The Research Is About The TCM Syndrome In Severe Pneumonia With Relating To The Death In Risk Factors

Objective①Search for the character of the TCM syndrome distribution from the severe pneumonia patients②TO Calculate the mortality of different type syndrome and observate their clinical features ③TO find out the Prognosis risk factors in different type syndrome.MethodThis research uses a method ofretrospective analysis.According to the inclusion and exclusion criteria,215patients are recorded who dated from October2010to March2013in ICU and emergency ward of China Academy of Traditional Chinese Medicine, Guang An Men Hospital. The collection contain the general, laboratory tests, the Clinical feature. To summarize the TCM syndromes. To calculate the mortality of different type syndrome; To record clinical prognostic risk factors, such as CRP, PCT, APACHE Ⅱ score, clinical pulmonary infection score; To observethe characteristics of the risk factors in different type syndrome.To make a clinical database and have a statistical analysis after import data to SPSS16.0.Results1. The analysis general situationThis study collected215patients with severe pneumonia from ICU and emergency ward of China Academy of Traditional Chinese Medicine, Guang An Men Hospital, including114cases of male patients (53%)and101cases of female patients (47%). The age of patients is from45to91years old. The average age is76.75±9.25. The average day of hospital stay in ICU was15.00+9.88days. According to the prognosis ending, the patients were divided into two groups, group of death and survival group,86cases were dead, the fatality rate is40%.48male and38female in group of death,66male and63female in another group, the gender ratio between the two groups is no statistical significance. The average age in group of death is76.83±10.56years, and76.71±8.31years in another group, the age between two groups is no statistical difference. The Cases involved wide range of the primary disease, coronary heart disease is the most common combination which number is170cases (79.07%), followed by hypertension149cases (69.30%), chronic cerebrovascular disease108cases (50.23%), diabetes mellitus and acute cerebrovascular disease and so on.2.The Features of the TCM syndrome distribution and complications:The research shows the main TCM syndromes are toxic syndrome of deficiency yin and yang yun syndrome^phlegm heat Off the lungsyndrome、 Qi deficiency with blood stasis and phlegm syndrome,stasis with heat and toxic syndrome, Deficiency of qi and yin syndrome. The complications of toxic syndrome of deficiency yin and yang yun syndrome are hypoproteinemia、septic shock, DIC, gastrointestinal dysfunction. The complications of phlegm heat Off the lung syndrome are gastrointestinal dysfunction、DIC, hypoproteinemia.The complications of Qi deficiency with blood stasis syndromeand phlegm syndrome are hypoalbuminemia、DIC、acid-base balance.3. Fatality rate:the research recorded215patients from ICU and emergency ward of China Academy of Traditional Chinese Medicine, Guang An Men Hospital.86patients were dead, the mortality rate was40%. The highest fatality rate54.8%is toxic syndrome of deficiency yin and yang yun syndrome, followed by Qi deficiency with blood stasis and phlegm syndrome (43.6%), phlegm heat Off the lung syndrome (43.4%), stasis with heat and toxic syndrome (24.4%), Deficiency of qi and yin syndrome(10.0%).4. The clinical features of Three groups with highest fatality rate:In the group of toxic syndrome of deficiency yin and yang yun syndrome, dead and survival patients in albumin, lactate, APACHE Ⅱ scores between the difference was statistically significant. In the group of phlegm heat Off the lung syndrome, dead and survival patients in CRP, PCT, APTT, CPIS scores difference was statistically significant. In the group of Qi deficiency withblood stasis and phlegm syndrome,dead and survival patients in PCT, ALB, APTT difference was statistically significant.5. The analysis of the prognosis risk factors in severe pneumonia5.1The analysis of the prognosis risk factors in general casesSingle factor analysis:the correlation coefficient of TCM syndrome is-0.246(P <0.05), there is statistical significance, it is negatively correlated with death. And the fatality rate of TCM syndrome is toxic syndrome of deficiency yin and yang yun syndrome is the highest fatality rate54.8%, followed by Qi deficiency withblood stasis and phlegm syndrome (43.6%), phlegm heat Off the lung syndrome (43.4%), stasis with heat and toxic syndrome (24.4%), Deficiency of qi and yin syndrome(10.0%) from high to low.The correlation coefficient of APACHE Ⅱ score is0.194(P<0.05), there is statistical significance, it is positive correlation with death. The