难治性风温肺热病中医证候学规律研究
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摘要
研究背景
细菌性肺炎属于风温肺热病范畴,是临床常见病和多发病。抗生素并不能完全解决细菌性肺炎的治疗问题。众多证据表明,随着抗生素的不断升级,其病死率却没有太明显的下降。分析主要有以下几方面原因：①有慢性感染性基础疾病,常长期、反复应用抗生素,导致耐药性的出现,甚至产生耐药菌株；②主要病原菌是革兰氏阴性杆菌感染,其中又以铜绿假单胞菌(Pseudomonas aeruginosa, PA)、鲍曼不动杆菌常见,产生多种内毒素；③病原体复杂,常混合感染,抗生素不能完全覆盖病原菌。近年提出的无反应肺炎,也是针对抗感染无效的情况而提出的。无反应肺炎的死亡率为一般肺炎的3-5倍,总的死亡率可高达49%。感染仍是无反应肺炎的主要原因。耐药菌感染又是感染性原因中主要组成部分。王成祥教授教授提出耐药菌相关的风温肺热病为难治性风温肺热病,以PA肺部感染为难治性风温肺热病的代表进行研究。最新调查显示,2010年中国不同地区14所医院呼吸道病原菌分布结果显示,PA在普通病房中最为多见。PA耐药问题比较显著：对很多抗生素天然耐药,对其有活性的抗生素不多,对抗菌活性最强的碳青霉烯类抗生素近年来也出现了较高水平耐药。PA感染后可以通过多种途径释放多种致病因子,如藻酸盐、侵袭性酶类,这些都增加了治疗难度。目前PA相关的难治性风温肺热病的研究较少,尚无PA肺部感染的证候学规律研究。
目的
调查PA肺部感染的临床特点,探索PA肺部感染的证候学规律,为中医药干预、治疗PA肺部感染提供临床依据。
方法
1制定PA肺部感染调查表,从北京中医药大学东直门医院热病研究小组积累的资料中选择PA肺部感染为研究对象,回顾性采集PA肺部感染的临床资料。建立Epidata数据库,进行数据的录入和核对,再将其转化为SPSS数据库。
2描述PA肺部感染的一般临床资料特征。对症状频次进行统计；运用聚类分析、因子分析,提取和确定PA肺部感染证候要素。
3描述PA肺部感染的疾病演变过程中经历的卫气营血各阶段的分布；采用等级相关分析(Spearman等级相关)比较卫气营血各阶段的好转及病死率；描述卫气营血各阶段的证候要素。
4运用单因素分析和Logistic回归分析研究多重耐药铜绿假单胞菌(Multi-drugResistant Pseudomonas aeruginosa, MDRPA)肺部感染的临床特点。
结果
1PA肺部感染一般资料分布规律。共采集285例患者,65岁以上共219例,总数76.84%。PA肺部感染的临床特点分布从高到低依次为卧床、鼻饲、尿管、抑酸药、胃肠动力药、糖皮质激素、安定类镇定类药物、气管切开。男性患者吸烟、饮酒比例较显著高于女性(p<0.05)。
2基础疾病分布规律。≥20%的基础疾病依次为高血压病49.12%、冠状动脉粥样硬化心脏病41.40%、慢性支气管炎34.39%、心功能不全29.82%、肿瘤25.26%、慢性阻塞性肺疾病24.91%、脑梗死后遗症期24.92%、心律失常22.46%、糖尿病21.40%。
3结局分布规律：PA肺部感染住院天数较长,其中住院天数2周内仅占总数14.74%；总的病死率为17.54%；3月内再入院率(包括住院时间3月以上)为27.72%。
4分离出PA前使用抗生素情况。285例PA肺部感染共有202例患者分离出PA前一月内使用连续使用抗生素7天或7天以上,占总数70.88%,其中只有81例只使用1种抗生素。常用的抗生素为三代头孢菌素或加酶抑制剂、广谱青霉素或加酶抑制剂、碳青霉烯类、喹诺酮类、氨基糖苷类。
5病原学结果。入院7天内分离出PA的仅占总患者45.61%。对PA敏感的抗生素前五位是阿米卡星、亚胺培南、哌拉西林/他唑巴坦、妥布霉素、头孢他啶/舒巴坦；对PA耐药程度低的前五位是头孢哌酮、头孢他啶、阿米卡星、亚胺培南、奈替米星。
6中医症状分布规律。PA肺部感染出现在前10位的症状为咳嗽、粘痰、喘息、白痰、憋气、大便干、眠差、发热、纳呆食少、痰多；舌象最多见的是暗红舌、红舌和黄腻苔；脉象多表现为复合脉,其中含滑脉特征的脉象最多,其次是弦脉、细脉、数脉、沉脉。
7基于聚类分析、因子分析的结果。PA肺部感染证候要素为痰,热,肺,心神；主要证候类型为痰热壅肺证和痰扰心神证。
8分离出PA时卫气营血各阶段例数有显著差别(p=0.000)。气分阶段例数最多,气分和营分共185例,占64.91%。294例次卫气营血各阶段中,卫分证6例次,气分证162例次,营分证68例次,血分证32例次,后期26例次。病情最重经历血分、营分、气分各阶段的死亡率依次降低(Spearman相关系数=0.588,p=0.000)。气分较营分阶段易透邪,营分较血分阶段易透邪(Spearman相关系数=0.376,p=0.000)。
9卫气营血各阶段证候要素。卫分证实证病性证候要素主要为风、热；气分和营分、血分阶段,病性证候要素主要为热、痰、血瘀；血分阶段还有动血、风。卫分阶段病位证候要素为肺；气分阶段病位证候要素为肺、胃、大肠；营分阶段病位证候要素为心神、肺、胃和肌肤；血分阶段主要病位要素为血、肺、脾、胃。卫气营血各阶段虚证的证候要素分布规律：气分阶段,前三位主要虚性证候要素体现在肺、气、阴；营分阶段,前三位主要虚性证候要素体现在气、阴、肺；血分阶段,前三位主要虚性证候要素体现在阴、气、血。
10MDRPA临床特点。多因素分析结果显示：鼻饲与MDRPA感染呈正相关(p=0.008),其相对危险度(OR)值分别为4.244,95%的可信区间是(1.460-12.339)；尿管与MDRPA感染呈正相关(p=0.005),其相对危险度(OR)值分别为4.540,95%的可信区间是(1.565～13.174)。其他因素与MDRPA感染无显著性关系。症状特点比较：单因素卡方分析MDRPA组咳嗽、喘息、眠差、胸闷、痰中带血出现的频次显著低于非MDRPA组(p<0.05)；MDRPA组喉中痰鸣、昏迷、嗜睡出现的频次显著高于非MDRPA组(p<0.05)；其余症状出现频次比较两组间无显著性差异(p≥0.05)。结局方面：MDRPA组住院时间超过28天比例、3月内再入院比例较非MDRPA组高(p<0.05)。两组病死率没有显著性差异(p≥0.05)。
