从“肺合大肠”探讨肠道菌群紊乱与脓毒症急性肺损伤的相关性  

Exploring the Correlation Between Gut Microbiota Disorder and Sepsis Induced Acute Lung Injury from the Perspective of“Lung and Large Intestine”

作　　者：许一飞 靳敏燕 黄迪[1] 梁明昊 陈宪海[2] 邱占军[2] XU Yifei;JIN Minyan;HUANG Di;LIANG Minghao;CHEN Xianhai;QIU Zhanjun(Shandong University of Traditional Chinese Medicine,Jinan 250355,China;The Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250014,China)

机构地区：[1]山东中医药大学,山东济南250355 [2]山东中医药大学附属医院,山东济南250014

出　　处：《山东中医杂志》2024年第12期1342-1348,1386,共8页Shandong Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(编号:82274320);山东省自然科学基金项目(编号:ZR2020MH392);山东省自然科学联合基金项目(编号:ZR2021LZY027)。

摘　　要：脓毒症急性肺损伤发病机制复杂、死亡率高,目前尚缺乏有针对性的治疗手段。肠道菌群紊乱可通过“肠-肺轴”参与急性肺损伤发生发展。通过肠道菌群这一现代医学认识来阐释中医学“肺合大肠”理论,基于“肺合大肠”探讨肠道菌群紊乱在急性肺损伤中医发病机制中的作用,以“肺肠同治”为基本原则,提出以改善肠道生态平衡为核心的急性肺损伤防治新策略,明确分期论治:初期邪在卫表,肺气郁闭,肠络受损,治疗以清热宣肺、润下通腑为主,佐以理气机、消痈滞;中期邪炽气营,肺络瘀阻,肠腑失通,治疗以解毒清肺、攻下通腑兼以凉血化瘀;后期血分热极,肺阴亏耗,津枯肠结,逆证丛生,治以养阴透热、通腑开闭佐以扶正救逆。The pathogenesis of acute lung injury caused by sepsis is complex,and the mortality rate is high,and there is currently a lack of targeted treatment methods.Intestinal flora disorders,which can participate in the occurrence and development of acute lung injury through the“intestine-lung axis”.The paper interprets the basic theory of“lung being connected with large intestine”in traditional Chinese medicine through the modern medical understanding of intestinal flora,discusses the role of intestinal flora disturbance in the pathogenesis of acute lung injury in traditional Chinese medicine,takes“lung and intestine co-treatment”as the fundamental principle,proposes a new prevention and treatment strategy for acute lung injury with the improvement of intestinal ecological balance as the core,and clearly defines the stage treatment.In the early stage,the pathogenic factors are on the surface of the body,there are lung qi stagnation and intestinal collateral damage.The treatment mainly focuses on clearing heat,promoting lung function,moistening the lower-jiao and clearing fu-viscera,and promoting qi circulation,as well as eliminating carbuncle stagnation.In the middle stage,the pathogenic factors are intense and the intestines and organs are obstructed.The treatment is to detoxify and clear the lungs,drege the lower-jiao and clear fu-viscera,and cool blood and dissipate blood stasis.In the late stage,the blood is in extreme heat,the fluid dries up and the lung yin is depleted,the intestines stagnation is formed,and the syndrome of inversion is clustered.The treatment is to nourish yin and clear heat,open the fu-viscera,which is assisted by supporting the healthy qi and reversing qi.

关 键 词：脓毒症急性肺损伤 肠道菌群紊乱 肺合大肠 肠-肺轴 肺肠同治 

分 类 号：R256.3[医药卫生—中医内科学]