【作者】 焦莉；

【导师】 韩云；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2011， 硕士

【摘要】 研究背景慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)是一种具有气流受限特征的可以预防和治疗的疾病,气流受限不完全可逆、呈进行性发展,常合并呼吸衰竭、肺心病等并发症,其患病人数多,死亡率高,社会经济负担重,已成为一个重要的公共卫生问题,目前尚无法使其病变逆转,急性加重期频繁发作,可使病情恶化而威胁患者的生命。总体而言,中医治疗COPD急性加重期呼吸衰竭有一定的疗效,但是目前中医辨证分型尚无统一的标准,缺乏科学、规范的诊断标准及疗效判定标准,从而导致研究结果的可比性及科学性较差,影响着中医临床应用推广和疗效的进一步提高。研究目的通过对COPD急性加重期呼吸衰竭中医证候及治疗的横断面调查研究,观察其证候规律,研究了解COPD急性加重期呼吸衰竭中医证候流行病学特征、分布规律及相应治疗规律,初步探讨COPD急性加重期呼吸衰竭的中医辨治规范。研究方法采用临床横断面调查研究方法,对符合纳入标准的病例进行横断面调查及完成信息采集表；信息采集表完成后经核查合格后使用EpiData 3.02构建COPD急性加重期呼吸衰竭中医证候信息数据库；研究方法采取spss17.0统计软件包进行统计分析,采用描述性分析、聚类分析的方法进行数据处理,初步探讨COPD急性加重期呼吸衰竭的中医证候的分布及辨治规律。研究结果1、COPD急性加重期呼吸衰竭患者的基本特点：本病好发于中老年男性,年龄多分布在76-85岁,病程多在10-19年,吸烟是其常见危险因素,外感及天气变化是其急性加重常见诱因,患者流行病学特征与国内外本病的流行病学调查结果有较大的一致性。2、中医症状分布：根据统计结果,咳嗽、咯痰、气喘三证所占频数较多,为COPD急性加重期呼吸衰竭主症。舌暗红、苔黄腻、脉滑数、脉弦滑为其常见舌脉,频数波动于38%-44%。3、中医证型分布：通过聚类分析得出痰热雍肺、痰瘀阻肺为其常见中医证型,其次为肺脾肾虚,痰热瘀阻、肺脾肾虚,痰瘀阻肺、痰蒙神窍。4、中医治法分布：本病治则多以急则治标为主,占65.3%,其次为标本兼治,占34.7%,而单纯补虚者较少见。治法上以清热化痰、活血化瘀为主,其中化痰占99.4,其次为活血化瘀、清热,分别占82.4%、50.3%。更多还原

【Abstract】 BackgroundChronic obstructive pulmonary disease (COPD) is a disease with the feature of airflow-limitat ion, which can be prevented and cued, not fully reversible airflow limitation, showing progressive development. COPD is often associated with respiratory failure, pulmonary heart disease and other complications Because of its big number of patients, high mortality, social and economic burdens, it has become an important public health problem. However, it is not yet possible to reverse the disease. Frequent episodes of acute exacerbation of this disease will worsen the disease even threaten the lives of patients Overall, TCM treatments for respiratory failure of COPD with acute exacerbation have a certain effect. But, until now there is no uniform classification of TCM standards, no scientific, standardized diagnostic criteria and standard for determining the efficacy, making comparability of results and scientific research poor, and influences the application and promotion of clinical TCM and further improvement of TCM effect.Object ivesThrough cross-sectional survey study of the syndromes and treatment of respiratory failure in Acute exacerbation of COPD, observation on the laws of the syndrome, and understanding of the epidemiological characteristics of TCM, distribution and the corresponding treatment law of COPD with acute exacerbation of respiratory failure, it is able lo build TCM Syndrome specifications of acute exacerbation of COPD with respiratory failure preliminarily. MethodsUsing cross-sectional survey of clinical research methods to do cross-sectional survey on cases that meet the inclusion criteria and complete the information collecting form; after inspecting the finishing information collection form for qualification, construct cute respiratory failure Syndrome Information Database using EpiData 3.02 COPD; Researching methods use spssl7.0 statistical package for statistical analysis, use Descriptive analysis and cluster analysis method for data processing, and discuss COPD acute respiratory failure in the distribution of the Syndrome and Treatment Law.Result1、Basic characteristics of COPD patients with acute respiratory failure The disease often occurs in middle-aged male, distribute in the 76-85 years old, and 10-19 years of the course of the disease, smoking is the common risk factor, exogenous and weather changes are common causes of the acute exacerbation, Epidemiological characteristics and epidemiology of the di sease at home and abroad there is great consistency.2、Symptoms Distribution:According to statistics, cough, expectoration, wheezing frequency greater share for respiratory failure in COPD with acute exacerbation of the primary disease. Dark red tongue, yellow greasy moss, pulse a few slip, slippery pulse string are their common tongue-pulse, frequency fluctuations in the 38%-44%.3、TCM Distribution:By Cluster analysis, Phlegm obstruct pulmonary, lung phlegm syndromes are common, followed by lung and spleen deficiency, phlegm stasis, lung and spleen kidney, lung phlegm, sputum God awakened.4、TCM treatments Distribution:The disease is more to treat the symptoms when it is acute, accounting for 65.3%, followed by treating the symptoms and its origin,34.7%, while those who simply tonic are rare. As for treatment, heat phlegm, promoting blood circulation mainly phlegm which accounted for 99.4, fol lowed by blood circulation, heat, respectively,82.4%,50.3%.更多还原