结论
1本研究中PA肺部感染高龄患者男性较女性多,男性吸烟、饮酒比例较女性高；基础疾病种类多,最常见基础病为高血压病、冠状动脉粥样硬化心脏病、慢性支气管炎；病情重,住院时间长、死亡率较高、反复就诊；对多种抗生素耐药、混合感染较多见。
2285例PA肺部感染患者分离出PA时和分离后病情演变过程中气分证和营分证居多。通过对PA肺部感染患者症状的数据挖掘和利用卫气营血结合脏腑辨证发现：热邪、气虚、阴虚贯穿PA肺部感染的始终,气分、营分、血分三个阶段痰、热、血瘀都是共同的病性证候要素。
3气分证预后较佳。气分证、营分证、血分证死亡率逐步上升,好转率逐步下降。气分是难治性风温肺热病治疗的关键阶段。
4使用鼻饲、尿管侵袭性操作可以增加MDRPA的感染。MDRPA感染以嗜睡、昏迷、喉中痰鸣等痰扰心神的表现明显。MDRPA病人反复入院几率较高。
Background
Bacterial Pneumonia is one of the common and multiplex diseases in clinical practice. Antibiotics can't completely solve the treatment of bacterial pneumonia. There is a good deal of evidence showing that the mortality rate did not decline obvious with the escalating of antibiotics. There are several reasons.1. Patients with chronic infectious underlying disease, often use antibiotics long-term and repeated. It is leading to the emergence of drug resistance, even drug-resistant strains.2. The main pathogens are gram-negative bacilli infections. Pseudomonas aeruginosa and Acinetobacter baumannii are common. They produce a variety of endotoxin.3Infection is mixed. Antibiotics don't completely cover the pathogens. Nonresponding pneumonia is also aimed at this situation. The nonresponding pneumonia mortality is3to5times the ordinary pneumonia mortality and the total mortality rate can be as high as49%. Infection remains a major reason of nonresponding pneumonia. Resistant infections is a major component of infectious causes. The latest survey of respiratory pathogen distribution from14hospital of different parts of China in2010showed that PA was the most common pathogen in the general ward. The PA drug resistance problem:natural resistance to many antibiotics; less active antibiotics; there have been high-level drug resistance to Carbapenem antibiotics in recent years, which was activity to PA.
A variety of pathogenic factors can be released at the course of PA infection, which increasing the difficulty of treatment. Bacterial pneumonia belongs to wind-warm lung-heat disease. Professor Wang Chengxiang proposed that drug-resistant related wind-warm lung-heat disease as refractory wind-warm lung-heat disease. There is few research on PA related wind-warm lung-heat disease. There is no TCM syndrome and evolvement rule theory on PA pulmonary infection.
Objective
Explore the syndrome features, TCM syndrome and evolvement rule on PA lung infection. So that can provide a clinical basis of Chinese medicine interventions.
