Interstitial pneumonia is inflammation of interstitial tissue of lung. Inflammation mainly invades the alveolar wall of the bronchial wall, especially the connective tissue between the lobules around the bronchial vessels and the alveolar septum, and most of them are necrotic lesions.
Interstitial pneumonia is mostly caused by viruses, mainly adenovirus, respiratory syncytial virus, influenza virus, parainfluenza virus and measles virus. Interstitial pneumonia caused by adenovirus and influenza virus is more common and serious, often forming necrotizing bronchitis and bronchopneumonia, and it is easy to evolve into chronic pneumonia with prolonged course of disease.
Mycoplasma pneumoniae can also cause interstitial pneumonia. Mycoplasma mainly invades bronchioles and tissues around bronchi after invading through respiratory tract, and can recover completely because there is no destructive lesion.
therapeutic regimen
Traditional therapy
Idiopathic pulmonary interstitial fibrosis is a progressive disease. The average natural course of untreated patients is 2 ~ 4 years, which can be extended to about 6 years after the application of adrenocortical hormone. Both early and late stages should be treated immediately, which can improve the absorption of new alveolitis, improve some fibrosis and prevent the development of the disease. Glucocorticoid is the first choice, followed by immunosuppressants and traditional Chinese medicine. Adrenal cortical hormone can regulate inflammation and immune process, reduce the content of immune complex, inhibit the proliferation of alveolar macrophages and the function of T lymphocyte factors. When used for alveolitis and cell exudation, it can improve the absorption of lung X-ray shadow in some patients, significantly improve clinical symptoms and improve lung function. If the treatment is started at the stage of extensive interstitial fibrosis and honeycomb lung, the clinical symptoms can be improved to varying degrees, but there is no obvious progress in lung shadow and lung function. The routine initial dose of chronic type is 40 ~ 60 mg/d of prednisone, which is taken 3 ~ 4 times. When the condition is stable and X-ray shadow is no longer absorbed, the dosage can be gradually reduced, and the dosage can be reduced by 5mg each time after 4-8 weeks. When it is reduced to 20mg/d, it should be reduced by 2.5mg per week, and the maintenance of 10mg/d should be shorter than 1 year. If the disease recurs and gets worse during the reduction process, the dose should be increased again to control the disease, which is still effective. The course of treatment can be extended to two years, and it can be used for life if necessary. Attention should be paid to the detection of drug side effects, so as to achieve the best effect with the minimum dose and the least side effects. Attention should be paid to opportunistic pathogen infection, tuberculosis recurrence, combined use of anti-tuberculosis drugs when necessary, and fungal infection when glucocorticoid is used for a long time. If the condition is dangerous or acute, glucocorticoid shock therapy can be used, such as methylprednisolone (methylprednisolone) 500mg/d for 3 ~ 5 days, and oral administration can be changed after the condition is stable. Finally, according to individual differences, find out the best maintenance amount to avoid recurrence. Those who can't accept hormones and can't tolerate hormones for special reasons can switch to immunosuppressants, or reduce the dosage of corticosteroids and add immunosuppressants. Traditional Chinese medicines, such as ligustrazine, acanthopanax senticosus and salvia miltiorrhiza, have the functions of promoting blood circulation and removing blood stasis, and can prevent interstitial fibrosis to some extent. Tripterygium wilfordii polyglycoside has definite anti-inflammatory and immunosuppressive effects, can inhibit helper T lymphocytes, indirectly inhibit humoral immunity, has a certain effect on preventing pulmonary interstitial fibrosis, and can be used as an important adjuvant drug.
