【作者】 周信杰；

【导师】 吴宣富；

【作者基本信息】 广州中医药大学 ， 中医学， 2010， 硕士

【摘要】 目的：制定《癫痫中医证候调查表》,促进癫痫中医辨证的标准化。使用《癫痫中医证候调查表》调查我院癫痫患者,了解证素分布特点。方法：①通过古今中医文献的研究,回顾癫痫的病因、病机,结合临床经验,提出癫痫中医辨证的9个证素。②参照已出版的癫痫中医诊断标准及多版中医内科学,汇总癫痫症状、体征的条目,整理成癫痫症状体征条目池,编成《癫痫中医辨证专家问卷调查表》。③根据我国地域分布,分层抽取我国在三甲医院从事中医、中西医结合治疗脑病的副高或博士以上的医师,进行专家问卷调查,并进行结果统计分析、筛选条目,制定《癫痫中医证候临床调查表》,并以专家对各条目评定的平均分作为条目对各证素诊断的权重。④选取癫痫病例,进行临床预调查,根据预调查结果,统计《癫痫中医证候临床调查表》中各条目的缺失率,并对调查表的辨证结果进行准确性评价,调整确诊阈值。⑤把《癫痫中医证候临床调查表》、条目权重、确诊阈值结合为一整体,制定《癫痫中医证候调查表》。结果：16个省份的46位专家完成了“专家问卷调查”,专家问卷回收率100%。回收问卷合格率：78.26%。统计各条目的平均分、0分率、标准差、变异系数。分析、删除0分率高的条目,制定了《癫痫中医证候临床调查表》。并以各条目专家评定的平均分作为条目对证素诊断的权重,制定了《条目-证素权重表》。使用《癫痫中医证候临床调查表》进行临床预调查,共调查患者41例,调查表合格率为100%。其中全部条目均填写完整的调查表29例,占70.73%。统计各条目的缺失率显示癫痫发作期的条目缺失明显多于缓解期的条目。按调查表辨证法分析临床预调查的证素分布有如下特点：火证、风证、闭证、痰证最常见；肾阴虚证、瘀证次之；心血虚证、脾气虚证、肾阳虚证较少见。对《癫痫中医证候调查表》的诊断准确性评定示：肾阴虚证的灵敏度、特异度、符合率均达到90%以上；风证、闭证诊断符合率均达到90%以上,灵敏度、特异度也较高,且病例数较多；火证、痰证、瘀证的诊断符合率均在70%-80%之间；心血虚证、脾气虚证、肾阳虚证符合率均达到90%以上,但收集到的病例较少。结论：编制了《癫痫中医证候调查表》。该调查表包括9个证素,75个条目,已经确定了条目的权重、阈值,并进行了临床预调查。该调查表较好地代表了我国中医、中西医结合神经病学专家对癫痫病辨证的多数意见,为日后进行大规模临床调查奠定基础。更多还原

【Abstract】 Objective Development of "epileptic syndromes questionnaire" to promote the standardization of TCM epilepsy. Use the "epileptic syndromes Survey" survey of epilepsy patients in our hospital to find evidence prime distribution.Methods①By ancient and modern Chinese literature, review of epilepsy etiology, pathogenesis, clinical experience, TCM made of 9 epileptic syndrome elements.(2)Reference to published diagnostic criteria for epilepsy and a number of Chinese version of Chinese medical science, summarized epilepsy symptoms and signs of entry, order entry into the pool of symptoms and signs of epilepsy, compiled "TCM experts in epilepsy questionnaire."③ccording to China’s geographical distribution and stratified in the top three hospitals in China Chinese medicine, Integrative Medicine encephalopathy than vice Dr. Gao Huo, MD, an expert survey and statistical analysis carried out to screen entry, to develop "epileptic syndromes Clinical Investigation Form "and an expert on the assessment of the average of all entries on the cards as entry element diagnostic weight.④Selected cases of epilepsy, pre-clinical investigation, according to pre-survey results, statistics "epileptic syndromes Clinical Investigation Form" in the absence of the entry rate, and the dialectical survey accuracy of the results, adjust the diagnosis threshold.⑤The "epileptic syndromes clinical survey", entry weight, diagnosis threshold combination of a whole, to develop "epileptic syndromes questionnaire."Results 16 provinces,46 experts completed the "expert survey", the expert response rate was 100%. Questionnaires returned pass rate:78.26%. Statistical average of all entries,O rates, standard deviation, coefficient of variation. Analysis, the high rate of entry to delete 0, formulated the "epileptic syndromes clinical survey." And expert assessment of each entry as the entry points check against an average weight of prime diagnosis, developed a "entry-Certificate prime weight table." Use the "epileptic syndromes Clinical Investigation Form" pre-clinical investigations,41 patients were investigated,100% pass rate survey. Which all entries are completed questionnaires in 29 cases, accounting for 70.73%. Statistics show the rate of entry of the missing entries in absence of seizures was more than ease of entry. Dialectical method of analysis by questionnaire investigation Evidence in pre-clinical distribution of the following characteristics:fire card, air card, closed cards, the most common phlegm; Kidney Yin Deficiency, followed by stasis; blood deficiency, spleen deficiency syndrome, renal Yang Deficiency rare. Of "epileptic syndromes survey" Assessment of the diagnostic accuracy of the show:Kidney Yin Deficiency sensitivity, specificity, consistent with rates above 90%; wind permits, Imaging and closed more than 90% compliance rate, sensitivity, specificity was also high, and the larger number of cases; fire card, phlegm, stasis in the diagnosis rate of 70%-80%; blood deficiency, spleen deficiency syndrome, deficiency syndrome consistent with rates up More than 90%, but fewer cases collected.Conclusion The preparation of the "epileptic syndromes questionnaire." The questionnaire includes nine card factor,75 items have been identified entry weight, threshold, and conducted pre-clinical investigation. The survey form to better represent our medicine, Integrative Medicine Neurology experts epilepsy syndrome of the majority opinion, for the future lay the foundation for large-scale clinical investigation.更多还原