Method
1Design PA lung infection questionnaire. Choose PA lung infection as the research object from information accumulated by the Fever research team from Dongzhimen Hospital affiliated Beijing University of Chinese Medicine. Collect clinical data of PA lung infection. Establish Epidata database based on the acquisition information, entry and check data. Convert it into SPSS database.
2Describe the clinical features on PA lung infection. Count the frequency of symptoms. Exraction and determine the evidence of PA lung infection syndrome elements by the using of cluster analysis and factor analysis.
3Statistics the number of cases of Wei Qi Ying Xue and fever late stage of PA lung infection. Spearman rank correlation analysis can be used to compare the improvement and mortality of Wei Qi Ying Xue various stages. Statistics the syndrome elements of various stages of Wei Qi Ying Xue.
4Using of univariate analysis and logistic regression analysis to study the clinical features of multi-drug resistant PA(MDRPA) lung infection.
Result
1PA lung infection general distribution law.285patients were collected. A total of219cases over the age of65, accounting for76.84%of the total number of patients. The clinical features of distribution from more to less were Immobilization, nasogastric catheter, acid-suppress ing drugs, gastrointestinal drugs, glucocorticoids, calm drugs. Male patients with smoking and drinking significantly higher proportion of women (p<0.05).
2Law of distribution of the underlying disease.≥20%of the underlying disease were hypertension (49.12%), coronary atherosclerotic heart disease (41.40%), chronic bronchitis (34.39%), heart failure (29.82%), the tumor (25.26%), chronic obstructive pulmonary disease (24.91%), the sequelae of cerebral infarction (24.92%), arrhythmia (22.46%) diabetes (21.40%)
3Finale distribution law. PA lung infection longer hospital stays, which accounted for only14.74%of the total of the total number of hospital days2weeks; overall mortality rate was17.54%; March readmission patients (including hospital stay of3months or more)27.72%.
4Isolated PA before the use of antibiotics:285cases of PA lung infection total of202patients isolated PA within the previous month continuous use of antibiotics for7days or7days or more, accounting for70.88%of the total. Only use antibiotics only28.42%. Commonly used antibiotics for third-generation cephalosporin or enzyme inhibitors, broad-spectrum penicillin or enzyme inhibitors, carbapenems, quinolones, aminoglycosides.