There was no significant difference between penicillamine, hormone and hormone alone in the treatment of pulmonary interstitial fibrosis, but the side effects of penicillamine+hormone group were significantly less than those of hormone alone. However, penicillamine skin test should be done before penicillamine application, and its side effects should be paid attention to. The main side effects are gastrointestinal reaction and allergic reaction. Anti-cytokine therapy is still in the experimental research stage, and there is no conclusion. Other symptomatic treatments include correcting hypoxia, improving cardiopulmonary function and controlling bacterial infection. Lung transplantation technology has been carried out in some technologically advanced countries and achieved certain results. The one-year survival rate of single lung transplantation was 73. 1%, the three-year survival rate was 62.7%, the two-lung transplantation was 70%, and the three-year survival rate was 55%.
medicine
Western medicine treatment
IPF is a continuously developing disease. The principle of treatment mainly lies in actively controlling alveolitis and reversing it, so as to prevent it from developing into irreversible pulmonary fibrosis, but there is no specific treatment so far. Glucocorticoids are still the first choice, followed by immunosuppressants.
1. The conventional initial dose of chronic corticosteroids is 30 ~ 40mg/ day, taken in 3 ~ 4 times. When the patient's condition is stable, the X-ray shadow can be gradually reduced when it is no longer absorbed. After about 4-6 weeks, reduce 5mg each time to 20mg/ day, and reduce 2.5mg each time. If the patient feels unstable, the dosage should be reduced more slowly, even only by 1mg at a time. The maintenance dose shall not be less than 10mg/ day, and the course of treatment shall not be less than 1 year. If the illness is repeated during the reduction, the dosage should be increased again to control the illness, which is still effective. It can be taken for life if necessary. After the start of treatment, most patients' clinical symptoms improved or significantly improved in a short time, but the changes of lung X-ray shadow were not obvious. If it is acute or has developed to the stage of severe hypoxia, in order to quickly reverse the disease, hormones should start with large doses. Prednisone 60 ~ 80 mg/day, divided into 3 ~ 4 times. If the condition is dangerous, pulse therapy should be used first, and methylprednisolone 500 ~ 1000mg/ day should be injected intravenously for 3 ~ 5 days. Take it orally after the condition is stable, and finally find out the best maintenance amount according to individual differences to avoid recurrence.
2. When the effect of immunosuppressive hormone is not satisfactory, immunosuppressants or combined drugs can be used, but the effect is to be determined.
⑴ Azathioprine: the first choice drug, the dosage is 100mg/ day, 1 time, with little side effect.
⑵ Cyclophosphamide: The dosage is 100mg/ day, taken orally. The effect is not as good as azathioprine. Its side effects, such as bone marrow suppression, should be closely observed.
⑶ Tripterygium wilfordii polyglycoside: It has definite anti-inflammatory and immunosuppressive effects. Combined application with hormone or immunosuppressant can reduce the dosage of the above two drugs and increase the curative effect. The dosage is 10 ~ 20 mg, taken orally three times a day.
3. If secondary infection occurs in symptomatic treatment, antibiotics should be selected according to the type of bacteria; Hypoxemia can be given low-flow oxygen inhalation.
Chinese traditional treatment
Interstitial pneumonia belongs to the category of "lung arthralgia" in traditional Chinese medicine. Lung evil, qi and blood are blocked, collaterals are blocked, and there is a clinical evolution process from lung arthralgia to lung flaccidity; Pulmonary fibrosis can be classified as "lung flaccidity" if the course of disease is long, the lungs are weak and useless, the qi and blood are not full, and the collaterals are weak but not glorious. Some scholars believe that both "lung arthralgia" and "lung flaccidity" can be used as their disease names, reflecting the pathogenesis characteristics of different stages of the course of disease. Therefore, the dialectical relationship between them should be correctly handled in clinical practice to determine the attribution of the disease name.
When choosing Chinese medicine to treat interstitial pneumonia, we should pay attention to the overall adjustment, syndrome differentiation and treatment, and give individualized treatment, but so far there is no fixed prescription that can "cure" the disease.
Matters needing attention in life of interstitial pneumonia:
1. Ensure adequate rest, keep warm, avoid catching a cold and prevent various infections. Pay attention to climate change, especially in winter and spring, when the temperature changes drastically, and increase or decrease clothes in time to avoid aggravating the illness after catching a cold.
