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从气血理论探讨围术期应激反应调控及相关并发症防治
From the Metatheory of Qi-blood to Study on Controlling Perioperative Stress Responses and Preventing Complications of Surgery
【作者】 苏帆；
【导师】 姜建国；
【作者基本信息】 山东中医药大学 ， 中医临床基础， 2013， 博士
【摘要】 目的以气血理论为基础，研究围术期应激反应及相关并发症的中医理论，探讨该理论指导下的中医药围术期应激反应调控及相关并发症的防治思路。方法以应激反应机制、神经－内分泌－免疫学说和中医气血平衡与肾元理论为基础，采用类比方法分析围术期应激反应发生发展以及与其相关并发症发生的中医机制；对比研究中药调控围术期应激反应及相关并发症病理学模型有效的生物学证据和中医机制；临床观察血流动力学及血凝状态改变与气血平衡的关系，以及气血平衡状态与应激反应水平的关系。结果分析对比认为围术期应激反应的激发就是肾气调动的过程；应激反应引起的器官高消耗代谢期就是肾元气大量损耗的阶段；而应激反应终末发生的系统器官功能障碍就是肾气虚衰导致气虚血瘀发生脏腑功能紊乱的结果。该理论指导下的中药干预可调控围术期应激反应，取得在应激状态、免疫介质和炎性因子水平等方面调控有效的证据；结论围术期应激反应发生发展与结局与肾气调动损耗后的气血平衡状态紊乱导致的气虚血瘀密切的平行关系；提出“培元固本、回阳补气”调控应激反应防治并发症的理论思想。
【Abstract】 Objective With qi-blood of TCM as theoretical guidance to study on the relative theoriesabout perioperative stress response, and to explore the mathods and mechanisms of controllingperioperative stress response with chinese medicine drug under these relative theories. MathodsWith the mechanisms of stress response, neuro-endocrine-immune theory and qi-blood ofTCM,and adoptting the analogy analytical method to analyze the traditional chinese medicinemechanisms of perioperative stress response. Use comparative study to explore the effectivebiological evidences of intervention pathological model with antiinflammatory and chinesemedicine drug.To make a clinical observation about mediate factors and developmentmechanism of inducing postoperative stess response of old people. Results Exploring Resultsshow that the development of perioperative stress response is a process of mobilized theprimordial qi of kidney, and the systemic function injuries caused by the ultimate stress responsea “inceptive kidney asthenia,qi asthenia greater than blood deficiency and qi deficiency bloodstasis”, and traditional chinese medicine can control the levels of stress hormone, immune functionand inflammatory factor. Conclusion To establish a series of TCM about postoperativestess responses, that is “inceptive kidney asthenia,qi asthenia greater than blood deficiency and qideficiency blood stasis”, make a suggestion of “Pei-yuan strengthening the economy and therestoring yang reinforcing qi” to control the postoperative stess responses with traditional chinesedrug.