基于德尔菲法的冠状动脉血运重建后双心疾病辨证分型探析

Analysis on the Syndrome Differentiation of Psychological Heart Disease after Coronary Artery Revascularization Based on Delphi Method

目的:确立冠状动脉血运重建后双心疾病(心理心脏病)的辨证分型,为中医药针对性地干预双心疾病提供依据。方法:从全国范围内邀请从事中医及中西医结合临床心血管领域工作的专家填写德尔菲专家调查问卷,应用SPSS 22.0软件计算各证型内容效度(I-CVI)、评分均数(x)、得分≥7分的重要百分率(Ki)、得分≤3分的不重要性百分率(Ri)、满分频率(Kj)、等级和(Si)、变异系数(CV)对证型进行评价筛选。根据CV及Cronbach′sα系数评价问卷结果的内部一致性。根据专家权威系数(Cr)评价结果的权威程度。结果:问卷覆盖北京、上海、辽宁、吉林、广东等11个省、自治区、直辖市,共咨询39位专家,2轮咨询共进行问卷78人次,专家积极系数100%,平均总体权威系数0.893。2轮咨询的Cronbach′sα系数分别为0.899和0.954。最终确立的7项辨证分型整体内容效度(S-CVI/Ave)0.97,Cronbach′sα系数0.892。结论:气滞痰郁证、气滞血瘀证、气郁化火证、痰瘀互结证、痰瘀互结兼气郁证、痰瘀互结兼气虚证及痰热扰心证为冠状动脉血运重建后双心疾病的主要辨证分型,整体效信度良好。

Objective:To analyze and establish the syndrome differentiation classification of double heart disease(psychological heart disease)after coronary revascularization,so as to provide convenience for traditional Chinese medicine to better intervene in double heart disease.Methods:Experts engaged in clinical cardiovascular work of traditional Chinese medicine and integrated traditional Chinese and western medicine were invited from across the country to fill in the Delphi expert questionnaire.SPSS 22.0 was used to calculate the content validity(I-CVI),average score,the important percentage(Ki),the unimportant percentage(Ri),the frequency of full marks(Kj),the grade sum(Si),and the coefficient of variation(CV)of each syndrome type of the questionnaire feedback to evaluate and screen the syndrome types.The internal consistency of the questionnaire results was evaluated according to CV and Cronbach'sαcoefficient.The degree of authority of the results was evaluated according to the expert authority coefficient(Cr).Results:The questionnaire covered 11 provinces,autonomous regions and municipalities,including Beijing,Shanghai,Liaoning,Jilin,and Guangdong,etc.Thirty-nine experts were consulted.A total of 78 people were asked to conduct the questionnaire in two rounds.The expert positive coefficient was 100%,and the overall authority coefficient was 0.893.The Cronbach alpha coefficients of the two rounds of survey results were 0.899 and 0.954,respectively.The overall content validity(S-CVI/Ave)of the 7 finally established syndrome differentiation types was 0.97,and the Cronbach'sαcoefficient was 0.892.Conclusion:Qi stagnation and phlegm-stagnation syndrome,qi stagnation and blood stasis syndrome,qi stagnation and heat-reducing syndrome,phlegm and blood stasis syndrome,phlegm and blood stasis and qi stagnation syndrome,phlegm and blood stasis and qi deficiency syndrome,and phlegm-heat disturbing heart syndrome are the main syndrome differentiation of double heart disease after coronary revascularization,and the overall validity and reliability are better.