4. Have a comfortable living environment. The room should be quiet, clean and sanitary, and the air should be fresh, moist and circulated. Avoid strong irritating factors such as smoke, perfume and air freshener, and avoid inhaling air that is too cold, too dry and too wet.
3. The diet should be light and easy to digest, mainly liquid or semi-liquid, eat more fruits and vegetables and drink more water, and avoid spicy, sour, hemp, spicy and fried foods and foods that are easy to induce asthma such as eggs, fish and shrimp. Don't eat irritating food. Generally speaking, the characteristics of diet should be: the diet must be diversified, reasonably matched, nutritious, and suitable for digestion and absorption.
4. Keep a cheerful and optimistic mood mentally to prevent mental stimulation and stress. This requires you to have an open-minded and cheerful attitude towards life, that is to say, to maintain the spirit of happiness, we must cultivate the idea of "contentment is always happy", not to pursue fame and fortune excessively, and to enjoy the truth that "the mind is willing but unable to do so", so as to feel the satisfaction of life and psychology. Keep your spirits happy and make your daily life colorful.
5. Stay away from exogenous allergens, such as: some flowers and plants (especially allergic to pollen), bedding filled with allergic items such as feathers or old cotton wool, pillows, birds, animals (pets or experimental breeders), wood (sequoia dust, cork processing), sugar processing, mushroom breeding, cheese, wine processing, moldy straw exposure, water sources (hot water pipes, air conditioners, etc.).
Selected class table
Glucocorticoid therapy, prednisone (40 ~ 60 mg/d), after the condition is stable for 4 ~ 8 weeks, gradually reduce it, reducing it by 5mg to 20mg/d each time, and reducing it by 2.5mg to 10mg/d each time, and maintaining it at least 1 year.
repair
Rehabilitation of patients with pulmonary interstitial fibrosis is also very important, including:
① Nutritional support therapy: With the progress of the disease and the further aggravation of hypoxia, the patient's activity is obviously reduced and the muscle tissue is obviously atrophied. In addition, repeated infections, loss of appetite, often accompanied by progressive weight loss, eventually lead to respiratory muscle failure, aggravation, and even death. Therefore, nutritional support therapy is particularly important. Its purpose is to provide patients with reasonable nutrition, ensure cell metabolism, maintain the structure of organs and tissues, participate in the regulation of physiological and immune functions and tissue repair, and promote the rehabilitation of patients.
② Oxygen therapy: There should be an oxygen bottle or a small oxygen generator at home, which can relieve the symptoms of dyspnea at any time.
③ Exercise: Patients with mild illness are most suitable to apply rehabilitation therapy such as medical exercise, which has a good effect, can significantly improve lung function and self-conscious symptoms, and prevent further development of the disease. People with serious illness can exercise cautiously to adapt to daily light activities.
④ Prevention of infection: If you change clothes according to climate change, you can use immunosuppressants to improve your immunity.
Life care:
Special formula
From the perspective of traditional Chinese medicine, it should be four diagnoses: looking at the topic, smelling the diagnosis and touching the diagnosis. The four diagnoses are incomplete and can only be treated symptomatically. From the theoretical point of view of traditional Chinese medicine, it can be considered as yin deficiency of lung and kidney, and the treatment should be nourishing yin and tonifying kidney, dispersing lung and resolving phlegm.
Take Polygonatum 30g, Radix Rehmanniae Preparata 1 5g, Radix Rehmanniae 1 5g, Radix Ophiopogonis 1 g, Radix Glycyrrhizae1g, Gypsum Fibrosum1g, Rhizoma Anemarrhenae, Rhizoma Dioscoreae, Caulis Sargentodoxae, Radix Achyranthis Bidentatae, whole buckwheat, Scutellariae Radix and Cortex Lycii. Take it first.
If you have heart symptoms, you can use Danshen dripping pills.
medicated diet
Pneumonia can be divided into lobar pneumonia, bronchial pneumonia and interstitial pneumonia according to pathological anatomy. The main clinical manifestations are cough, expectoration, shortness of breath and chest tightness. And can choose appropriate medicated diet as adjuvant therapy.
