世界中医药

目的：评价山东省肺病科、儿科医师咳嗽诊疗的认知情况。方法：选取2016年4—6月山东省内87家中医院，1 268名肺病科、儿科临床医师，采用调查问卷的方法，了解其对咳嗽中西医诊疗的认知情况。结果：在咳嗽的概念认知方面，肺病科医师及儿科医师均认为中西医教材是咳嗽诊断和治疗依据来源的首位；认为外感咳嗽发病率最高的季节均是冬季；痰湿质、气虚质、阴虚质为前3位最常见的内伤咳嗽患者体质；外感咳嗽最为常见。肺病科医师及儿科医师均认为辨外感内伤是首要的辨证要点；在咳嗽的辨证分型上,外感咳嗽之风寒袭肺证最常见，内伤咳嗽之痰湿蕴肺证最常见；肺病科及儿科医师认为风寒、风热咳嗽最主要的鉴别点是咳痰颜色；对于风寒咳嗽入里化热时间，儿科医师认为更短。咳嗽的诊疗上，均认为胸部X线正位片是最常见的咳嗽检查方法；内科及儿科大夫对于咳嗽频剧的患者常用的中药均是杏仁、桔梗、紫苑、蜜百部；对于咯痰量多的患者，常用的前4位中药均是半夏、陈皮、茯苓、瓜蒌。对于久咳不愈的患者，内科大夫及儿科大夫均依次选择敛肺、补气、养阴之品。治疗风寒袭肺之咳嗽，内科与儿科大夫常用的前3位中药均是麻黄、杏仁、荆芥；治疗风热犯肺之咳嗽，前3位中药均是桑叶、菊花、连翘；治疗燥邪伤肺之咳嗽，前3位中药均是麦冬、北沙参、桑叶。在预防调摄上，内科及儿科医师均认为膏方水丸是治疗久治不愈咳嗽患者的最适合的调摄方式。结论：明确了临床肺病科医师及儿科医师对咳嗽诊疗的认知水平，可为进一步修订咳嗽中医诊疗指南提供客观依据，为更好针对临床医师进行指南的推广提供参考。

English Summary:

To provide basis for promoting the implementation of clinical guidelines for diagnosis and treatment of traditional Chinese medicine, and to make standards better reflect the clinical diagnosis and treatment of traditional Chinese medicine. To improve diagnosis and treatment of lung disease, pediatric residency, by carrying out cough cognitive experience survey work. Methods:Questionnaire method: 1 268 lung disease, pediatric clinicians from 87 hospitals of Shandong province from Apr to Jun of 2016 were received questionnaire survey about their perceptions of their cough diagnosis and treatment of traditional Chinese and Western medicine. Results:According to the clinical investigations, in the cognitive aspects of cough, lung disease physicians and pediatricians agreed that western medicine textbooks were the first way of cough diagnosis and treatment; it was believed that the season of highest incidence of cough was winter, and phlegm-dampness, deficiency of qi and yin deficiency were the top 3 of the most common constitutions of internal injuries patients with cough; In the syndrome differentiation type of cough, the wind cold invading the lung syndrome was the most common in exogenous cough, and the phlegm and dampness accumulating in the lung was the most common in internal damage cough. Internal medicine and pediatricians believed that the main distinguishing point of wind cold and wind heat cough was the color of expectoration; for wind cold cough, pediatricians thought the time of heat transformation was shorter. In the diagnosis and treatment of cough, chest X-ray film was considered to be the most common method for cough examination; the medicines used by internal medicine physicians and paediatric doctors for frequent cough were Semen Armeniacae Amarum, Radix Platycodonis, Aster tataricus L. f., honey Radix Stemonae; For patients with profuse expectoration, the four Chinese herbal medicines commonly used were Rhizoma Pinelliae, Pericarpium Citri Reticulatae, Poria, and Fructus Trichosanthis. For those patients who suffer from chronic cough, doctors of internal medicine and pediatric chose the herbs with actions of converging lungs, replenishing qi, and nourishing yin. For the treatment of cough caused by wind cold invading the lung, the first three Chinese herbs were Herba Ephedrae, Semen Armeniacae Amarum, and Herba Schizonepetae. For the treatment of wind heat invading the lung cough, the first three Chinese herbs were Folium Mori, Flos Chrysanthemi, and Fructus Forsythiae. For the treatment of dryness pathogen damaging the lung cough, the first three Chinese herbs were Radix Ophiopogonis, Radix Glehniae, and Folium Mori. In prevention and regulation, both internal medicine doctors and pediatricians believed that cream formula and water-bindered pill are the most suitable method of regulation. Conclusion:Through clinical investigation, the cognition level of clinical pulmonologists and pediatricians for cough diagnosis and treatment can be clarified, which can provide objective basis for further revision of cough by traditional Chinese medicine diagnosis and treatment guideline, so as to provide reference for better promotion of guidelines for clinicians.

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