344例重度、极重度慢性阻塞性肺疾病患者中医证型特点研究

目的:通过对344例重度、极重度慢性阻塞性肺疾病患者中医证型特点的观察分析,总结其规律及分布特点,为今后辨证及疾病预后判断提供依据。方法:收集2008年11月—2011年4月在新疆医科大附属中医医院呼吸科住院的重度、极重度慢性阻塞性肺疾病患者344例,记录患者一般资料、中医四诊、病程、主要临床表现、客观检查等,明确其诊断、分级及中医分型等内容。结果:在重度慢性阻塞性肺疾病患者中,中医证型以痰热蕴肺证居多,其次为肺气虚证,多数不出现呼吸衰竭,病程多在10年以内,体重指数在18.5～25之间。在极重度慢性阻塞性肺疾病患者中,中医证型以水凌心肺证居多,其次为肾阳虚证、血瘀证,均多数发生呼吸衰竭,病程多在15年以上,体重指数小于18.5。结论:重度、极重度慢性阻塞性肺疾病患者,其病性以痰热为标,肺气及肾阳虚为本,兼有水凌心肺证、血瘀证。其病情的轻重与病程呈正相关性,与体重指数呈负相关性。这与中医理论"久病必虚","久病及肾","久病必瘀",等相符合。在临床中,出现肾阳虚之症候,尤其是兼有水凌心肺证、血瘀证,可能是COPD患者是病情危重的标志。

Analysis of TCM Syndrome Types in 344 Cases with Severe and Extremely Severe Chronic Obstructive Pulmonary Disease

Objective:Through a observation of TCM syndrome type characteristics of 344 cases with severe and extremely severe chronic obstructive pulmonary disease.To sum up the rules and distribution characteristics and provide the basis for differentiation and prognosis.Methods:The data of 344 cases with severe and extremely severe chronic obstructive pulmonary disease from November 2008 to April 2011 in respiratory department of Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University was collected.The general data,Chinese medicine four diagnostic methods,duration,major clinical manifestations,objective examination,the diagnosis,classification and traditional Chinese classification were recorded.Results:For severe chronic obstructive pulmonary disease patients,phlegm-heat accumulating in lung syndrome is the majority,followed by lung Qi deficiency,mostly without respiratory failure,the course was almost less than 10 years,the body mass index was between 18.5~25.For the extremely severe chronic obstructive pulmonary disease patients,water attacking heart and lung syndrome is the majority,followed by kidney Yang deficiency,blood stasis syndrome,mostly with respiratory failure,the course was mostly more than 15 years,the body mass index was less than 18.5.Conclusion:For the severe and extremely severe chronic obstructive pulmonary disease,the branch is phlegm-heat and the root is lung Qi and kidney Yang deficiency,with water attacking heart and lung syndrome or blood stasis syndrome.The severity of illness has positive relationship with course of parturients,and the body mass index is negative correlation.It is consistent with the Chinese medicine theory of prolonged illness being virtual,prolonged illness invading kidney and prolonged illness leading to stasis.In clinic,kidney yang deficiency syndrome,especially with water attacking heart and lung syndrome or blood stasis syndrome,may be the sign of COPD.