小兒肺炎中醫(yī)證型演變特點及不同年齡中醫(yī)證型分布特點

1、小兒肺炎中醫(yī)證型演變特點及不同年齡中醫(yī)證型分布特點         10-04-22 14:55:00     編輯：studa20                         作者：呂玉霞， 申聰， 黃陽， 李娜【摘要】 

2、目的 探討小兒肺炎中醫(yī)證型演變特點及不同年齡中醫(yī)證型分布特點。方法 通過對納入的380例小兒肺炎患兒，在治療當日(基線點)、治療后第3，5，7，10天觀察并記錄中醫(yī)證型，統(tǒng)計小兒肺炎在不同觀察時段中醫(yī)證型演變特點;觀察小兒肺炎治療當日的中醫(yī)證型分布與發(fā)病年齡有否相關性。結果 380例小兒肺炎在基線點至治療后第3天，以風熱閉肺證、痰熱閉肺證為主，各證型發(fā)生轉變的病例較少。在治療后第5天，仍以風熱閉肺證、痰熱閉肺證為主，大部分證型發(fā)生了證型轉變。在治療后第7天，部分證型轉至陰虛肺熱證、肺脾氣虛證。在治療后第10天，風寒閉肺證、風熱閉肺證、痰熱閉肺證絕大多數(shù)恢復正常。380例小兒肺炎中痰熱閉肺證、毒

3、熱閉肺證主要見于13歲小兒;風熱閉肺證、痰熱閉肺證主要見于47歲肺炎患兒;風寒閉肺證和風熱閉肺證主要見于814歲肺炎患兒。結論 小兒肺炎中醫(yī)證型在疾病發(fā)展過程中，呈現(xiàn)動態(tài)演變過程，從而使各證型在不同觀察時段的分布具有一定特點;小兒肺炎的中醫(yī)證型分布與發(fā)病年齡有相關性。 【關鍵詞】  肺炎; 證型演變特點; 年齡分布特點; 兒童Evolvement characteristics of syndrome types and distribution characteristics of different ages of TCM syndromes in infantile pneum

4、onia LV Yuxia，SHEN Cong，HUANG Yang，et al. Department of Pediatrics, the First Hospital Affiliated to Heilongjiang University of TCM, Harbin 150040,China【Abstract】 Objective To explore evolvement characteristics of syndrome types and distribution characteristics of different ages of TCM syndromes in

5、infantile pneumonia.Methods Through the clinical observation of 380 children patients with infantile pneumonia, we observed and recorded the syndrome types of the patients on the day of admission (basic point), and on the 3rd, 5th, 7th and 10th day after medication， to explore evolvement characteris

6、tics of syndrome types in different observation period. We also observed the correlation between the distribution of TCM syndromes and ages on the day of admission.Results Of the 380 cases of pneumonia in children，from baseline point to the 3rd day after treatment，windheat lung affection and phlegma

7、ccumulation lung affection were the major types，and fewer cases had change of types.Five days after treatment，the abovementioned two types were still the major ones，but most cases had change of types.On the 7th day of treatment，some cases changed to Yindeficiency lung affection and insufficiency of

8、lungqi and spleenqi.On the tenth day，most of the windcold lung affection，windheat lung affection and phlegmaccumulation lung affection turned to normal cases.Of the 380 cases of pneumonia，phlegmaccumulation lung affection and toxicheat lung affection were presented mainly in children aged one to thr

9、ee，windheat lung affection and phlegmaccumulation lung affection were presented mainly in children aged 4 to 7，and windcold lung affection and windheat lung affection were presented mainly in children aged 8 to 14.Conclusion TCM syndromes of infantile pneumonia is a dynamic evolution process during

10、the whole disease course, so distribution of each type has certain characteristics in different periods. There is correlation between distribution of TCM syndromes and ages.【Key words】 Pneumonia; Evolvement characteristics of syndrome types; Distribution characteristics of different ages; Children中醫(yī)