5Etiological result. Within7days of the admission of isolated PA accounted for only45.61%of patients. PA-sensitive top five antibiotics amikacin, imipenem, piperacillin/tazobactam, tobramycin, ceftazidime; the low PA resistant top five cefoperazone ceftazidime and amikacin, imipenem, netilmicin.
6TCM symptom distribution law. PA lung infection appear in the top10symptoms of cough, phlegm, wheezing, white sputum, hold your breath, dry stool, poor sleep, fever, poor appetite, eat less, phlegm; Tongue of the most common is a dark red tongue, red tongue, yellow greasy moss; pulse performance of composite veins, containing slippery pulse characteristics of the pulse, followed by Wiry, veinlets, rapid pulse, deep pulse.
7Based on cluster analysis, factor analysis of PA lung infection syndrome elements phlegm, lungs, mind; syndromes of phlegm obstruct the lung and sputum disturbance of mind Certificate.
8There is a significant difference of the number of cases of Wei Qi Ying Xue the various stages when PA was isolated (p=0.000).The number at the stage of qifen and yingfen was185,64.91%. In the process of changes, a total of294different stages:Weifen syndrome(6); qifen syndrome(162); yingfen syndrome(68); xuefen syndrome(32); later stage(26). The mortality of experienced xuefen stage, yingfen stage, xuefen state was gradually reduced (Spearman correlation coefficient=0.588, p=0.000). The recovery rate of xuefen stage, yingfen stage, xuefen state was gradually increased (Spearman correlation coefficient=0.376, p=0.000). Syndrome elements of excess syndrome:the disease syndrome factors at the weifen stage were wind and heat. The disease syndrome factor at the qifen, yingfen and xuefen stages were hot, phlegm and blood stasis; besides the disease syndrome factor at the xuefen stage were stirring blood and endogenous wind. The disease location syndrome factor at the qifen stage was lung. The disease location syndrome factors at the qifen stage were lung, stomach, large intestine. The disease location syndrome factors at the yingfen stage were heart spirit, lung, stomach and skin. The disease location syndrome factor at the xuefen stage were blood, lung, heart spirit, spleen, stomach. Deficiency syndrome:the main syndrome factors were qi and yin.
8Clinical characteristics of MDRPA. Multivariate analysis results showed that:the na so gastric MDRPA infection was positively correlated (p=0.008), the relative risk (OR) values were4.244,95%CI (1.460to12.339); catheter MDRPA of infection was positively correlated (p=0.005), the relative risk (OR) values were4.540,95%CI (1.565to13.174). The other factors MDRPA infection no significant relationship. Symptoms features:single factor chi-square analysis by the MDRPA group cough, wheezing, poor sleep, chest tightness, the bloody sputum frequency significantly lower than the the non-MDRPA group (p<0.05); the throat phlegm MDRPA group, coma, drowsiness appears frequency significantly higher than the non-MDRPA group (p<0.05); the rest of the onset of symptoms was no significant difference in frequency between the two groups (p≥0.05).The outcome aspects:hospitalized with MDRPA group for more than28days proportion, March readmission ratio than non-MDRPA group (p<0.05). Two groups CFR there was no significant difference (p≥0.05).
Conclusion
1The number of male of advanced age is more than female's number. They had a lot's of foundation disease. The patients' condition are sever.
2Qifen and Yinfen syndromes are common. Fever, Qi deficiency and Yin deficiency are the basic syndrome of PA lung infection. Plegm, fever and are the joint syndromes at the stages of Qifen, Yinfen and Xue fen.
3The result from Qifen stage was good. The mortality of experienced xuefen stage, yingfen stage, xuefen state was gradually reduced. The recovery rate of xuefen stage, yingfen stage, xuefen state was gradually increased. Qifen stage is the crucial stage of medical treatment of refractory wind-warm lung-heat disease.