Here are several recipes for dietotherapy and medicated diet for you to choose from:
1. Unilateral
Among the above-mentioned dietotherapy traditional Chinese medicines for treating colds and bronchitis, there are chrysanthemum, lobster sauce and so on. It can disperse wind and heat, and it can be applied to patients with wind and heat invading the lungs in the early stage of pneumonia; Water chestnut, lily, pear, lotus root, honey, etc. It has the effects of clearing away heat and resolving phlegm or nourishing yin and moistening lung, and can also be used for patients with lung heat excess or lung yin deficiency pneumonia.
① Garlic
Take 5% garlic juice, 20 ml each time, 4 times a day; Or take 10% garlic syrup, each time 15-20 ml, every 4 hours 1 time.
Allicin, the effective component in this prescription, has a strong antibacterial effect, so garlic juice and garlic syrup can be used to treat pneumonia
② Purslane
50 grams of japonica rice and 30 grams of purslane are boiled into porridge, and taken 1-2 times a day, which can be used as an auxiliary treatment for pneumonia.
This recipe is the whole herb of Portulaca oleracea of Millettiaceae, which is an edible wild vegetable with the functions of clearing away heat, cooling blood, detoxicating and inhibiting various bacteria.
2. Compound prescription
In the early stage of pneumonia, wind-heat invading the lungs can refer to the application of wind-heat cold or wind-heat acute bronchitis drug diet compound. With the further development of pneumonia, medicinal and dietary compound can be used when phlegm-heat bronchitis has lung heat symptoms. For patients with deficiency of both qi and yin in the recovery period of pneumonia, we can refer to the application of herbal diet compound to treat chronic bronchitis with lung deficiency. Here are more diets:
① Compound Yinju tea
Take 30g of Phragmites communis (twice as fresh), 2 1 g of honeysuckle, 9g of chrysanthemum, 9g of mulberry leaves and 6g of almond, add water to decoct, remove residues, and add 30g of honey to substitute tea.
This prescription is suitable for patients with pneumonia whose first symptom is wind-heat invading the lungs.
② Porridge with reed root and bamboo juice
60g of reed rhizome (twice as fresh) is decocted in water, filtered to remove residues, 50g of japonica rice is added, appropriate amount of water is added, * * * is boiled into gruel, 30g of bamboo juice is added, and crystal sugar 15g is taken after a little boiling, 1-2 times, 1 time per day. For patients with pneumonia and lung heat, it can be taken.
This can be used as adjuvant therapy. [ 1]?
Prognostic prevention
prognosis
For the prognosis estimation of interstitial fibrosis, most of the prognosis is poor, and the length of its course depends on the progress of the disease. He died in the shortest two weeks in the acute phase, and the slow development can last for more than 20 years. Since the application of glucocorticoid, immunosuppressant and traditional Chinese medicine, the course of disease has been obviously prolonged. But most patients eventually died of respiratory failure. Very few patients have been in stable remission for a long time after treatment.
prevent
Prevention of pneumonia
There is no way to prevent ILD with unknown etiology. However, the risk of idiopathic pulmonary interstitial fibrosis in smokers increases, and the risk increases with the increase of smokers. For the prevention of ILD with known etiology, we should focus on monitoring the long-term exposure to irritating gases such as chlorine, ammonia, carbon dioxide and formaldehyde, various acid fogs, radiation injuries and poultry breeders, and regularly carry out lung function determination, blood gas analysis and routine X-ray examination, so as to find the disease early and make timely diagnosis and treatment.
In addition, various microorganisms, particulate matter, exogenous protein allergens and harmful irritating gases inhaled into the air can also cause lung injury. Through clinical observation, the pathogenesis of ILD is sometimes very slow. Clinically, patients who have been exposed to dust or poisons when they are young often have obvious symptoms when they are old. However, for these elderly patients, due to low immune function, poor nutritional status and the existence of basic diseases such as heart, lung and kidney, treatment is very difficult and the mortality rate is very high.
