从“风痰瘀虚”辨析儿童难治性肺炎支原体肺炎细胞因子风暴  

Analysis of the cytokine storm of refractory mycoplasma pneumoniae pneumoniain children from the perspective of “Wind-phlegm and stasis-deficiency”

作　　者：余欢 蔡萌 王孟清[1] 帅云飞[1] YU Huan;CAI Meng;WANG Mengqing;SHUAI Yunfei(The First Hospital of Hunan University of Chinese Medicine,Changsha 410007,China)

机构地区：[1]湖南中医药大学第一附属医院、湖南中医药大学中医学国内一流建设学科,湖南长沙410007 [2]南方医科大学珠江医院儿科中心,广东广州510280

出　　处：《陕西中医》2025年第1期80-83,87,共5页Shaanxi Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金资助项目(82174437);湖南省自然科学基金资助项目(2020JJ4478);湖南省卫生健康委员会科研计划项目(20200289);湖南中医药大学中医儿科学湖南省“双一流”学科建设项目(4912-0005001010)。

摘　　要：难治性肺炎支原体肺炎(RMPP)常由肺炎支原体肺炎进展而来,儿童发病率逐年升高,临床上迁延不愈容易并发多器官损伤。中医药辨治该病有一定优势,重归经典,与本病病理变化结合,提出细胞因子风暴是导致肺系重症症候群的主要原因,其特点与风温之邪致病相类,痰瘀为病进之主因,虚象显现于疾病始末。现以“风痰瘀虚”为总纲,阐述儿童RMPP细胞因子风暴之治则治法,当分三期:细胞因子风暴前驱期,宣泻结合以平温热;风暴爆发期,化瘀逐痰以通肺络;细胞因子风暴缓解期,健脾益肺以养气阴,当灵活遣用方药,并结合中医外治之法以进一步提升疗效。Refractory mycoplasma pneumoniae pneumonia(RMPP)often arises from misdiagnoses or inadequate treatments of mycoplasma pneumoniae pneumonia(MPP).The incidence rate among children is escalating annually,and if left untreated,it can lead to multi-organ damage.Traditional Chinese medicine offers potential benefits in treating this disease by revisiting classical methods and aligning them with the pathological changes observed in the disease.It suggests that a cytokine storm is the primary cause of severe pulmonary syndrome.This storm shares similarities with the pathogenesis induced by the evils of Wind-warmth and phlegm-stasis,with Deficiency manifesting at both the onset and conclusion of the disease.Based on the overarching framework of“Wind-phlegm and stasis-deficiency”,the treatment for pediatric RMPP cytokine storm is divided into three phases:the prodromal stage,which requires catharsis to clear heat and dampness;the outbreak stage,during which stasis resolving and phlegm expelling should be used to unblock the lung collaterals;and the remission phase,during which strengthening the spleen and lungs to nourish qi and yin is emphasized.Prescription drugs are judiciously used in conjunction with external traditional Chinese medicine techniques to improve clinical outcomes.

关 键 词：难治性肺炎支原体肺炎 肺炎支原体感染 细胞因子风暴 儿童 辨证论治 

分 类 号：R563.12[医药卫生—呼吸系统]