细菌性肺炎属于风温肺热病范畴,是临床常见病和多发病。抗生素并不能完全解决细菌性肺炎的治疗问题。众多证据表明,随着抗生素的不断升级,其病死率却没有太明显的下降。分析主要有以下几方面原因：①有慢性感染性基础疾病,常长期、反复应用抗生素,导致耐药性的出现,甚至产生耐药菌株；②主要病原菌是革兰氏阴性杆菌感染,其中又以铜绿假单胞菌(Pseudomonas aeruginosa, PA)、鲍曼不动杆菌常见,产生多种内毒素；③病原体复杂,常混合感染,抗生素不能完全覆盖病原菌。近年提出的无反应肺炎,也是针对抗感染无效的情况而提出的。无反应肺炎的死亡率为一般肺炎的3-5倍,总的死亡率可高达49%。感染仍是无反应肺炎的主要原因。耐药菌感染又是感染性原因中主要组成部分。王成祥教授教授提出耐药菌相关的风温肺热病为难治性风温肺热病,以PA肺部感染为难治性风温肺热病的代表进行研究。最新调查显示,2010年中国不同地区14所医院呼吸道病原菌分布结果显示,PA在普通病房中最为多见。PA耐药问题比较显著：对很多抗生素天然耐药,对其有活性的抗生素不多,对抗菌活性最强的碳青霉烯类抗生素近年来也出现了较高水平耐药。PA感染后可以通过多种途径释放多种致病因子,如藻酸盐、侵袭性酶类,这些都增加了治疗难度。目前PA相关的难治性风温肺热病的研究较少,尚无PA肺部感染的证候学规律研究。
目的
调查PA肺部感染的临床特点,探索PA肺部感染的证候学规律,为中医药干预、治疗PA肺部感染提供临床依据。
方法
1制定PA肺部感染调查表,从北京中医药大学东直门医院热病研究小组积累的资料中选择PA肺部感染为研究对象,回顾性采集PA肺部感染的临床资料。建立Epidata数据库,进行数据的录入和核对,再将其转化为SPSS数据库。
2描述PA肺部感染的一般临床资料特征。对症状频次进行统计；运用聚类分析、因子分析,提取和确定PA肺部感染证候要素。
3描述PA肺部感染的疾病演变过程中经历的卫气营血各阶段的分布；采用等级相关分析(Spearman等级相关)比较卫气营血各阶段的好转及病死率；描述卫气营血各阶段的证候要素。
4运用单因素分析和Logistic回归分析研究多重耐药铜绿假单胞菌(Multi-drugResistant Pseudomonas aeruginosa, MDRPA)肺部感染的临床特点。
结果
1PA肺部感染一般资料分布规律。共采集285例患者,65岁以上共219例,总数76.84%。PA肺部感染的临床特点分布从高到低依次为卧床、鼻饲、尿管、抑酸药、胃肠动力药、糖皮质激素、安定类镇定类药物、气管切开。男性患者吸烟、饮酒比例较显著高于女性(p<0.05)。
2基础疾病分布规律。≥20%的基础疾病依次为高血压病49.12%、冠状动脉粥样硬化心脏病41.40%、慢性支气管炎34.39%、心功能不全29.82%、肿瘤25.26%、慢性阻塞性肺疾病24.91%、脑梗死后遗症期24.92%、心律失常22.46%、糖尿病21.40%。
3结局分布规律：PA肺部感染住院天数较长,其中住院天数2周内仅占总数14.74%；总的病死率为17.54%；3月内再入院率(包括住院时间3月以上)为27.72%。
4分离出PA前使用抗生素情况。285例PA肺部感染共有202例患者分离出PA前一月内使用连续使用抗生素7天或7天以上,占总数70.88%,其中只有81例只使用1种抗生素。常用的抗生素为三代头孢菌素或加酶抑制剂、广谱青霉素或加酶抑制剂、碳青霉烯类、喹诺酮类、氨基糖苷类。
5病原学结果。入院7天内分离出PA的仅占总患者45.61%。对PA敏感的抗生素前五位是阿米卡星、亚胺培南、哌拉西林/他唑巴坦、妥布霉素、头孢他啶/舒巴坦；对PA耐药程度低的前五位是头孢哌酮、头孢他啶、阿米卡星、亚胺培南、奈替米星。
6中医症状分布规律。PA肺部感染出现在前10位的症状为咳嗽、粘痰、喘息、白痰、憋气、大便干、眠差、发热、纳呆食少、痰多；舌象最多见的是暗红舌、红舌和黄腻苔；脉象多表现为复合脉,其中含滑脉特征的脉象最多,其次是弦脉、细脉、数脉、沉脉。
7基于聚类分析、因子分析的结果。PA肺部感染证候要素为痰,热,肺,心神；主要证候类型为痰热壅肺证和痰扰心神证。
8分离出PA时卫气营血各阶段例数有显著差别(p=0.000)。气分阶段例数最多,气分和营分共185例,占64.91%。294例次卫气营血各阶段中,卫分证6例次,气分证162例次,营分证68例次,血分证32例次,后期26例次。病情最重经历血分、营分、气分各阶段的死亡率依次降低(Spearman相关系数=0.588,p=0.000)。气分较营分阶段易透邪,营分较血分阶段易透邪(Spearman相关系数=0.376,p=0.000)。
9卫气营血各阶段证候要素。卫分证实证病性证候要素主要为风、热；气分和营分、血分阶段,病性证候要素主要为热、痰、血瘀；血分阶段还有动血、风。卫分阶段病位证候要素为肺；气分阶段病位证候要素为肺、胃、大肠；营分阶段病位证候要素为心神、肺、胃和肌肤；血分阶段主要病位要素为血、肺、脾、胃。卫气营血各阶段虚证的证候要素分布规律：气分阶段,前三位主要虚性证候要素体现在肺、气、阴；营分阶段,前三位主要虚性证候要素体现在气、阴、肺；血分阶段,前三位主要虚性证候要素体现在阴、气、血。
10MDRPA临床特点。多因素分析结果显示：鼻饲与MDRPA感染呈正相关(p=0.008),其相对危险度(OR)值分别为4.244,95%的可信区间是(1.460-12.339)；尿管与MDRPA感染呈正相关(p=0.005),其相对危险度(OR)值分别为4.540,95%的可信区间是(1.565～13.174)。其他因素与MDRPA感染无显著性关系。症状特点比较：单因素卡方分析MDRPA组咳嗽、喘息、眠差、胸闷、痰中带血出现的频次显著低于非MDRPA组(p<0.05)；MDRPA组喉中痰鸣、昏迷、嗜睡出现的频次显著高于非MDRPA组(p<0.05)；其余症状出现频次比较两组间无显著性差异(p≥0.05)。结局方面：MDRPA组住院时间超过28天比例、3月内再入院比例较非MDRPA组高(p<0.05)。两组病死率没有显著性差异(p≥0.05)。
