護(hù)理醫(yī)學(xué)中醫(yī)護(hù)理學(xué)課件感冒咳嗽哮喘

中醫(yī)內(nèi)科護(hù)理主講：高健GoalsofStudying掌握各個病證的病情分析及護(hù)理。掌握相關(guān)專業(yè)詞匯。熟悉各個病證的定義。了解各個病證的健康指導(dǎo)。能夠靈活運(yùn)用理論知識對個案進(jìn)行有針對性的護(hù)理。://class.ibucm/neikehl/12/hll.htmibucm/neikehl/l2/hl1.htm感冒CommoncoldCommoncoldDefinition

Commoncold

是感受觸冒外邪所導(dǎo)致的常見外感疾病，臨床表現(xiàn)以鼻塞，流涕，噴嚏，頭痛，惡寒、發(fā)熱、全身不適等為特征。四季均可發(fā)病，尤以冬春季節(jié)為多。

感冒一名，北宋《仁齋直指方》即有記載。而《內(nèi)經(jīng)》已指出感冒主要是外感風(fēng)邪所致。元《丹溪心法·傷風(fēng)》明確指出病位屬肺，根據(jù)辨證，分列辛溫、辛涼兩大治法。此后醫(yī)家又對虛人感冒有進(jìn)一步的認(rèn)識，提出扶正達(dá)邪的治療要求。CommoncoldCauseofDiseaseandPathomechanism六淫(sixexogenouspathogenicfactors)時行病毒(seasonalvirus)人體正氣(healthqi

)不足其病機(jī)關(guān)鍵在于邪實(shí)正虛(excessofevilandastheniaofhealthqi

)。

CommoncoldAnalysesofpathologicalconditions風(fēng)寒感冒(commoncoldduetowind-cold)風(fēng)熱感冒(commoncoldduetowind-heat)暑濕感冒(commoncoldduetosummer-dampness)體虛感冒氣虛感冒

(commoncoldduetoastheniaofqi)陰虛感冒(commoncoldduetoastheniaofyin)CommoncoldAnalysesofpathologicalconditionsCommoncoldduetowind-cold

惡寒重，發(fā)熱輕，無汗頭痛，肢體痰楚，鼻塞聲重，時流清涕，咽癢咳嗽，痰稀薄色白，口不渴或喜熱飲，苔薄白而潤，脈浮或浮緊。CommoncoldAnalysesofpathologicalconditionsCommoncoldduetowind-heat

身熱較著，微惡風(fēng)，汗泄不暢，頭脹痛，鼻塞，流黃濁涕，口渴欲飲，咽喉紅腫疼痛，咳嗽，痰黃粘稠，苔薄黃，脈浮數(shù)。CommoncoldAnalysesofpathologicalconditionsCommoncoldduetosummer-dampness

身熱，微惡風(fēng)，汗少，肢體酸重或疼痛，頭昏重脹痛，咳嗽痰粘，鼻流濁涕，心煩口渴，或口中粘膩，渴不多飲，胸悶，泛惡，小便短赤，舌苔薄黃而膩，脈濡數(shù)。CommoncoldAnalysesofpathologicalconditionsCommoncoldduetoastheniaofqi

經(jīng)常感冒，反復(fù)不愈，惡寒重，發(fā)熱，咳嗽，咳痰無力，氣短，倦怠，舌淡苔白，脈浮無力。

Commoncoldduetoastheniaofyin

頭痛身熱，微惡風(fēng)寒，少汗，頭昏，心煩，口干，于咳少痰，舌紅少苔，脈細(xì)數(shù)。CommoncoldProblemsofpatientsNursinggoalsCommoncoldNursinginterventions

Commoncoldduetowind-coldPrincipleofnursing：辛溫解表Entiretynursing：

Lifecare：Dietcare：Drugscare：Acupuncture：Tuina：CommoncoldNursinginterventionsCommoncoldduetowind-heatPrincipleofnursing：辛涼解表Entiretynursing：

Lifecare：Dietcare：Drugscare：Acupuncture：Tuina：CommoncoldNursinginterventions

Commoncoldduetosummer-dampnessPrincipleofnursing：驅(qū)濕解表Entiretynursing

：

Lifecare：Dietcare：Drugscare：Acupuncture：Tuina：CommoncoldNursinginterventions

CommoncoldduetoastheniaofqiPrincipleofnursing：益氣解表Entiretynursing

：

Lifecare：Dietcare：Drugscare：Acupuncture：Tuina：CommoncoldNursinginterventions

CommoncoldduetoastheniaofyinPrincipleofnursing：滋陰解表Entiretynursing

：

Lifecare：Dietcare：Drugscare：Acupuncture：Tuina：CommoncoldNursingevaluationIntroductiononhealth氣候突變時要注意保暖，坐臥須防外邪。保持室內(nèi)空氣流通，或選用食醋熏蒸法、消毒香熏法等做空氣消毒。時行感冒流行期間，可用板藍(lán)根沖劑預(yù)防給藥。積極參加體育鍛煉，以增強(qiáng)體質(zhì)。

