艾滋病复发性口腔溃疡中医诊疗规程的问卷调查

艾滋病复发性口腔溃疡(AIDS-ROU)的发病机制不清,治疗手段单一,但与AIDS的发病及进展关系密切.中医辨证论治从整体调节出发,对于病因、机制不清的疾病具有优势.本研究通过文献调研与专家论证,建立AIDS-ROU中医诊疗规程草案.基于该草案,采用2轮专家问卷调查接受程度及建议,修订该草案,进而提高专家认可度.结果显示第1轮调查的完整问卷回收率为96％,概述、病史和体检、阴虚火旺的辨证标准、心脾积热和阴虚火旺的辨证用药、西医治疗和调护等条目的认可程度较高,对发病率、脾胃气虚的辨证用药和疗效评价标准等条目的认识差异较大,Cronbach系数α(CCA)=0.998,分半信度R=0.91.第2轮调查的完整问卷回收率为100％,概述、病因病机、病史和体检、辅助检查、诊断标准、心脾积热和阴虚火旺的辨证标准及辨证用药等条目的认可程度较高,对寒热错杂和脾胃气虚的辨证标准及辨证用药、调护、其他治法等条目的认识差异较大,CCA=0.428,分半信度R=0.96.第2轮的变异系数比第1轮小.2轮问卷中单个条目对总体评价结果所做出的贡献相差不大.通过2轮问卷调查,专家对AIDS-ROU的辨证分型、用药等关键问题达成了较好的共识.

Establish proposal of diagnosis and treatment of traditional Chinese medicine in AIDS patients with recurrent oral ulcerations

The pathogenesis of acquired immune deficiency syndrome-associated recurrent oral ulcerations(AIDS-ROU) remained obscure and these was no specific treatment for it. Syndrome differentiation in traditional Chinese medicine (TCM) focus on integral regulation and has an advantage of the disease that etiology and pathogenesis remain obscure. A draft of Chinese medicine diagnosis and treatment standard procedure for AIDS-ROU was established by literature retrieval and peer review. Two questionnaires were carried out to investigate the confirmation and advice of in-group specialist to key points of the draft including diagnosis, treatment and nursing. Then the procedures were revised accordingly. The preliminary results showed the recovery rate of complete questionnaires in the 1st survey was 96%. Specialists confirmed more on outline, case history and physical examinations, syndrome differentiation of hyperactivity of fire due to Yin deficiency syndrome (HFYDS), treatment of heat accumulated in heart and spleen syndrome (HAHSS) and HFYDS, treatment of western medicine and nursing. They held different opinions on incidence, treatment of deficiency of spleen-QI and stomach-QI syndrome(DSSS) and criterion of therapeutical evaluation. Cronbach coefficient alpha(CCA)was 0.998 and split-half reliability R was 0.91. Recovery rate of complete questionnaires in 2nd survey was 100%. Specialists confirmed more on outline, etiology and pathogenesis, case history and physical examination, auxiliary examination, diagnostic criteria, syndrome differentiation and treatment of HAHSS and HFYDS. They held different opinions on syndrome differentiation and treatment of intermingled cold and heat syndrome and DSSS, nursing and the other therapies. CCA was 0.428 and split-half reliability R was 0.96. Coefficient of variations of the 2nd survey were less than those of the 1st survey, which mean coordination was improved. Each single item in two surveys contributed less difference in overall results according to weight coefficients. A new revision of the procedure was preliminarily established according to results of two surveys. Experts'activeness, concentration and coordination were good in two surveys. They had reached consensus in key points of the draft including diagnosis, treatment and nursing on the whole.