慢性阻塞性肺病急性加重期的中西医认知与思考

Cognition and thinking of acute exacerbation of chronic obstructive pulmonary disease in traditional Chinese and western medicine

目的慢性阻塞性肺病(COPD)为临床常见呼吸病之一,其急性加重(AECOPD)是导致患者死亡的关键原因之一,中西医对该病认知各有不同,中医药参与该病治疗有一定优势。本文拟通过中西医角度分析来为该病相关研究的深入发展提供理论参考。方法本文从概念、病因病机、临床治疗等方面探讨中西医对AECOPD之认知,并综合实际临床经验,对中西医治疗AECOPD现存问题及如何更好发挥中西医之协同治疗作用,以提高临床疗效,降低病死率等问题进行讨论。结果COPD在中医学范畴主要归为肺胀,古文中对于其发作特点有类似表述。AECOPD的西医病机包括炎症反应、氧化应激、免疫失调等,而中医病机主要在于肺脾肾亏虚,而痰浊、水饮和瘀血等病理产物积聚,影响肺之宣肃。AECOPD的西医治疗手段包括氧疗、扩张支气管、激素及抗感染等,而中医则需辨证论治,以痰热壅肺证和痰湿阻肺证为主;用治AECOPD的中成药及方剂可以通过减轻炎症、改善免疫、减少黏液分泌等机制发挥作用。结论AECOPD治疗宜中西合用、标本兼顾、个体化治疗,但仍需更严谨和高质量的临床及基础研究提供依据。

Objective Chronic obstructive pulmonary disease(COPD)is one of the common diseases of respiratory system.The acute exacerbation of COPD(AECOPD)is one of the crucial causes of death of COPD patients.There are different cognitive modes between western medicine and Chinese medicine.TCM has rich theoretical knowledge on etiology and pathogenesis of AECOPD,and TCM has some advantages in AECOPD treatment.Methods This paper discussed the cognition of traditional Chinese and western medicine on AECOPD from the aspects of concept,etiology,pathogenesis and clinical treatment,and discusses the existing problems of traditional Chinese and western medicine in the treatment of AECOPD and how to give better play to the synergistic treatment of traditional Chinese and western medicine in order to improve the clinical curative effect and reduce the mortality.Results COPD was mainly classified as lung distension in the field of traditional Chinese medicine,and there were similar expressions for its attack characteristics in ancient literature.The pathogenesis of AECOPD in western medicine included inflammatory response,oxidative stress,immune disorders,etc.,while the pathogenesis of traditional Chinese medicine mainly lied in the deficiency of lung,spleen and kidney,and the accumulation of pathological products such as phlegm turbidity,water drinking and blood stasis,which affected the normal function of the lung.Western medicine treatments for AECOPD included oxygen therapy,bronchial dilation,hormones,anti-infection,and so on.TCM treatment of AECOPD required syndrome differentiation and treatment,mainly with phlegm-heat obstructing the lung and phlegm-damp obstructing the lung.Proprietary Chinese medicines and prescriptions for the treatment of AECOPD could work through mechanisms such as improving inflammation,regulating immunity,and inhibiting sputum secretion.Conclusion The cure of AECOPD should be integrated TCM and western medicine,taking into account the etiology and symptomatic atthesametime,and individualized.More evidence still needs to be supported by rigorous and high-quality clinical and laboratory research.