基于德尔菲法的新型冠状病毒肺炎中医辨证规范专家问卷分析

目的:分析河南省新型冠状病毒肺炎(简称新冠肺炎)的常见证候及其与临床分型/分期的关系,为进一步优化新冠肺炎的中医辨证治疗提供支撑。方法:采用德尔菲法对支援河南省基层新冠肺炎疫情医疗救治工作的12名省级救治专家和6名新冠肺炎定点医院的医疗救治专家进行咨询,应用SPSS 20.0统计软件,分析专家积极程度、专家意见集中程度、专家意见协调程度与专家权威程度,统计常见证候及与临床分型/分期的关系构成比。结果:①专家积极程度:专家问卷的回收率100%,即专家积极系数为100%;专家意见集中程度:各证候重要性评分均值范围为1.19~3.11;专家意见协调程度:各证候重要性评分变异系数范围为0.27~0.63,Kendall协调系数为0.315(χ~2=62.452,P<0.05);专家权威程度:专家熟悉程度系数为0.89,判断系数为0.92,专家权威系数为0.91。②临床分型方面:轻型常见证候为风热犯肺证(77.8%)、湿遏肺卫证(61.1%)、寒湿郁肺证(61.1%);普通型常见证候为湿遏肺卫证(88.9%)、湿阻肺胃证(88.9%)、寒湿郁肺证(83.3%)、风热犯肺证(77.8%)、肺脾气虚证(77.8%)、邪热壅肺证(66.7%)、湿热蕴肺证(66.7%)、气阴两虚证(66.1%);重型常见证候为疫毒闭肺证(94.4%)、邪热壅肺证(88.9%)、湿热蕴肺证(66.7%);危重型常见证候为内闭外脱证(94.4%)、邪陷心包证(83.3%)、阳气欲脱证(77.8%)、疫毒闭肺证(61.1%)。③临床分期方面:初期常见证候为湿遏肺卫证(88.9%)、风热犯肺证(88.9%)、寒湿郁肺证(77.8%);进展期常见证候为湿阻肺胃证(88.9%)、邪热壅肺证(88.9%)、湿遏肺卫证(77.8%)、湿热蕴肺证(72.2%);危重期常见证候为疫毒闭肺证(88.9%)、内闭外脱证(88.9%)、邪陷心包证(88.9%)、阳气欲脱证(83.3%)、邪热壅肺证(72.2%);恢复期常见证候为肺脾气虚证(88.9%)、气阴两虚证(77.8%)。结论:本轮专家咨询的专家积极程度、权威程度均较高,但个别证候的专家意见集中程度、协调程度有待提高。明确了新冠肺炎临床分型/分期的常见证候,可为辨证治疗方案的优化提供参考。

Expert Questionnaire Analysis of TCM Syndrome Differentiation Standard for COVID-19 Based on Delphi Method

Objective: To analyze the common syndromes of corona virus disease 2019( COVID-19) in Henan province,and the relationship between the syndromes and clinical classification and stage,providing support for further optimizing the TCM syndrome differentiation and treatment of COVID-19. Methods: 12 provincial experts supporting medical treatment work of COVID-19 in primary hospitals in Henan province and 6 medical experts in designated hospitals were asked for advice by Delphi method. Expert’s positive degree,concentrative degree,coordination degree of expert’s opinions and expert’s authority degree,and constituent ratio of common syndromes in the clinical classification and stage were analyzed using SPSS 20. 0. Results:(1)Expert’s positive degree:the recovery rate of expert questionnaire was 100%;that is,the positive coefficient was 100%. Concentrative degree of expert’s opinions: the range of mean importance scores of each syndrome was from 1. 19 to 3. 11. Coordination degree of expert’s opinions:the range of variation coefficient of importance scores of each syndrome was from 0. 27 to 0. 63,and the Kendall coordination coefficient was 0. 315( χ2= 62. 452,P < 0. 05). Expert’ s authority degree: the familiarity degree coefficient was 0. 89,the judgment coefficient was 0. 92,and the expert’s authority coefficient was 0. 91.(2)In the clinical classification,the common syndromes of the light type of COVID-19 were the syndrome of wind heat attacking lung( 77. 8%),the syndrome of dampness repressing defensive qi of lung( 61. 1%),and the syndrome of cold dampness closing lung( 61. 1%);the common syndromes of the common type of COVID-19 were the syndrome of dampness repressing defensive qi of lung( 88. 9%),the syndrome of dampness blocking lung and stomach( 88. 9%),the syndrome of cold dampness closing lung( 83. 3%),the syndrome of wind heat attacking lung( 77. 8%),the syndrome of qi deficiency of lung and spleen( 77. 8%),the syndrome of pathogenic heat accumulating lung( 66. 7%),and the syndrome of dampness heat accumulating lung( 66. 7%),the syndrome of qi and yin deficiency( 66. 1%);the common syndromes of the severe type of COVID-19 were the syndrome of epidemic virus closing lung( 94. 4%),the syndrome of pathogenic heat accumulating lung( 88. 9%),and the syndrome of dampness heat accumulating lung( 66. 7%);the common syndromes of the critical type of COVID-19 were the syndrome of internal block and outward desertion( 94. 4%),the syndrome of evil invading pericardium( 83. 3%),and the syndrome of Yang qi loss( 77. 8%),and the syndrome of epidemic virus closing lung( 61. 1%).(3)In the clinical stage,the common syndromes of COVID-19 in the early stage were the syndrome of dampness repressing defensive qi of lung( 88. 9%),the syndrome of wind heat attacking lung( 88. 9%),and the syndrome of cold dampness closing lung( 77. 8%);the common syndromes of COVID-19 in the advanced stage were the syndrome of dampness blocking lung and stomach( 88. 9%),the syndrome of pathogenic heat accumulating lung( 88. 9%),the syndrome of dampness repressing defensive qi of lung( 77. 8%),and the syndrome of dampness heat accumulating lung( 72. 2%);the common syndromes of COVID-19 in the critical stage were the syndrome of epidemic virus closing lung( 88. 9%),the syndrome of internal block and outward desertion( 88. 9%),the syndrome of evil invading pericardium( 88. 9%),the syndrome of yang qi loss( 83. 3%),and the syndrome of pathogenic heat accumulating lung( 72. 2%);the common syndromes of COVID-19 in the recovery stage were the syndrome of qi deficiency of lung and spleen( 88. 9%) and the syndrome of qi and yin deficiency( 77. 8%). Conclusion: The expert’s positive degree and authority degree were both good. However,the concentrative degree and coordination degree of expert’s opinions of individual syndromes remained to be improved. In addition,common syndromes in the clinical classification and stage were clarified. This study could provide reference for the optimization of treatment in COVID-19.