焦虑症中医临床诊疗指南在真实世界中的应用效果分析

Analysis of Application Efficacy of the Clinical Guideline for Chinese Medicine Diagnosis and Treatment of Anxiety in the Real World

目的了解焦虑症中医临床诊疗指南(以下简称"焦虑症指南")在真实世界中的应用符合情况,为指南修订提供依据。方法采用病例调查分析方法,前瞻性观察临床274例焦虑症住院或门诊病例,采集病历号、性别、年龄、病程,描述分析中西医疾病诊断、辨证论治等焦虑症指南应用是否符合的信息,统计焦虑症指南临床应用符合度,并交叉分析它们对临床应用效果的作用。结果中医疾病诊断符合度为96.71%、西医疾病诊断符合度97.81%、证候分类符合度87.59%、治疗法则符合度88.32%、方剂名称和药物组成符合度86.50%。临床效果评价中的总疗效好转、显效和痊愈率累计达到99.26%,安全性和经济性较好的比例累计达到96.35%和91.61%。焦虑症指南应用于临床病例后,当证候分类、治疗法则、方剂名称和药物组成都符合的情况下,其临床应用效果都好的患者比例为75.18%。应用效果分析表明不同临床应用符合情况对应用效果的作用存在一定的影响。结论焦虑症指南比较符合临床辨证论治的实际情况;指南整体临床应用效果较好;焦虑症中医诊疗指南临床应用符合情况对其临床应用效果的作用存在一定的影响。对存在部分应用不符合的病例,可结合焦虑症诊断、辨证论治等具体不符合原因对指南作进一步修订。

Objective To investigate the application of the Clinical Guideline for Chinese Medicine Diagnosis and Treatment of Anxiety（ ＂anxiety guideline＂for short） in the real world to get to know how it fit the circumstances of clinical reality,and provide reference for revising the guideline. Methods A prospective observation was conducted on 274 anxiety case records（ hospitalized patients or outpatients） with case investigation and analysis method.Data such as medical record number,gender,age and course of disease was collected. Information on diagnosis of Chinese medicine and western medicine,treatment based on syndrome differentiation,etc. was described and analyzed to see if it is accordance with the anxiety guideline. The conformity of anxiety guideline in clinical application was calculated. Cross-over analysis was conducted on the effect of conformity on clinical application. Results The conformity of disease diagnosis in Chinese medicine or in western medicine were 96. 71% and 97. 81%,repectively.The conformity of syndrome classification was 87. 59%. The conformity of treating principle was 88. 32%. The conformity of prescription name and herb composition was 86. 50%. Total rate of improvement,obvious effective rate,and cure effect added up to 99. 26% in clinical effect evaluation. The percentage of good safety and economy reached to 96. 35% and 91. 61%. After the anxiety guideline was applied in clinical,under the circumstances that syndrome classification,treating principle,prescription name and herb composition were all in accordance with the anxiety guideline,the percentage of patients with good clinical effect was 75. 18%. Application effect analysis showed that different clinical application conforming status could influence the application effect. Conclusion The anxiety guideline might conform to the actual situation of clinical treatment based on syndrome differentiation. The clinical application effect of the anxiety guideline seemed generally good. The conforming status of guideline for clinical diagnosis and treatment of anxiety in clinical could influence the clinical application effect. The guideline could be further revised for some cases without application conforming,considering the specific reasons in diagnosis,treatment based on syndrome differentiation,etc.,that caused the inconformity with the guideline.