CommoncoldCough咳嗽Teachingobjectives熟悉咳嗽的病因病機(jī)了解其診斷與鑒別診斷熟悉外感咳嗽及內(nèi)傷咳嗽的護(hù)治原則掌握常見七種類型咳嗽的辨證施護(hù)了解預(yù)防與調(diào)養(yǎng)。

Whatiscough?Definition

Cough是指肺氣上逆做聲，咯吐痰涎而言，為肺系疾病的主要證候之一。分別言之，有聲無痰為咳，有痰無聲為嗽，一般多痰、聲并見，故以咳嗽并稱。

EvolutionHistory《內(nèi)經(jīng)》對咳嗽已有論述，《素問·咳論》明確指出“五臟六腑皆令人咳，非獨(dú)肺也?！泵鞔鷱埦霸缹⒖人詺w納為外感、內(nèi)傷兩大類，為咳嗽的辨證奠定了基礎(chǔ)。

Whatisitscause?CauseofDisease&Pathomechanism

咳嗽的病因有外感與內(nèi)傷兩大類，外感咳嗽為六淫外邪人侵肺系；內(nèi)傷咳嗽為臟腑功能失調(diào)，內(nèi)邪干肺。病機(jī)關(guān)鍵在于肺失宣肅，肺氣上逆而作咳。外感咳嗽(exogenouscough)內(nèi)傷咳嗽(coughduetointernalinjury)Analysesofpathologicalconditions

exogenouscough

coughduetointernalinjury風(fēng)寒襲肺

風(fēng)熱犯肺

風(fēng)燥傷肺

痰濕犯肺

痰熱郁肺

肝火犯肺肺陰虧耗

Exogenouscough風(fēng)寒襲肺(wind-coldattackinglung)

咳嗽聲重，氣急，咽癢，咳痰稀薄色白，常伴有鼻塞、流清涕、頭痛、肢體酸楚、惡寒發(fā)熱、無汗等表證，苔薄白，脈浮或浮緊。AnalysesofpathologicalconditionsExogenouscough風(fēng)熱犯肺(wind-heatattackinglung)

咳嗽頻劇，氣粗，或咳聲嘶啞，喉癢咽痛，咳痰不爽，痰粘稠或色黃，咳時汗出，常伴有鼻流黃涕、口渴、身熱等表證，舌苔薄黃，脈浮數(shù)。AnalysesofpathologicalconditionsExogenouscough風(fēng)燥傷肺(wind-drynessattackinglung)

干咳頻作，連聲作嗆，咽喉干痛，唇鼻干燥，無痰，或痰少而粘連成絲，不易咳出，痰中帶血絲，口干，初起可伴有鼻塞、頭痛、微寒身熱等表證，苔薄白或薄黃，質(zhì)紅，干而少津，脈浮數(shù)。AnalysesofpathologicalconditionsCoughduetointernalinjury痰濕犯肺(phlegm-dampnessobstructinglung

)

咳嗽反復(fù)發(fā)作，咳聲重濁，痰多，因痰而咳，痰出咳平，痰粘膩或稠厚成塊，色白或黃灰色，胸悶，脘痞，嘔惡，食少，體倦，大便時溏，苔白膩，脈濡滑。AnalysesofpathologicalconditionsCoughduetointernalinjury痰熱郁肺(stagnationofphlegm-dampnessinlung)

咳嗽氣息粗促，或喉間有痰聲，痰多質(zhì)粘或稠黃，咯吐不爽，或吐血痰，胸脅脹滿，咳時引痛，面赤，或有身熱，口干欲飲，舌紅，苔薄黃膩，脈滑數(shù)。AnalysesofpathologicalconditionsCoughduetointernalinjury肝火犯肺(liver-fireattackinglung)

上氣咳逆陣作，咳時面赤，咽干，常感痰滯咽喉，咯之難出，量少質(zhì)粘，胸脅脹痛，咳時引痛，口干苦，可隨情緒波動而增減，舌苔薄黃少津，脈弦數(shù)。

AnalysesofpathologicalconditionsCoughduetointernalinjury肺陰虧耗(lackoflung-yin)

干咳，咳聲短促，痰少粘白，或痰中夾血，或聲音逐漸嘶啞，口干咽燥，或午后潮熱顴紅，手足心熱，盜汗，神疲，舌質(zhì)紅，少苔，脈細(xì)數(shù)。Analysesofpathologicalconditions診斷Diagnosis鑒別診斷