结论
1本研究中PA肺部感染高龄患者男性较女性多,男性吸烟、饮酒比例较女性高；基础疾病种类多,最常见基础病为高血压病、冠状动脉粥样硬化心脏病、慢性支气管炎；病情重,住院时间长、死亡率较高、反复就诊；对多种抗生素耐药、混合感染较多见。
2285例PA肺部感染患者分离出PA时和分离后病情演变过程中气分证和营分证居多。通过对PA肺部感染患者症状的数据挖掘和利用卫气营血结合脏腑辨证发现：热邪、气虚、阴虚贯穿PA肺部感染的始终,气分、营分、血分三个阶段痰、热、血瘀都是共同的病性证候要素。
3气分证预后较佳。气分证、营分证、血分证死亡率逐步上升,好转率逐步下降。气分是难治性风温肺热病治疗的关键阶段。
4使用鼻饲、尿管侵袭性操作可以增加MDRPA的感染。MDRPA感染以嗜睡、昏迷、喉中痰鸣等痰扰心神的表现明显。MDRPA病人反复入院几率较高。
Background
Bacterial Pneumonia is one of the common and multiplex diseases in clinical practice. Antibiotics can't completely solve the treatment of bacterial pneumonia. There is a good deal of evidence showing that the mortality rate did not decline obvious with the escalating of antibiotics. There are several reasons.1. Patients with chronic infectious underlying disease, often use antibiotics long-term and repeated. It is leading to the emergence of drug resistance, even drug-resistant strains.2. The main pathogens are gram-negative bacilli infections. Pseudomonas aeruginosa and Acinetobacter baumannii are common. They produce a variety of endotoxin.3Infection is mixed. Antibiotics don't completely cover the pathogens. Nonresponding pneumonia is also aimed at this situation. The nonresponding pneumonia mortality is3to5times the ordinary pneumonia mortality and the total mortality rate can be as high as49%. Infection remains a major reason of nonresponding pneumonia. Resistant infections is a major component of infectious causes. The latest survey of respiratory pathogen distribution from14hospital of different parts of China in2010showed that PA was the most common pathogen in the general ward. The PA drug resistance problem:natural resistance to many antibiotics; less active antibiotics; there have been high-level drug resistance to Carbapenem antibiotics in recent years, which was activity to PA.
A variety of pathogenic factors can be released at the course of PA infection, which increasing the difficulty of treatment. Bacterial pneumonia belongs to wind-warm lung-heat disease. Professor Wang Chengxiang proposed that drug-resistant related wind-warm lung-heat disease as refractory wind-warm lung-heat disease. There is few research on PA related wind-warm lung-heat disease. There is no TCM syndrome and evolvement rule theory on PA pulmonary infection.
Objective
Explore the syndrome features, TCM syndrome and evolvement rule on PA lung infection. So that can provide a clinical basis of Chinese medicine interventions.
Method
