从“醒神-宣肺-通腑”治法探讨神经重症患者急性呼吸窘迫综合征的辨证论治思路  

Therapeutic Strategies for ARDS Associated with Neurocritical Illnesses Based on the Treatment Methods of Inducing Resuscitation,Ventilating Lung,and Relaxing Bowels

作　　者：王睿弘 袁方 李惠平[2] 卢爱丽[2] 马朝晖[2] 黄燕 王立新[2,3] WANG Rui-hong;YUAN Fang;LI Hui-ping;LU Ai-li;MA Chao-hui;HUANG Yan;WANG Li-xin(The Second Clinical School of Guangzhou University of Chinese Medicine,Guangzhou Guangdong 510120;Neurologic Critical Care Unit of Guangdong Provincial Hospital of TCM,Guangzhou Guangdong 510120;Guangdong Provincial Key Laboratory of Chinese Medicine Emergency Research,Guangzhou Guangdong 510120)

机构地区：[1]广州中医药大学第二临床医学院,广东广州510120 [2]广东省中医院神经重症科,广东广州510120 [3]广东省中医急症研究重点实验室,广东广州510120

出　　处：《世界中西医结合杂志》2022年第11期2320-2325,2332,共7页World Journal of Integrated Traditional and Western Medicine

基　　金：广东省中医急症研究重点实验室(2017B030314176);广东省中医药局——黄燕广东省名中医传承工作室;广州市校(院)联合资助项目(202102010248)。

摘　　要：急性呼吸窘迫综合征(Acute respiratory distress syndrome,ARDS)是神经危重症中的重要并发症,严重影响患者预后并升高病死率。文中通过分析神经重症相关ARDS的中医病机及临床症候特点,结合其西医病理机制和相关药理学研究,探讨“醒神-宣肺-通腑”法辨证治疗神经重症相关ARDS的思路。神经重症合并ARDS的病机包含元神失用、肺失宣降和腑气不通三方面,元神失用是其发病基础,肺失宣降是发病的关键,腑气不通则进一步加重病情。治疗神经重症相关ARDS以醒神开窍、宣通肺气和通腑行气为法,能够起到减轻脑组织损伤、改善意识状态、抑制肺水肿和肺部感染、减轻炎症反应等作用,从而防治ARDS、改善预后。Acute respiratory distress syndrome(ARDS)is a severe complication associated with neurocritical illnesses,which seriously affects the prognosis of patients and increases mortality.By analyzing the pathogenesis and clinical symptoms of ARDS in traditional Chinese medicine(TCM),the present study explored the syndrome differentiation-based treatment methods of inducing resuscitation,ventilating lung,and relaxing bowels for ARDS associated with neurocritical illnesses in combination with the pathological mechanism of western medicine and related pharmacological studies.According to TCM,the pathogenesis of ARDS associated with neurocritical illnesses includes disuse of original spirit,disorder of lung qi,and blockage of qi in Fu organs.Disuse of original spirit is the basis of its pathogenesis,disorder of lung qi is pivotal in the pathogenesis,and blockage of qi in Fu organs aggravates the pathological processes.The treatment of ARDS associated with neurocritical illnesses should follow the therapeutic principles of inducing resuscitation,ventilating lung,and relaxing bowels,which can reduce cerebral injury,improve the state of consciousness,inhibit pulmonary edema and lung infection,and alleviate inflammatory responses,thereby relieving ARDS and improving outcomes.

关 键 词：神经危重症 急性呼吸窘迫综合征 醒神开窍 宣降肺气 通腑行气 

分 类 号：R563.8[医药卫生—呼吸系统]