中医药治疗重症社区获得性肺炎概况(1)
【摘 要】 重症肺炎是常见的呼吸系统危重疾病，病情进展迅速，病死率高。近年来随着抗生素的滥用，耐药菌的出现，重症肺炎的治疗失败率居高不下。中医药治疗重症肺炎具有一定的疗效和优势，主要从临床辨证分型、经典方加减、经验方、中药注射液等方面进行对中医药治疗重症肺炎的现状进行概述，显示了中医药在缓解临床症状，减轻炎症反应，减少机械通气时间，改善预后等方面的积极作用。但是目前对于中医药干预重症肺炎的研究主要是单一药物治疗，单一证型的研究，辨证分型、疗效的判定缺乏统一标准;且方法学质量较低，影响研究结论的真实性和可靠性。文章对中医药治疗重症肺炎现状进行概述，为重症肺炎的中医药治疗及临床研究提供参考。
【关键词】 重症肺炎;中医药;辨证论治
【中图分类号】R563.1+9 【文献标志码】 A 【文章编号】1007-8517(2020)12-0068-05
Abstract：Severe pneumonia is a common severe respiratory disease，which progresses rapidly with high mortality.In recent years，with the abuse of antibiotics and the emergence of resistant bacteria，the treatment failure rate of severe pneumonia remains high.The treatment of severe pneumonia by traditional Chinese medicine has certain curative effect and advantages. The clinical research is mainly carried out from the aspects of syndrome differentiation，classic prescription addition and subtraction，self-preparation formula and traditional Chinese medicine injection，showing the positive effect of traditional Chinese medicine in relieving clinical symptoms，reducing inflammatory response，reducing mechanical ventilation time and improving prognosis.However，the current research on TCM intervention in severe pneumonia is mainly single drug therapy，single syndrome type research，syndrome differentiation and efficacy evaluation lack of unified standards.And the quality of methodology is low，which affects the authenticity and reliability of research conclusions.This paper summarizes the current situation of TCM treatment of severe pneumonia，and provides reference for TCM treatment of severe pneumonia and clinical research.In this paper，the current situation of the treatment of severe pneumonia by traditional Chinese medicine was summarized to provide reference for the treatment of severe pneumonia by traditional Chinese medicine.
Keywords：Severe Pneumonia;Traditional Chinese Medicine;Treatment Based on Syndrome
重癥社区获得性肺炎(Severe Community Aquired Pneumonia，SCAP)是肺组织炎症进一步发展恶化，引起器官功能障碍甚至危及生命的常见呼吸系统危重病[1]。重症肺炎除具有肺炎常见呼吸系统症状外，还有发展迅速，死亡率高，预后差的特点[2-4]。SCAP目前无统一的判定标准，2009年英国胸科学会(British Thoracic Society，BTS)强调了综合评估在肺炎严重程度评价中的作用，尤其是CURB65评分3分以上应住院治疗，4～5分考虑重症监护病房治疗，但未明确提出SCAP的诊断标准[5];中华医学会呼吸病学分会2016年公布了SCAP的诊断标准：主要标准：①需要气管插管行机械通气治疗;②脓毒症休克经积极液体复苏后仍需要血管活性药物治疗。次要标准：①呼吸频率≥30次/min;②氧合指数≤250 mmHg;③多肺叶浸润;④意识障碍和(或)定向障碍;⑤血尿素氮>7.14 mmol/L;⑥收缩压<90 mmHg，需要积极的液体复苏。符合1项主要标准或≥3项次要标准者可诊断SCAP[6]。重症肺炎患者易发生低氧血症、呼吸衰竭、感染性休克，导致多脏器功能衰竭，积极有效的抗感染是治疗关键[7-8]。尽管西医治疗手段不断更新，但抗生素研制进展缓慢，且多重耐药菌越来越普遍，重症肺炎死亡率仍然居高不下[9-10]。研究表明中医药有调节免疫、抗炎的作用[11]，中医药在辅助治疗急危重症上取得了较好的疗效[12]。有研究报道重症肺炎患者病原体与中医证候之间的相关性[13-14]，也为重症肺炎的中医药辨证治疗提供了参考。临床研究证明，在西医常规治疗的基础上联合中医药治疗重症肺炎具有一定的疗效[15-16]，文章就中医药在重症肺炎诊疗中的运用综述如下。, http://www.100md.com(张康 张亚青 谢凯)
