不同医生辨证与针刺处方差异的临床研究

Clinical Study on Differences of Syndrome Differentiation and Acupuncture Protocols between Doctors

目的探索不同临床医生临床辨证与针刺处方中存在的差异性。方法以癌症化疗后出现恶心、呕吐患者为研究对象,拟对其进行针刺治疗。分别由两名不同医生对同一患者进行独立的四诊辨证,并拟定具体的针刺方案,包括选穴、针刺深度、手法强度、补泻手法、留针时间。对辨证一致性进行Kappa检验,比较不同医生针刺方案的差异。结果两名医生的辨证结果一致性很低(一致率38.5%,k=0.22),但对于穴位的选择基本一致,以中脘、天枢(双侧)、内关(双侧)、足三里(双侧)为主穴,选穴结果差异无统计学意义(χ~2=8.746,P=0.724)。两名医生针刺方案的手法强度、针刺深度、留针时间、补泻手法差异均有统计学意义(P<0.05)。结论针对癌症化疗后恶心、呕吐患者,不同医生辨证结果一致性低,但对穴位选择影响不大,差异体现在针刺手法的不同。

Objective To explore the difference of syndrome differentiation and acupuncture prescription between doctors. Methods The study objects were the cancer patients who had nausea and vomit after chemotherapy, and acupuncture was selected as the therapeutic method. Two doctors independently differentiated syndrome of the same patient by four diagnostic methods and conducted specific acupuncture protocols, including point selection, needling depth, manipulation strength, reinforcement and reduction, and the time of retaining needle. The consistency of syndrome differentiation was measured by Kappa test, and the differences between doctors were compared. Results The consistency of syndrome differentiation was low （consistency 38.5%, k =0. 22）, but the points selected were basically same. The master points were Zhongwan （RN 12）, Tianshu （ST 25, bilateral）, Neiguan （PC 6, bilateral）, and Zusanli （ST 36, bilateral）, and there was no significant difference in points selected （ X^2 = 8. 746, P = 0. 724）. But there were significant differences in the manipulation strength, needling depth, time of retaining needle, and the reinforcement and reduction between the two doctors＂ protocols （ P 〈 0. 05 ）. Conclusion For the cancer patients with nausea and vomit after chemotherapy, the consistency of syndrome differentiation between doctors was low, which had minimal effect on point selection. The main difference was reflected in the manipulation methods.