《桡骨远端骨折中医诊疗指南》临床应用评价

Clinical application evaluation research in TCM Clinical Practice Guideline of Distal Fracture of Radius

目的:评价《桡骨远端骨折中医诊疗指南》临床应用情况。方法:采用前瞻性临床病例观察的方法,由4家国家中医药管理局中医药标准研究推广基地进行桡骨远端骨折病例观察,并与指南内容比较,填写《桡骨远端骨折中医诊疗指南应用评价病例调查表》,统计方法采用描述性分析和关联分析方法,评价指南的应用符合度(包括中、西医诊断要点、证候分类、治则治法、方剂名称、药物组成、其他治法、预防调摄)、应用效果(包括疗效、安全性、经济性),并进行关联分析。结果:符合度评价:《桡骨远端骨折中医诊疗指南》在中、西医诊断、证候分类和治则治法的符合率高,预防调摄和其他治法的符合率略有下降,而方剂名称、药物组成的符合率相对较低;指南应用效果评价:疗效(较好以上)为99.2%,安全性、经济性分别为97.9%、52.3%,疗效>安全性>经济性;应用性综合评:总体疗效与技术水平较好的比例为97.9%,指南满意度为99.6%,临床的适用性为97.9%;指南符合度与应用效果评价结果关联分析:符合指南方药的病例疗效、安全性"很好"的比例高于不符合指南的比例(P<0.01),经济性比较无统计学差异。结论:《桡骨远端骨折中医诊疗指南》应用符合度较好,具有良好的疗效、安全性;符合指南方药的病例具有更好的疗效和安全性;不符合指南方药的治疗方案也有部分具有很好的疗效、安全性和经济性,是指南修订补充的重要内容来源。

Objective： To evaluate application effect in TCM Clinical Practice Guideline of Distal Fracture of Radius. Methods： The cases of distal fracture of radius were collected from four standardization research bases that approved by the State Administration of TCM to assess the guideline. The prospective clinical case observation method was used to observe these cases. The results were finally needed to fill out the Application and Evaluation Questionnaire of TCM Clinical Practice Guideline of Distal Fracture of Radius, where two pivotal evaluation factors were considered that referred to the coincidence rate of guideline including the main points of diagnosing of Chinese and western medicine, syndrome, therapeutic principle, prescription, drug composition, and other therapies, and the guideline applied effect including the curative effect, safety and economy. In this study, descriptive analysis and association rules algorithm were used to analyze the data. Results： The results of the coincidence rate showed that the diagnosis, syndrome types and therapeutic principles in the clinical cases were highly coincided with the guideline. The coincidence rate of prevention and others therapies declined slightly. But, the prescription and drug composition were lowly coincided with the guideline（79.3%, 81.3%）. The results of application effect evaluation were in sequence from highto low as following： the curative effect（99.2%）, safety（97.9%） and economy（52.3%）. The results of applied comprehensive evaluationwere in sequence from high to low as following： the ratio of overall curative effect to the technical curative effect（97.9%）, the satisfaction（99.6%） and the applicability（97.9%）. The results of association rules algorithm showed that the proportion of curative effect and safety that were identified as ＂very good＂ was higher than that of inconformity with the guidelines（P〈0.01）. Additionally, there was no significant difference in economy. Conclusion： The TCM Clinical Practice Guideline of Distal Fracture of Radius was demonstrated with a better application consistency, curative effect, safety and economy. The cases that conformed to the guideline showed a better curative effect and safety. Although the cases that didn＇t conform to the guideline partly showed a good curative effect, safety and economy, these were thought as important source of supplementary the guideline.