Differentialdiagnosis

&診斷Diagnosis咳逆有聲，或伴咽癢咯痰。外感咳嗽，起病急，可伴有寒熱等表證；內(nèi)傷咳嗽，每因外感反復(fù)發(fā)作，病程較長，咳而伴喘。急性期，血白細(xì)胞總數(shù)和中性粒細(xì)胞增高。聽診可聞及兩肺野呼吸音增粗，或伴散在干濕性羅音。肺部Ｘ線攝片檢查，正?；蚍渭y理增粗。ProblemsofpatientsNursinggoalsExogenouscoughwind-coldattackinglung

Principleofnursing：疏風(fēng)散寒，宣肺止咳

Entiretynursing

：Lifecare：Dietcare：Drugscare：Acupuncture：Tuina：：NursinginterventionsExogenouscoughwind-heatattackinglung

Principleofnursing：疏風(fēng)清熱，宣肺化痰

Entiretynursing

：Lifecare：Dietcare：Drugscare：Acupuncture：Tuina：NursinginterventionsExogenouscoughwind-drynessattackinglung

Principleofnursing：疏風(fēng)清肺，潤燥止咳

Entiretynursing

：Lifecare：Dietcare：Drugscare：Acupuncture：Tuina：NursinginterventionsCoughduetointernalinjuryphlegm-dampnessobstructinglung

Principleofnursing：健脾燥濕，化痰止咳

Entiretynursing

：Lifecare：Dietcare：Drugscare：Acupuncture：Tuina：NursinginterventionsCoughduetointernalinjurystagnationofphlegm-dampnessinlung

Principleofnursing：清熱化痰肅肺

Entiretynursing

：Lifecare：Dietcare：Drugscare：Acupuncture：Tuina：NursinginterventionsCoughduetointernalinjuryLiver-fireattackinglung

Principleofnursing：清肺平肝，順氣降火

Entiretynursing

：Lifecare：Dietcare：Drugscare：Acupuncture：Tuina：NursinginterventionsCoughduetointernalinjuryLackoflung-yin

Principleofnursing：滋陰潤肺，止咳化痰

Entiretynursing

：Lifecare：Dietcare：Drugscare：Acupuncture：Tuina：NursinginterventionsNursingevaluationIntroductiononhealth

防寒保暖，避免外邪侵襲。若已有感冒跡象者，可服用姜糖水或解表藥以驅(qū)邪外出。鍛煉身體，增強(qiáng)體質(zhì)，配合氣功或呼吸操戒煙，忌食辛辣油膩之品。哮證WheezingsyndromeWheezingsyndromedefinition

Wheezingsyndrome

是一種發(fā)作性的痰鳴氣喘疾患。發(fā)作時喉中哮鳴有聲，呼吸氣促困難，甚則喘息不能平臥。

哮證發(fā)作期的基本病理變化為“伏痰（latentphlegm)”遇感飲觸，痰隨氣升，氣因痰阻，相互搏結(jié)，壅塞氣道，肺氣宣降失常，引動停積之痰，而致痰鳴如吼，氣息喘促。

CauseofDisease&PathomechanismAnalysesofpathologicalconditions寒哮(coldwheezing)：呼吸急促，喉中哮鳴有聲，胸膈滿悶如塞，咳不甚，痰少咯吐不爽，面色晦滯，口不渴；或渴喜熱飲，天冷或受寒易發(fā)，形寒肢冷，舌苔白滑，脈弦緊或浮緊。熱哮(hotwheezing)：氣喘息涌，喉中痰鳴如吼，胸高脅脹，嗆咳陣作，咳痰色黃或白，粘濁稠厚，排吐不利，煩悶不安，汗出，面赤，口苦，口渴喜飲，舌紅，苔黃膩，脈弦滑或滑數(shù)。

WheezingsyndromeProblemsofpatientsNursinggoalsWheezingsyndromeNursinginterventionsColdwheezing

Principleofnursing

：溫肺散寒，化痰平喘

EntiretynursingLifecare：Dietcare：Drugscare：Acupuncture：Othermethods:WheezingsyndromeNursinginterventionsHotwheezing

Principleofnursing

：清熱宣肺，化痰平喘

Entiretynursing:Lifecare：Dietcare：Drugscare：Acupuncture：Othermethods：WheezingsyndromeNursingevaluationIntroductiononhealth可視身體情況進(jìn)行跑步、太極拳、冷水浴等鍛煉。避免接觸刺激性的氣體、灰塵、花粉等，忌吸煙。飲食宜清淡，忌食肥甘、腥膻、辛辣、生冷等。

Wheezingsyndrome喘證Asthmasyndrome/dyspneasyndrome了解喘證的概念，范圍熟悉喘證的病因病機(jī)掌握實(shí)喘與虛喘的鑒別診斷和各證型的辨證施護(hù)熟悉喘脫的護(hù)治措施了解預(yù)防與調(diào)養(yǎng)。TeachingobjectivesDefinitionAsthmasyndrome

