concluded that acupuncture is effective for treating chronic pain, but the correct selection of acupuncture points seems to play a limited role; no conclusions could be drawn about the placebo aspect of acupuncture, due to the design of the studies. Overall, when compared to sham, acupuncture did not show a benefit in treating knee OA or LBP, but acupuncture was better than a wait-list control and standard of care, respectively. In women's health, acupuncture has been found to be beneficial for patients with premenstrual syndrome, dysmenorrhea, several pregnancy-related conditions, and nausea in females who have cancers. Evidence on moxibustion for breech presentation, induction of labor, and reduction of menopausal symptoms is still inconclusive. In mental health, evidence for acupuncture's efficacy in treating neurologic and functional bowel disorder is still inconclusive. For chronic cancer-related problems such as pain, acupuncture may work well in stand-alone clinics; however, for acute or treatment-related symptoms, integration of acupuncture care into a busy and complex clinical environment is unlikely, unless compelling evidence of a considerable patient benefit can be established.     

针刺拔罐加温和灸治疗局限性神经性皮炎疗效观察

目的 观察针刺、拔罐、温和灸三者合用治疗局限性神经性皮炎的疗效，为临床选择治疗提供依据。方法 将80例神经性皮炎患者分成两组，治疗组（48例）采用针刺拔罐加温和灸治疗，对照组（32例）采用曲安奈德软膏涂抹，持续治疗4周为1疗程，观察结果。结果治疗组总有效率95．83％，对照组总有效率81．25％，两组比较差异有显著性意义（χ^2=11.62，P〈0.05）。结论 针刺、拔罐、温和灸三者合用是治疗局限性神经性皮炎较为理想的方法之一．     

The effect of hand acupuncture therapy and hand moxibustion therapy on premenstrual syndrome among Korean women

Premenstrual syndrome (PMS) symptoms can reduce quality of life and impair daily functioning. This study examined the effects of Korean hand acupuncture therapy (HAT) and hand moxibustion therapy (HMT) on symptom severity in Korean women with PMS. This quasi-experimental pilot study based on the khi, yin, yang, and the five elements theory used a nonequivalent control group pretest-posttest design. Experimental groups received 10 sessions of either HAT or HMT treatment. Outcome measures included menstrual symptom severity as measured with the Menstrual Symptom Severity List and skin temperature change measured with Digital Infrared Thermographic Imaging. Both experimental groups had significantly reduced overall PMS symptom severity scores following therapy as compared to women in the control group. The HMT but not the HAT group showed improved flow of khi and balanced skin temperature in symmetric body areas. HAT and HMT may be effective strategies for women to reduce PMS symptoms.     

针灸配合康复训练对脑卒中偏瘫患者的康复作用

目的探究针灸配合康复训练对脑卒中偏瘫患者的康复作用。方法将100例脑卒中偏瘫患者随机分为观察组(针灸+康复训练)与对照组(常规康复训练),各50例。比较两组的康复治疗效果。结果康复治疗后,观察组的NIHSS、FMA、GQOLI-74及BI评分优于对照组(P<0.05)。随访1年后,观察组的正常患者占比高于对照组(P<0.05)。结论针灸配合康复训练对脑卒中偏瘫患者的康复有积极促进作用,是提升患者运动功能和生活质量的有效途径。     

循证医学在糖尿病研究中的应用

1型和2型糖尿病病因复杂,并发症多,治疗需针对本病和并发症进行综合治疗。其病因学和治疗学的研究需大样本的随机对照实验和系统评价方能得到较可靠结论。随着Meta分析方法学的不断进展,系统评价已日益广泛地应用于糖尿病的多方面研究,包括基因变异与糖尿病的关系、危险因素的评估、诊断性实验的评价和治疗学,并为临床工作者提供了有益信息。