评测中医临床医生观察舌象及脉象一致性的研究

目的：通过两名中医临床研究人员对舌脉的判断进行一致性评测，了解中医临床研究人员临床舌脉观察的一致性程度，为提高中医临床研究质量和研究结果的可靠性提供有价值的参考依据。方法：采用现场调查、直接询问的方法。由同一医院同一科室的两名专科医生分别独立观察舌脉象，以一致性检验Kappa值评测两位医生观察舌脉象的一致性程度。结果：两位医生所观察的55例患者中有13例（23．6％）舌质不一致，7例（12．7％）舌形不一致，舌质（Kappa=0．649）、舌形（Kappa=0．752）观察一致性程度较好。24例（43．6％）舌苔的判断不一致，舌苔（Kappa=0．525）判断的一致性中等。22例（40％）脉象的判断不一致，脉象判断的一致性中等（Kappa=0．562）。结论：舌脉象的一致性评测结果尚可，但仍有进一步提高的空间。分析不一致的原因，可能需要从判断标准的规范细致化、研究者的态度、完善研究人员的培训三方面来进行改进。

Evaluation of consistency of tongue and pulse signs observed by traditional Chinese medicine clinicians

Objective To evaluate the consistency of tongue manifestation and pulse condition observed by traditional Chinese medicine clinicians. Methods： Field investigation and direct inquiry were performed in the study. Two physicians from the same department judged tongue manifestation and pulse condition independently. The consistency among observers was assessed by means of Kappa statistics. Results： A total of 55 patients were included in the study. There were 13 inconsistent cases （23.6%） in tongue body observation and 7 cases （12.7 %） in form of the tongue observation. The observation consistency of tongue body （Kappa=0.64：9） and form of the tongue （Kappa=0. 752） were good. There were 24 inconsistent cases （43.6%） in tongue fur observation, the consistency of which was moderate （Kappa=0. 525）. There were 22 inconsistent cases （40%） in pulse condition diagnosis, the diagnosis consistency of which was also moderate （Kappa=0. 562）. Conclusion： Observation and diagnosis consistency of tongue manifestation and pulse condition were moderately the same between different clinicians. By analyzing the reasons of inconsistency, it is necessary to improve the consistency in three aspects, such as the detailed-oriented criterion, the attitude of researchers and better training of researchers.