11、辨證是施治的關鍵，因此，研究小兒肺炎中醫(yī)證型演變特點對提高辨證的準確性，制定有針對性的治療方案，提高臨床療效具有重要意義。筆者與遼寧中醫(yī)藥大學附屬醫(yī)院王雪峰教授在進行國家科技部攻關計劃課題“以小兒肺炎為示范建立辨證規(guī)范及中醫(yī)療效評價方法體系的研究”的基礎上，對居住在黑龍江地區(qū)小兒肺炎中醫(yī)證型演變特點及不同年齡中醫(yī)證型分布特點進行了臨床研究?，F(xiàn)將研究結果報告如下。1 資料與方法1.1 臨床資料 200603200903黑龍江中醫(yī)藥大學附屬第一醫(yī)院兒科門診和病房收治急性肺炎(肺炎喘嗽)患兒2 364例，從中篩選病例380例，其中男208例，女172例;年齡1歲且<3歲183例，3歲且<

12、7歲147例，7歲且14歲50例。均為居住在黑龍江地區(qū)的患兒。1.2 診斷標準1.2.1 西醫(yī)診斷標準 按照中華人民共和國衛(wèi)生部1986年小兒四病防治方案小兒肺炎診斷依據(jù)及1987年全國小兒呼吸疾病會議制定的標準1。1.2.2 中醫(yī)診斷標準 依據(jù)1994年國家中醫(yī)藥管理局中醫(yī)病證診斷療效標準2及新世紀全國高等中醫(yī)藥院校七年制規(guī)劃教材中醫(yī)兒科學肺炎喘嗽常證診斷標準3。1.3 病例納入標準 符合西醫(yī)小兒肺炎診斷標準者;符合中醫(yī)小兒肺炎喘嗽診斷標準者;年齡1歲且14歲者;病程7 d者。1.4 病例排除標準 小兒肺炎重癥及有并發(fā)癥者;小兒肺炎伴有原發(fā)性心血管、肝、腎及造血系統(tǒng)和精神神經(jīng)系統(tǒng)疾病者;年齡

13、<1歲且>14歲者。1.5 臨床觀察項目1.5.1 肺炎的臨床指標 發(fā)熱、咳嗽、痰壅、喘促、肺部聽診細濕啰音。1.5.2 中醫(yī)辨證分型 小兒肺炎根據(jù)臨床表現(xiàn)分為：(1)風寒閉肺證：惡寒發(fā)熱，無汗不渴，咳嗽氣急，痰稀色白，舌質(zhì)淡紅;苔薄白，脈浮緊或指紋浮紅;(2)風熱閉肺證：發(fā)熱惡風，微有汗出，口渴欲飲，咳嗽，痰稠色黃，呼吸急促，咽紅;舌尖紅，苔薄黃，脈浮數(shù)或指紋紫滯;(3)痰熱閉肺證：壯熱煩躁，喉間痰鳴，痰稠色黃，氣促喘憋，鼻翼煽動，或口唇青紫;舌質(zhì)紅，苔黃膩，脈滑數(shù);(4)濕熱閉肺證：身熱不揚，咳聲重濁，痰多黏稠，色白或黃;肢體困倦，腹脹，納呆，溲赤;舌苔黃膩，脈滑;(5)毒熱閉肺證：高熱持續(xù)，咳嗽劇烈，氣急鼻煽，甚至喘憋，涕淚懼無，鼻孔干燥如煙煤，面赤唇紅，煩躁口渴，溲赤便秘;舌紅而干，舌苔黃膩，脈滑數(shù);(6)陰虛肺熱證：病程延長，低熱出汗，面色潮紅，干咳無痰;舌質(zhì)紅而干，苔光剝，脈細數(shù);(7)肺脾氣虛證：病程延長，低熱起伏，氣短多汗，咳嗽無力，納差，便溏，面色淡白，神疲乏力，四肢欠溫;舌質(zhì)偏淡，苔薄白，脈細無力