The lack of physical activity in the elderly may cover up the symptoms such as dyspnea and shortness of breath caused by this disease. Therefore, the high-risk groups of this disease should take the family as the unit and the community as the scope, undertake the health care function, and regularly carry out health education and health care consultation.
Diet regulation
Fried carp with celery: 250g of carp, 50g of fresh celery, appropriate amount of starch, shredded ginger, shredded garlic, soy sauce, sugar, vinegar, refined salt, monosodium glutamate, yellow wine, pickled pepper and vegetable oil. Slice carp, cut celery into sections, and make soup with soy sauce, sugar, vinegar, monosodium glutamate, yellow wine, salt and starch. Put the wok on high fire, add oil and heat it to 50%, add mermaid and stir fry, drain the remaining oil, and add shredded ginger and pickled pepper. Stir-fry the celery, then boil the sauce to make the oil shine and take it out of the pot. Carp has the effects of clearing away heat and toxic materials, inducing diuresis to reduce swelling, relieving cough and reducing qi. Celery has the effects of calming the liver and clearing away heat, expelling wind and diuresis, nourishing the heart and benefiting qi. Carp and celery are suitable for adjuvant treatment of acute and chronic pneumonia.
Mushroom shredded rabbit meat: cooked rabbit meat 100g, mushroom 50g, onion 25g, appropriate amount of Chili oil, soy sauce, vinegar, sugar, sesame oil, sesame paste, pepper powder and monosodium glutamate. Shred the cooked rabbit meat and onion separately, and cook the mushrooms. Put onions and mushrooms at the bottom, cover the noodles with shredded rabbit and put them on a plate. Break the sesame sauce with soy sauce several times, mix the sesame oil evenly into a flavor juice, and pour it in shredded rabbit to eat. Meat-free has the effects of clearing away heat and toxic materials, invigorating qi and spleen, eliminating dampness and cooling blood, and facilitating defecation, while mushrooms have the effects of detoxifying and moistening dryness, invigorating qi and strengthening spleen, eliminating dampness and stopping diarrhea. The combination of rabbit meat and mushrooms is suitable for treating acute pneumonia.
Quail lily soup: quail 1, lily 25g, ginger, onion, monosodium glutamate and salt. After quail is slaughtered, hair, claws and viscera are removed, washed, scalded with boiling water, fished out and cut into pieces; Lily petals are broken and washed for later use. Wash ginger and onion, mash ginger and cut onion into sections. Put the pot on a big fire, pour in some water, add quail, bring to a boil, add lily, ginger and onion, simmer until the quail is cooked, add salt and monosodium glutamate for a few minutes, and put it in a soup bowl. Quail meat has the effects of nourishing five internal organs, benefiting liver and clearing lung, clearing heat and promoting diuresis, promoting digestion and stopping diarrhea. Lily has the effects of moistening lung, relieving cough, nourishing yin, clearing away heat, clearing heart fire and calming nerves. Both are suitable for acute and chronic pneumonia.
Lean cabbage soup: lean meat, cabbage heart 100g, a little ginger, garlic, salt, monosodium glutamate and chicken oil. Shred lean meat, wash and shred Chinese cabbage, put it in boiling water, take it out when it is just cooked, rinse it with clear water and drain it for later use; Put the pot on a big fire, add chicken oil and cook for five times, add garlic, stir-fry until golden brown, add lean meat and stir-fry, add fine salt, cook human soup, add cabbage to boil, and add monosodium glutamate to serve. Lean meat has the effects of invigorating the middle energizer, invigorating qi, promoting fluid production and moistening intestines; Chinese cabbage is flat and sweet, and has the effects of clearing away heat and toxic materials, resolving phlegm, relieving cough, removing annoyance and relaxing bowels. Lean meat and Chinese cabbage are suitable for acute and chronic pneumonia.