从“肾虚-痰瘀互结-毒损脑络”角度探讨老年谵妄的中医病机  

Chinese medicine pathogenesis of senile delirium discussed from the angle of"kidney deficiency-phlegm stasis interjunction-poison damage to brain collaterals"

作　　者：乔曦 徐曼如 陈金鑫 谢珊 伍文彬[1] QIAO Xi;Xu Manru;CHEN Jinxin;XIE Shan;WU Wenbin(Department of Geriatrics,The Affiliated Hospital,Chengdn University of Traditional Chinese Medicine,Chengdu 610072,China)

机构地区：[1]成都中医药大学附属医院老年病科,成都610072

出　　处：《西南医科大学学报》2024年第4期295-299,共5页Journal of Southwest Medical University

基　　金：国家重点研发计划项目(2020YFC2003100,2020YFC2003104);中华中医药学会专家共识项目(20211214-GS-CACM)。

摘　　要：谵妄,是一种以意识混乱为主要临床特征的急性脑综合征。老年谵妄是指发生在老年期的谵妄状态,其发病机制复杂,影响因素众多,是术后、ICU、姑息病房老年患者常见的老年综合征之一。老年谵妄是一系列临床负性事件的起因,会延长患者的住院时间,增加患者死亡的风险,加重患者家属的精神和经济负担,造成医疗资源浪费。现代医学对其发病机制尚未完全明确,目前学术界推崇的生理病理机制主要是炎症反应、神经递质水平异常和大脑结构异常。从中医病机角度进行探析,老年人肾虚精少、脑神失养、脏腑功能异常和痰瘀互结内蕴机体是本病的病理基础。邪气蓄积机体,日久化火酿毒,毒邪损伤脑络,致使脑神失养,神机逆乱是老年谵妄的主要病机。本文从“肾虚-痰瘀互结-毒损脑络”角度出发,探讨老年谵妄的中医病机,为老年谵妄的临床治疗及理论探讨提供依据。Delirium is an acute cerebral syndrome characterized by disturbance of consciousness.Geriatric delirium is a de-lirium state that occurs in the elderly.Its pathogenesis is complex and its influencing factors are numerous.It is one of the common geri-atric syndromes in elderly patients after surgery,ICU and palliative care wards.Delirium in the elderly is the cause of a series of nega-tive clinical events,which can prolong the hospital stay of patients,increase the risk of death of patients,increase the mental and eco-nomic burden of patients'family members,and cause unnecessary waste of medical resources.Modern medicine is not yet fully clear about its pathogenesis.At present,the physiological and pathological mechanisms favored by the academic community are mainly in-flammatory response,abnormal levels of neurotransmitters,and abnormal brain structure.From the perspective of pathogenesis of tradi-tional Chinese medicine,the pathological basis of this disease in the elderly is kidney deficiency and less essence,brain and spirit defi-ciency,abnormal function of viscera,mutual accumulation of phlegm and blood stasis.The accumulation of pathogenic qi in the body,the destruction of fire and poison over time,the damage of toxic factors to the brain collaterals,resulting in the loss of brain spirit,and the disorder of spirit and machinery is the main pathogenesis of senile delirium.This article discussed the pathogenesis of elderly de-lirium in traditional Chinese medicine from the perspective of"kidney deficiency-phlegm and blood stasis mutual accumulation-toxic damage to the brain collateral",in order to provide a basis for clinical treatment and theoretical discussion for elderly delirium.

关 键 词：老年谵妄 癫狂 肾虚 痰瘀互结 毒损脑络 中医病机 

分 类 号：R288[医药卫生—中药学]