【目的】探析肺肠同治理论指导下宣白承气汤结合肠内营养支持在慢性阻塞性肺疾病急性加重 （AECOPD） 治疗中的应用 价值。 【方法】将92例AECOPD肺热腑实型患者随机分为观察组和对照组，每组各46例。2组患者均给予常规对症治疗，在 此基础上，对照组给予肠内营养支持干预，观察组给予宣白承气汤结合肠内营养支持干预，疗程为2周。观察2组患者治疗 前后血清白蛋白 （albumin，ALB） 、前白蛋白 （prealbumin，PA） 、转铁蛋白 （transferrin，TF） 等营养指标及肠道菌群分布的变 化情况，并比较2组患者的临床疗效及不良反应发生率。 【结果】（1） 疗效方面，治疗2周后，观察组的总有效率为97.83% （45/46） ， 对照组为82.61% （38/46） ，组间比较 （χ2 检验） ，观察组的疗效明显优于对照组，差异有统计学意义 （P＜0.05） 。 （2） 营养指标方 面，治疗后，2组患者的血清ALB、PA、TF水平均较治疗前明显升高 （P＜0.05） ，且观察组对血清ALB、PA、TF水平的升高 幅度均明显优于对照组，差异均有统计学意义 （P＜0.05或P＜0.01） 。 （3） 肠道菌群分布方面，治疗后，2组患者的乳杆菌、双 歧杆菌菌种数量均较治疗前明显升高 （P＜0.05） ，肠球菌菌种数量均较治疗前明显降低 （P＜0.05） ，且观察组对肠道乳杆菌、 双歧杆菌菌种数量的升高幅度及对肠球菌菌种数量的降低幅度均明显优于对照组，差异均有统计学意义 （P＜0.05或P＜ 0.01） 。 （4） 不良反应方面，观察组的不良反应发生率为4.35% （2/46） ，明显低于对照组的19.57% （9/46） ，组间比较，差异有统 计学意义 （P＜0.05） 。 【结论】肺肠同治理论指导下宣白承气汤结合肠内营养支持应用于AECOPD肺热腑实型患者临床效果显 著，可有效改善患者营养状态及肠道菌群失衡，降低不良反应发生风险。

Objective To explore the application value of Xuanbai Chengqi Decoction combined with enteral nutrition support in the treatment of acute exacerbation of chronic obstructive pulmonary disease （AECOPD） guided by the theory of simultaneous treatment of lung and intestine. Methods A total of 92 patients with AECOPD were randomly divided into an observation group and a control group，46 cases in each group. Both groups were given routine symptomatic treatment. In addition，the control group was given enteral nutrition support intervention，and the observation group was given Xuanbai Chengqi Decoction combined with enteral nutrition support intervention. The course of treatment lasted for two weeks. The changes in the nutritional parameters such as serum albumin （ALB） ，prealbumin （PA） ，and transferrin （TF） ，and in the distribution of intestinal flora of the two groups were observed before and after treatment. After treatment，the clinical efficacy and the incidence of adverse reactions were compared between the two groups. Results （1） After two weeks of treatment，the total effective rate of the observation group was 97.83%（45/46），and that of the control group was 82.61%（38/46） . The comparison between the two groups （tested by chi-square test） showed that the therapeutic efficacy of the observation group was significantly superior to that of the control group，and the difference was statistically significant（P＜0.05） . （2）After treatment，the serum levels of nutritional parameters of ALB，PA and TF in the two groups were significantly higher than those before treatment （P＜0.05） ，and the increase of serum ALB，PA and TF levels in the observation group was significantly superior to that in the control group，the differences being statistically significant （P＜0.05 or P＜0.01） . （3） After treatment，the number of Lactobacillus and Bifidobacterium strains of intestinal flora in the two groups was significantly higher than that before treatment （P＜0.05） ，and the number of Enterococcus strain was significantly lower than that before treatment（P＜0.05） . The increase in the number of Lactobacillus and Bifidobacterium strains and the decrease in the number of Enterococcus strains in the observation group were significantly superior to those in the control group，and the differences were statistically significant （P＜0.05 or P＜0.01） . （4） The incidence of adverse reactions in the observation group was 4.35% （2/46） ，which was significantly lower than that in the control group （19.57%，9/46） . The difference between the two groups was statistically significant （P＜0.05） . Conclusion Significant clinical efficacy has been achieved after the application of Xuanbai Chengqi Decoction combined with enteral nutrition support in treating AECOPD patients with lung heat and bowel excess syndrome guided by the theory of simultaneous treatment of lung and intestine. The combined therapy is effective on improving the nutritional status and intestinal flora imbalance of patients，and reducing the incidence of adverse reactions.

R259.63

国家重点研发计划“中医药现代化研究”重点专项项目 （编号：2018YFC1704803）；河北省中医药管理局中医药类科研计划项目 （编号：2022543）