【关键词】 重症肺炎;中医药;辨证论治
【中图分类号】R563.1+9 【文献标志码】 A 【文章编号】1007-8517(2020)12-0068-05
Abstract：Severe pneumonia is a common severe respiratory disease，which progresses rapidly with high mortality.In recent years，with the abuse of antibiotics and the emergence of resistant bacteria，the treatment failure rate of severe pneumonia remains high.The treatment of severe pneumonia by traditional Chinese medicine has certain curative effect and advantages. The clinical research is mainly carried out from the aspects of syndrome differentiation，classic prescription addition and subtraction，self-preparation formula and traditional Chinese medicine injection，showing the positive effect of traditional Chinese medicine in relieving clinical symptoms，reducing inflammatory response，reducing mechanical ventilation time and improving prognosis.However，the current research on TCM intervention in severe pneumonia is mainly single drug therapy，single syndrome type research，syndrome differentiation and efficacy evaluation lack of unified standards.And the quality of methodology is low，which affects the authenticity and reliability of research conclusions.This paper summarizes the current situation of TCM treatment of severe pneumonia，and provides reference for TCM treatment of severe pneumonia and clinical research.In this paper，the current situation of the treatment of severe pneumonia by traditional Chinese medicine was summarized to provide reference for the treatment of severe pneumonia by traditional Chinese medicine.
Keywords：Severe Pneumonia;Traditional Chinese Medicine;Treatment Based on Syndrome
重癥社区获得性肺炎(Severe Community Aquired Pneumonia，SCAP)是肺组织炎症进一步发展恶化，引起器官功能障碍甚至危及生命的常见呼吸系统危重病[1]。重症肺炎除具有肺炎常见呼吸系统症状外，还有发展迅速，死亡率高，预后差的特点[2-4]。SCAP目前无统一的判定标准，2009年英国胸科学会(British Thoracic Society，BTS)强调了综合评估在肺炎严重程度评价中的作用，尤其是CURB65评分3分以上应住院治疗，4～5分考虑重症监护病房治疗，但未明确提出SCAP的诊断标准[5];中华医学会呼吸病学分会2016年公布了SCAP的诊断标准：主要标准：①需要气管插管行机械通气治疗;②脓毒症休克经积极液体复苏后仍需要血管活性药物治疗。次要标准：①呼吸频率≥30次/min;②氧合指数≤250 mmHg;③多肺叶浸润;④意识障碍和(或)定向障碍;⑤血尿素氮>7.14 mmol/L;⑥收缩压<90 mmHg，需要积极的液体复苏。符合1项主要标准或≥3项次要标准者可诊断SCAP[6]。重症肺炎患者易发生低氧血症、呼吸衰竭、感染性休克，导致多脏器功能衰竭，积极有效的抗感染是治疗关键[7-8]。尽管西医治疗手段不断更新，但抗生素研制进展缓慢，且多重耐药菌越来越普遍，重症肺炎死亡率仍然居高不下[9-10]。研究表明中医药有调节免疫、抗炎的作用[11]，中医药在辅助治疗急危重症上取得了较好的疗效[12]。有研究报道重症肺炎患者病原体与中医证候之间的相关性[13-14]，也为重症肺炎的中医药辨证治疗提供了参考。临床研究证明，在西医常规治疗的基础上联合中医药治疗重症肺炎具有一定的疗效[15-16]，文章就中医药在重症肺炎诊疗中的运用综述如下。, http://www.100md.com(张康 张亚青 谢凯)