基于专家问卷的艾滋病皮肤瘙痒性病变中医诊疗规程研究

A Research of Chinese Medicine Diagnosis and Treatment Standard Procedure for Patients with HIV Associated Pruritus Based on Experts′ Questionnaires

目的建立艾滋病皮肤瘙痒性病变中医诊疗规程草案。方法通过文献调研和专家论证,建立艾滋病皮肤瘙痒性病变中医诊疗规程草案。采用两轮问卷调查中医或中西医结合艾滋病领域专家对诊断、治疗、调护等关键问题的接受程度及建议,并修订诊疗规程。结果第1轮完整问卷回收率为96%,专家对病史及体检、3个证型的辨证标准、血虚风燥的辨证用药和调护等条目的认可程度较高,对概述、辅助检查、血热生风和风淫湿胜的辨证用药等条目的变异系数(CV)在0.1603～0.2473之间,认识差异较大。根据回收意见,对规程进行修改,并开展第2轮问卷调查。第2轮完整问卷回收率为100%,专家对病史及体检、诊断标准、血虚风燥、风淫湿胜的辨证标准和血虚风燥的辨证用药等条目的CV为0,认可程度高,一致性好。其他条目的CV为0.0638～0.1439,所以差异程度比第1轮小,专家意见的一致性有较大提高。两轮调查中单个条目对总体评价结果所做出的贡献相差不大。通过两轮调查得到了该规程的修订版本。结论两轮问卷调查的专家积极性较好,集中程度和协调程度均较好。通过两轮问卷调查,对该规程的诊断、治疗、调护等关键问题基本达成了较好的共识。

Objective To establish Chinese medicine diagnosis and treatment standard proce- dure for patients with HIV associated pruritus. Methods A Chinese medicine diagnosis and treatment standard procedure for patients with HIV associated pruritus was established by literature retrieval and peer review. Two questionnaires were carried out to investigate the confirmation and advice of in-group specialists to key points of the draft including diagnosis, treatment and nursing. Then the procedures were revised accordingly. Results The recovery rate of complete questionnaires in the 1st survey was 96%. Specialists confirmed more on case history and physical examinations, syndrome differentiation of three syndrome types, treatment of blood deficiency wind dryness syndrome （BDWDS） and nursing. They held different opinions on the outlines, auxiliary examinations, treatment of blood heat induced wind evil syndrome （BHWES） and wind cold and dampness accumulation syndrome （WCDAS）, of which the coefficient of variations （CVs） was within 0. 1603-0.2473. The procedures were revised and the 2nd survey was launched. The recovery rate of complete questionnaires in the 2nd survey was 100%. Special- ists confirmed more on case history and physical examinations, diagnostic criteria, syndrome differenti-ation of BDWDS and WCDAS, and treatment of BDWDS, of which CVs was 0. All indicated high agree- ment and good compliance. The CVs of other items were within 0.0638 -0. 1439, less than those of the 1 st survey. The consistency of experts＇ opinions were somewhat improved. The contribution by one single item showed less difference in assessing the overall results in the two surveys. A new revision of the pro- cedure was preliminarily established according to results of two surveys. Conclusions Experts＇ activeness, concentration, and coordination were good in the two surveys. They had reached consensus in key points of the draft including diagnosis, treatment, and nursing.