有创机械通气危重病人胃肠功能障碍中医辨证量表研究

Due to the objective conditions of invasive mechanical ventilation critically ill patients,it affects the accuracy of the clinical syndrome differentiation because of the lack of interrogation information. The research extracts TCM syndrome element and its subordinate entries of invasive mechanical ventilation critically ill patients with gastrointestinal dysfunction(GID), develops initial TCM syndrome differentiation questionnaire based on the theory of TCM through the literature analysis and the semi-structured interview; sifts entry and scores of the initial questionnaire through expert Delphi method; fits syndrome differentiation model and correction using SEM based on the epidemiological cross-sectional survey;analysises the contribution of different items to syndrome element using SEM to dialectical data for parameter estimation,determines the weight of each syndrome according to the different contribution combined with the Delphi expert scoring; finally develops the invasive mechanical ventilation critically ill patients with GID questionnaire of TCM based on syndrome differentiation using the ROC to determine diagnosis threshold; With three Sub-senior high above expert dialectical results as the gold standard, evaluates the diagnostic performance by the sensitivity, specific degrees and other indicators.

有创机械通气危重病人因客观情况，临床辨证缺乏证候诊断关键性问诊信息，影响了临床辨证的准确性。本项目基于中医理论，通过文献分析、半结构化专家访谈，提取适用于有创机械通气危重病人胃肠功能障碍（GID）中医证素及所属条目，构建中医辨证初量表；通过专家德尔菲法，对有创机械通气危重病人GID辨证初量表进行条目筛选及赋分，基于流行病学横断面调查，运用结构方程模型（SEM）对辨证模型进行拟合及修正；运用SEM对辨证数据进行参数估计，分析不同条目对证素的贡献度，依据不同贡献度结合德尔菲法专家计分，确定各证素所属证候条目的权重值；运用受试者工作特征曲线方法（ROC）确定各证素诊断阈值，从而构建《有创机械通气危重病人GID中医辨证量表》；以三名副高级以上专家辨证结果作为金标准，采用敏感度、特异度等多种指标对《有创机械通气危重病人GID中医辨证量表》诊断性能的真实性及可靠性进行评价。

有创机械通气危重病人因客观情况，临床辨证缺乏证候诊断关键性问诊信息，影响了临床辨证的准确性。课题组基于中医理论基础，通过纳入29篇文献分析、19例半结构化专家访谈，提取了适用于有创机械通气危重病人胃肠功能障碍（GID）的理论框架、中医证素及所属条目，构建了中医辨证初量表；通过两轮专家德尔菲法，对有创机械通气危重病人GID辨证初量表进行了条目筛选及赋分；基于378例流行病学横断面调查，项目组运用结构方程模型（SEM）对辨证模型进行拟合及修正，依据不同条目贡献度结合德尔菲法专家计分，确定了各证素属证候条目的权重值；最后项目组运用受试者工作特征曲线方法（ROC）确定了各证素诊断阈值为3分，成功构建了《有创机械通气危重病人GID中医辨证量表(1.0)》，并在后续临床实际工作中进行量表评价及优化。《有创机械通气危重病人GID中医辨证量表(1.0)》的研制将有助于此类危重病人证候诊断客观化，有利于医生的临床决策，提高辨证准确率，从而充分发挥中医药临床疗效，在中医药证候规范领域有着广泛的应用前景。