1Design PA lung infection questionnaire. Choose PA lung infection as the research object from information accumulated by the Fever research team from Dongzhimen Hospital affiliated Beijing University of Chinese Medicine. Collect clinical data of PA lung infection. Establish Epidata database based on the acquisition information, entry and check data. Convert it into SPSS database.
2Describe the clinical features on PA lung infection. Count the frequency of symptoms. Exraction and determine the evidence of PA lung infection syndrome elements by the using of cluster analysis and factor analysis.
3Statistics the number of cases of Wei Qi Ying Xue and fever late stage of PA lung infection. Spearman rank correlation analysis can be used to compare the improvement and mortality of Wei Qi Ying Xue various stages. Statistics the syndrome elements of various stages of Wei Qi Ying Xue.
4Using of univariate analysis and logistic regression analysis to study the clinical features of multi-drug resistant PA(MDRPA) lung infection.
Result
1PA lung infection general distribution law.285patients were collected. A total of219cases over the age of65, accounting for76.84%of the total number of patients. The clinical features of distribution from more to less were Immobilization, nasogastric catheter, acid-suppress ing drugs, gastrointestinal drugs, glucocorticoids, calm drugs. Male patients with smoking and drinking significantly higher proportion of women (p<0.05).
2Law of distribution of the underlying disease.≥20%of the underlying disease were hypertension (49.12%), coronary atherosclerotic heart disease (41.40%), chronic bronchitis (34.39%), heart failure (29.82%), the tumor (25.26%), chronic obstructive pulmonary disease (24.91%), the sequelae of cerebral infarction (24.92%), arrhythmia (22.46%) diabetes (21.40%)
3Finale distribution law. PA lung infection longer hospital stays, which accounted for only14.74%of the total of the total number of hospital days2weeks; overall mortality rate was17.54%; March readmission patients (including hospital stay of3months or more)27.72%.
4Isolated PA before the use of antibiotics:285cases of PA lung infection total of202patients isolated PA within the previous month continuous use of antibiotics for7days or7days or more, accounting for70.88%of the total. Only use antibiotics only28.42%. Commonly used antibiotics for third-generation cephalosporin or enzyme inhibitors, broad-spectrum penicillin or enzyme inhibitors, carbapenems, quinolones, aminoglycosides.
