| Purpose: Building a Liaoning Provincial Local Syndrome Differentiation Standard for Coronary Heart Disease Phlegm and Blood Stasis Mutual Syndrome,and try to apply clinical audit to evaluate the clinical consistency of the standard item pool for the first time,so as to improve the objectivity and accuracy of the standard content,which is conducive to the clinical application and promotion in the future.Methods: This study is divided into two parts.The first part passed the literature research,semi-structural expert interview forming initial entry pool,"Expert questionnaire on local syndrome differentiation criteria of coronary heart disease with phlegm and blood stasis syndrome in Liaoning Province" was formulated,and the Delphi method was applied to 15 Chinese or Western medicine practitioners in Liaoning Province.Combined with clinical cardiovascular experts,TCM scientific research experts,and related experts involved in TCM internal medicine,integrated TCM and western medicine,TCM clinical,TCM diagnostics,syndromes and other related experts,send two rounds of questionnaire surveys,and use SPSS25 for the effective answer sheets collected in each round.The software makes a statistical analysis of the concentration and coordination of expert opinions with reference to the mean,weight coefficient and coefficient of variation,and preliminarily determines the entry pool of the "Liaoning Provincial Local Syndrome Differentiation Standard for Coronary Heart Disease Phlegm and Blood Stasis Mutual Syndrome".In the second part,by trying to quote the clinical audit method,after determining the audit theme,defining audit standards,audit methods and data collection and analysis,audit feedback,implementing changes and improvements,re-inspection and continuous improvement of the research framework,collected from Yingkou City,Liaoning Province From January 2015 to June 2020,the Hospital of Traditional Chinese Medicine diagnosed 60 patients with coronary heart disease with phlegm and blood stasis syndrome.By analyzing and comparing the matching degree of clinical symptoms with this standard item,the clinical adaptability of this standard item pool Evaluation and verification of practicality.Results:1.Combined literature research,semi-structured expert interviews and Delphi research,combined with the discussion of the project team.In the end,this study divided the item pool into five categories according to the importance of the recommended level,and initially determined the Liaoning Province local syndrome differentiation standard item pool for coronary heart disease phlegm and blood stasis mutual syndrome: The first category:sublingual collaterals curved,or blue purple,purple,purple black;purple face;dark purple tongue or purple spots;astringent pulse;chest pain aggravated at night;sublingual collaterals swelling,or blue purple,purple,purple black.The second category: sublingual collaterals bifurcation,or blue purple,purple,purple-black;astringent pulse;end of limbs cyanosis;the body has ecchymosis spots;chest tightness or pain.The third category: head heavy;dimish black complexion;fecal viscosity;sticky stools;greasy fur on tongue;scaly skin;dark lips.The fourth category: physical difficulties;heavy limbs;dim complexion;giddy head;abdominal full body fat;thick and greasy tongue;there are spots on the tip of the tongue;purple tongue;chest pain;through the line from time to time,from time to time,or closed collapse,or long leakage,blood dark purple or with blood clots;late menstruation,dark purple,with blood clots;white tongue coating;menstruation,accompanied by late menstruation,dark purple menstruation,blood clots;abdominal distention;mouth stick;slippery pulse;easy to get tired.The fifth category: fat tongue;tense pulse;toxic goiter;teeth-marked tongue;mammary nodules;thick lingual fur;immersion;abdominal mass;deep pulse;white and greasy tongue coating;teeth marks on the fat side of the tongue;yellowish fur;dark gingival color;chest distress.There are 49 items in 5 categories,including astringent pulse;chest pain aggravated at night;pulse sedentary;chest pain;fecal viscosity;sticky stool;abdominal full body fat;yellow and greasy tongue coating;physical difficulties;through the line from time to time,from time to time,or closed collapse,or long leakage,blood dark purple or with blood clots;late menstruation,dark purple,with blood clots;dim complexion;menstruation,accompanied by late menstruation,dark purple menstruation,blood clots;abdominal distention;easy to get tired;a meat gall;mammophilia;abdominal mass.The entries have unique regional characteristics in Liaoning Province and have great research value.2.In the clinical audit study,60 patients showed a total of 40 symptoms,of which 24 symptoms were recommended in the standard item pool,accounting for 60%,reaching more than half.According to the frequency of 40 symptoms,there were 15 symptoms that are more than 10 times,and 8 are recommended in the standard.They were: astringent pulse,greasy tongue coating,chest tightness,chest pain,chest tightness,heavy limbs,dizziness,slippery pulse.There are 24 symptoms that belong to the first category criteria,and 3 symptoms appear,accounting for 50% of the first category criteria.They were: astringent pulse(42times),chest pain aggravated at night(5 times),and purple face(2 times);there were 3symptoms of the second category,accounting for 60% of the second category,they were:chest tightness or pain(19 times),astringent pulse(7 times),end of limbs cyanosis(1 time);there were 4 symptoms of the third category,accounting for 57.1% of the third category,respectively: greasy fur on tongue(7 times),fecal viscosity(6 times),head heavy(3 times),dark lips(1 time);there were 8 symptoms of the fourth category,accounting for 47.1% of the fourth category standard.They were: chest pain(21 times),heavy limbs(19 times),giddy head(15 times),slippery pulse(14 times),mouth stick(5 times),abdominal distention(3times),physical difficulties(2 times),there are spots on the tip of the tongue(1 time);there were 6 symptoms in the fifth category,accounting for 42.9% of the fifth category,respectively: white and greasy tongue coating(23 times),chest distress(22 times),yellowish fur(9 times),deep pulse(7 times),teeth-marked tongue(6 times),immersion(1 time).The overall adaptability and practicality of standard items are better.Conclusion:1.The item pool is divided into five categories according to the importance level,and the item pool of syndrome differentiation standard of phlegm and blood stasis syndrome of coronary heart disease with regional characteristics in Liaoning Province is preliminarily obtained by large and complete classification presentation.It makes up for the lack of research on regional TCM disease syndrome differentiation standard in China,and provides ideas for the development of disease syndrome differentiation standards suitable for local areas.2.Attempt to innovatively cite the research evaluation method of clinical audit and apply it in the standard entry pool of syndrome differentiation of phlegm and blood stasis of coronary heart disease.This study shows that the method of clinical audit is highly feasible.It is of great significance for the clinical practice guidelines to provide reference for the evaluation of the application of the clinical practice guidelines in the field of traditional Chinese medicine,to more accurately and effectively apply and promote the guidelines and standards of the traditional Chinese medicine industry,and to improve the ability and level of traditional Chinese medicine to prevent and treat diseases. |
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