寿鑫甜　王禹萌　钟森杰　杨梦　段梦遥　胡志希

〔摘要〕 目的 研制慢性心力衰竭不同病理因素中西醫结合诊断量表，为慢性心力衰竭临床诊断提供指导。方法 检索慢性心力衰竭相关文献，挖掘相关症状、体征、理化指标，获得反映本病证候主要中西医学诊断的指标集合，形成诊断条目池。并通过主成分分析结合Apriori算法关联分析筛选，制定专家问卷调查表。通过德尔菲法开展两轮专家问卷调查，得出重要诊断条目，并确立条目赋分及诊断总积分，初步拟定慢性心力衰竭不同病理因素中西医结合诊断量表草案。结果 拟定了慢性心力衰竭气虚、阳虚、阴虚、血瘀、痰浊、水饮病理因素诊断量表草案，其宏观诊断指标分别为乏力、气短、心悸等;心悸、畏寒肢冷、气喘等;舌红、口渴、口燥咽干等;舌质有瘀点瘀斑、面唇发绀、面色晦暗等;咳吐稀白痰、苔腻、苔厚等;四肢浮肿、气喘、小便短少等。其理化诊断指标分别为左室射血分数（LVEF）下降、BNP升高等;LVEF下降、BNP升高等;心输出量（CO）异常;X线心影大，肺瘀血水肿、LVEF下降;X线心影大，肺瘀血水肿、肺活量较其自身最大值降低1/3;脑钠肽（BNP）升高。结论 本量表可为慢性心力衰竭中西医结合临床诊断提供指导，并为治疗用药提供参考。

〔关键词〕 慢性心力衰竭;病理因素;中西医结合;诊断指标;德尔菲法;诊断量表

〔中图分类号〕R256.2;R241      〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.01.002

〔Abstract〕 Objective To research and product a diagnostic scale of integrated traditional Chinese medicine （TCM） and western medicine for different pathological factors of chronic heart failure， and provide guidance for the clinical diagnosis of chronic heart failure. Methods Literatures on chronic heart failure were searched， and related symptoms， signs， physical and chemical indicators were collected， a collection of indicators that reflect the main Chinese and western medical diagnosis of the disease syndrome was obtained， and  a pool of literature entries was formed. An expert questionnaire was formulated through the principal component analysis combined with the Apriori algorithm correlation analysis screening. Two rounds of expert questionnaire survey were conducted by Delphi method to obtain the important diagnostic items， and to establish the score of items and the total score of diagnosis， so as to preliminary draft a diagnostic scale for integrated TCM and western medicine for different pathological factors of chronic heart failure. Results The draft of the diagnostic scale for pathological factors of qi deficiency， yang deficiency， yin deficiency， blood stasis， phlegm turbidity and fluid retention of chronic heart failure was formulated. Their macro factors are fatigue， shortness of breath， palpitations， etc; palpitations， chills and cold limbs， asthma， etc; red tongue， thirst， dry mouth and throat， etc; the tongue with petechia， cyanosis of face and lip， dull complexion， etc; vomiting thin white sputum， greasy fur， thick fur， etc; edema of extremities， gasp， shortness of urine， etc. Their physicochemical indicators are decreased left ventricular ejection fraction （LVEF）， increased brain natriuretic peptide （BNP）， etc; decreased LVEF， increased BNP， etc; abnormal cardiac output （CO）; large X-ray heart shadow with pulmonary congestion and edema， decreased LVEF; large X-ray heart shadow with pulmonary congestion and edema， lung capacity reduced by 1/3 of its maximum value; increased BNP. Conclusion This diagnostic scale of integrated TCM and western medicine for different pathological factors of chronic heart failure can provide guidances for the integrated TCM and western medicine clinical diagnosis of chronic heart failure， and provide a reference for treatment and medication.

〔Keywords〕 chronic heart failure; pathological factors; integrated traditional Chinese and western medicine; diagnostic index; Delphi method; diagnostic scale

慢性心力衰竭指由各种初始心肌损伤引起心脏结构或功能变化，导致心室泵血和（或）充盈功能低下的一种复杂的临床综合征[1]，其发病率高，5年存活率与恶性肿瘤相仿[2]。……