5Etiological result. Within7days of the admission of isolated PA accounted for only45.61%of patients. PA-sensitive top five antibiotics amikacin, imipenem, piperacillin/tazobactam, tobramycin, ceftazidime; the low PA resistant top five cefoperazone ceftazidime and amikacin, imipenem, netilmicin.
6TCM symptom distribution law. PA lung infection appear in the top10symptoms of cough, phlegm, wheezing, white sputum, hold your breath, dry stool, poor sleep, fever, poor appetite, eat less, phlegm; Tongue of the most common is a dark red tongue, red tongue, yellow greasy moss; pulse performance of composite veins, containing slippery pulse characteristics of the pulse, followed by Wiry, veinlets, rapid pulse, deep pulse.
7Based on cluster analysis, factor analysis of PA lung infection syndrome elements phlegm, lungs, mind; syndromes of phlegm obstruct the lung and sputum disturbance of mind Certificate.
8There is a significant difference of the number of cases of Wei Qi Ying Xue the various stages when PA was isolated (p=0.000).The number at the stage of qifen and yingfen was185,64.91%. In the process of changes, a total of294different stages:Weifen syndrome(6); qifen syndrome(162); yingfen syndrome(68); xuefen syndrome(32); later stage(26). The mortality of experienced xuefen stage, yingfen stage, xuefen state was gradually reduced (Spearman correlation coefficient=0.588, p=0.000). The recovery rate of xuefen stage, yingfen stage, xuefen state was gradually increased (Spearman correlation coefficient=0.376, p=0.000). Syndrome elements of excess syndrome:the disease syndrome factors at the weifen stage were wind and heat. The disease syndrome factor at the qifen, yingfen and xuefen stages were hot, phlegm and blood stasis; besides the disease syndrome factor at the xuefen stage were stirring blood and endogenous wind. The disease location syndrome factor at the qifen stage was lung. The disease location syndrome factors at the qifen stage were lung, stomach, large intestine. The disease location syndrome factors at the yingfen stage were heart spirit, lung, stomach and skin. The disease location syndrome factor at the xuefen stage were blood, lung, heart spirit, spleen, stomach. Deficiency syndrome:the main syndrome factors were qi and yin.
8Clinical characteristics of MDRPA. Multivariate analysis results showed that:the na so gastric MDRPA infection was positively correlated (p=0.008), the relative risk (OR) values were4.244,95%CI (1.460to12.339); catheter MDRPA of infection was positively correlated (p=0.005), the relative risk (OR) values were4.540,95%CI (1.565to13.174). The other factors MDRPA infection no significant relationship. Symptoms features:single factor chi-square analysis by the MDRPA group cough, wheezing, poor sleep, chest tightness, the bloody sputum frequency significantly lower than the the non-MDRPA group (p<0.05); the throat phlegm MDRPA group, coma, drowsiness appears frequency significantly higher than the non-MDRPA group (p<0.05); the rest of the onset of symptoms was no significant difference in frequency between the two groups (p≥0.05).The outcome aspects:hospitalized with MDRPA group for more than28days proportion, March readmission ratio than non-MDRPA group (p<0.05). Two groups CFR there was no significant difference (p≥0.05).
Conclusion
1The number of male of advanced age is more than female's number. They had a lot's of foundation disease. The patients' condition are sever.
2Qifen and Yinfen syndromes are common. Fever, Qi deficiency and Yin deficiency are the basic syndrome of PA lung infection. Plegm, fever and are the joint syndromes at the stages of Qifen, Yinfen and Xue fen.
3The result from Qifen stage was good. The mortality of experienced xuefen stage, yingfen stage, xuefen state was gradually reduced. The recovery rate of xuefen stage, yingfen stage, xuefen state was gradually increased. Qifen stage is the crucial stage of medical treatment of refractory wind-warm lung-heat disease.
引文
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