是以呼吸困難，甚至張口抬肩，鼻翼煽動，不能平臥為特征。嚴(yán)重者可持續(xù)不解，發(fā)生喘脫。

EvolutionHistory《內(nèi)經(jīng)》認(rèn)為喘證以肺為主病之臟，并且描述了喘證的臨床特點(diǎn)?！督饏T要略·肺痿肺癰咳嗽上氣病》中，“上氣”即指喘息不能平臥的癥候。明張景岳把喘證歸納為虛實(shí)兩類，指出喘證的辨證綱領(lǐng)。清·葉天士進(jìn)一步指出喘證“在肺為實(shí)，在腎為虛”，為喘證的病機(jī)重點(diǎn)。CauseofDisease&Pathomechanism總之，喘證病因有外感與內(nèi)傷，病性有虛實(shí)不同，病位主要在肺腎兩臟，實(shí)喘(stheniadyspnea/excessdyspnea)在肺，為外邪、痰濁、肝郁氣逆等，邪壅肺氣，宣降不利；虛喘(asthenia-asthma/deficiency-asthma)責(zé)之于肺腎兩臟，因精氣不足，氣陰虧耗而致肺腎出納失常，重點(diǎn)在腎，且以氣虛為主。

AnalysesofpathologicalconditionsExcessdyspneaAstheniaasthma風(fēng)寒襲肺表寒里熱痰濁阻肺肺氣郁痹

肺虛

腎虛ExcessdyspneaWind-coldattackinglung

喘咳氣急，胸部脹悶，痰多稀薄色白，兼有頭痛，惡寒，或伴發(fā)熱，口不渴，無汗，苔薄白而滑，脈浮緊。AnalysesofpathologicalconditionsExcessdyspnea表寒里熱(exteriorcoldandinteriorheat)

喘逆上氣，胸脹或痛，鼻煽，咳而不爽，咳痰稠粘，伴有形寒，身熱，煩悶，身痛，有汗或無汗，口渴，舌質(zhì)紅，苔薄白或黃，脈浮數(shù)或滑。AnalysesofpathologicalconditionsExcessdyspnea痰濁阻肺(turbidphlegmobstructinglung)

喘而胸滿窒悶，甚則胸盈仰息，咳嗽痰多粘膩色白，咯吐不利，兼有嘔惡，納呆，口粘不渴，苔白厚膩，脈滑。

AnalysesofpathologicalconditionsExcessdyspnea肺氣郁痹(obstructionofpulmonaryqi

)

每遇情志刺激而誘發(fā)，發(fā)時突然呼吸短促，但喉中痰聲不著，氣憋，胸悶胸痛，咽中如窒，失眠，心悸，苔薄，脈弦。AnalysesofpathologicalconditionsAsthenia-asthma肺虛(lung-asthenia)

喘促短氣，氣怯聲低，喉有鼾聲，咳聲低弱，痰吐稀薄，自汗惡風(fēng)，或咳嗆痰少，質(zhì)粘，煩熱口干，咽喉不利，舌質(zhì)淡紅或舌紅苔剝，脈軟弱或細(xì)數(shù)。

AnalysesofpathologicalconditionsAsthenia-asthma腎虛(kidney-asthenia)

喘促日久，動則喘甚，呼多吸少，氣不得續(xù)，形瘦神憊，汗出肢冷，面青唇紫，舌苔淡白，脈微細(xì)或沉弱?；虼龋婕t煩躁，足冷，汗出如油，舌紅少津，脈細(xì)數(shù)。Analysesofpathologicalconditions診斷Diagnosis鑒別診斷

Differentialdiagnosis

&診斷Diagnosis以氣短喘促，呼吸困難，甚至張口抬肩，鼻翼煽動，不能平臥，口唇發(fā)紺為特征多有慢性咳嗽，哮病，肺痿，心悸等病史，每遇外感及勞累而誘發(fā)。呈桶狀胸，叩診胸部呈過清音，心濁音界縮小或消失，肝濁音界下移，肺呼吸音減低。診斷Diagnosis可聞及干、濕性羅音或哮鳴音?；蚋文[大，下肢浮腫，頸靜脈怒張。合并感染者，白細(xì)胞總數(shù)及中性粒細(xì)胞可增高。必要時查血鉀、鈉，二氧化碳結(jié)合力及X線胸部攝片，心電圖，心、肺功能測定，血?dú)夥治龅?。ProblemsofpatientsNursinggoalsExcessdyspneaWind-coldattackinglung

Principleofnursing：宣肺散寒平喘

Entiretynursing:Lifecare：Dietcare：Drugscare：Acupuncture：Othermethods：NursinginterventionsExcessdyspneaE