基于慢性阻塞性肺疾病急性加重危险窗的袪邪扶正序贯辨证治疗策略

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1、·1276·中国中西医结合杂志2011年9月第31卷第9期CJITWM，September2011，Vol．31，No.9·思路与方法学·基于慢性阻塞性肺疾病急性加重危险窗的袪邪扶正序贯辨证治疗策略1，22李建生王海峰摘要慢性阻塞性肺疾病(COPD)是严重危害公众健康的重大疾病，COPD急性加重(AECOPD)是影响COPD进程的主要因素，加强AECOPD的治疗至为关键。“AECOPD危险窗”是在AECOPD缓解后至稳定期前的时期内，病情极不稳定，主要以症状虽然改善但持续存在、肺功能尚未恢复到稳定期水平、炎症反应持续存在等为

2、特征，极易再次发生急性加重而导致住院率和病死率增高。AECOPD当以祛邪为主辨证治疗，当病情减轻后进入“AECOPD危险窗”时，当以扶正为主辨证治疗。“AECOPD危险窗”概念的提出为防治COPD提供新的思路与策略，即此期以虚证为主，多为正虚邪恋，以气虚、气阴两虚为主，涉及肺脾肾而以肺肾虚损为主，常兼以痰瘀，当以补虚扶正为主、佐以化痰活血而立法组方辨证治疗。关键词慢性阻塞性肺疾病;急性加重;危险窗;辨证治疗SequentialSyndromeDifferentiationbyEliminatingPathogenandStr

3、engtheningVitalQiontheBasisofAcuteExacerbationofChronicObstructivePulmonaryDiseaseRiskWindowLIJian-shengandWANGHai-fengInstituteofGeriatricMedicine，HenanUniversityofTraditionalChineseMedicine，Zhengzhou(450008)ABSTRACTChronicobstructivepulmonarydisease(COPD)remainsa

4、severepublichealthproblem．A-cuteexacerbationofCOPD(AECOPD)isamajorfactorthatinfluencestheprocessofCOPD．StrengtheningthetreatmentofAECOPDisveryessential．AECOPDriskwindow(AECOPD-RW)referstotheperiodfromAECO-PDremissiontothetimebeforethestablephase．Theconditionisveryu

5、nstable．Symptomsarerelievedbutcon-tinuallyexist．Thelungfunctionhasnotrestoredtothelevelsofthestablephase．Theinflammatoryreactionscontinuallyexist．InthisperiodpatientsaremostliabletosufferfromAECOPD，resultinginhigherhospitaladmis-sionrateandhighermortality．Dispellin

6、gpathogensshouldbetakenasthemainprincipleforAECOPDtreat-ment．However，whenittransformsfromAECOPDtoAECOPD-RW，strengtheningthebodyresistanceshouldbetakenasthemainprinciple．TheproposalofAECOPD-RWhasprovidednewthoughtsandstrategiesforCOPD．Inthisperioddeficiencysyndromed

7、ominates，mostbeinglingeringpathogensduetodeficientvitalqi．Qideficiencyandqi-yindeficiencyarethemostcommonsyndromes，involvingFei，Pi，andShen．DeficiencyofbothFeiandShendominates，complicatedwithphlegmandstasis．Therefore，thetreatmentprincipleofAECO-PD-RWshouldfocusonton

8、ifyingthedeficiencyandstrengtheningthebodyresistance，assistedwithdissipatingphlegmandactivatingbloodcirculation．KEYWORDSchronicobstructivepulmona