correlation coefficient of the change value of ALB is-0.194(P<0.05), there is statistical significance, it is negatively correlated with death. The correlation coefficient of the change value of LC is0.152(P<0.05), there is statistical significance, it is positive correlation with death. Multiariable logistic regression shows that APACHE Ⅱ score, the change value of ALB are risk factors related to death. The regression coefficient of APACHE Ⅱ score is0.106, and the OR value is1.112(P<0.05), there is statistical significance, it is positive correlation with death. The higher APACHE Ⅱ score, the higher the fatality rate. The regression coefficient of the change value of ALB is-0.053, and the OR value is0.948(P<0.05), there is statistical significance, it is negatively correlated with death. The lower albumin, the higher the fatality rate.5.2The analysis of the prognosis risk factors in three groups with highest fatality rate5.2.1The analysis of the prognosis risk factors in the group of toxic syndrome of deficiency yin and yang yun syndromeSingle factor analysis:the correlation coefficient of APACHE Ⅱ score is0.613(P<0.05),there is statistical significance, it is positive correlation with death. The correlation coefficient of the change value of ALB is-0.422(P<0.05),there is statistical significance, it is negatively correlated with death. Multiariable logistic regression shows that APACHE Ⅱ score, age are risk factors related to death. The regression coefficient of APACHE Ⅱ score is0.272, and the OR value is1.312(P<0.05), there is statistical significance, it is positive correlation with death. The higher APACHE Ⅱ score, the higher the fatality rate. The regression coefficient of age is0.035, and the OR value is1.035(P<0.05), there is statistical significance, it is positive correlation with death. The growing age. the higher the fatality rate.5.2.2The analysis of Prognosis risk factors in the group of phlegm heat off the lung syndrome Single factor analysis:the correlation coefficient of gender is0.383(P<0.05),there is statistical significance, it is positive correlation with death. The correlation coefficient of CPIS score is0.371(P<0.05),there is statistical significance, it is positive correlation with death. the correlation coefficient of the change value of CRP is0.392(P<0.05),there is statistical significance, it is positive correlation with death. The correlation coefficient of PCT is0.395(P<0.05),there is statistical significance, it is positive correlation with death. The correlation coefficient of the change value of APTT is0.367(P<0.05),there is statistical significance, it is positive correlation with death. Multiariable logistic regression shows that the change value of APTT%PCT are risk factors related to death. The regression coefficient of the change value of APTT is0.092, and the OR value is1.096(P<0.05), there is statistical significance, it is positive correlation with death. The regression coefficient of PCT is0.447, and the OR value is1.564(P<0.05), there is statistical significance, it is positive correlation with death.5.2.3The analysis of Prognosis risk factors Qi deficiency with blood stasis and phlegm syndromeSingle factor analysis:the correlation coefficient of PCT is-0.423(P<0.05),there is statistical significance, it is negatively correlated with death. the correlation coefficient of the change value of ALB is-0.521(P<0.05),there is statistical significance, it is negatively correlated with death. Multiariable logistic regression factors indicated no statistical difference.Conclusion1.The fatality rate of the group of toxic syndrome of deficiency yin and yang yun syndrome, phlegm heat Off the lung syndrome and Qi deficiency withblood stasis and phlegm syndrome are higher than the overall average fatality rate. It suggest that a sign of poor prognosis in these three groups.2. APACHE II score is an important indicator to predict the prognosis of death. The higher the score, the higher the mortality. Changes in albumin is another important indicator to predict the death. With the aggravation of the inflammation, the consumption of albumin is too large to produce enough to maintain organism, and then the fatality rate will be increased. 3. The analysis of Prognosis risk factors in three groups with highest fatality rate show that in the group of toxic syndrome of deficiency yin and yang yun syndrome, APACHE II score and age are Prognosis risk factors. In the theory of TCM, it believed deficiency of vital qi and Yin Yang dried off would lead a poor prognosis.In the group of phlegm heat off the lung, the changes of APTT and PCT are prognosis risk factors. It showed severe inflammatory response in this group. In the theory of TCM, it believed that vital qi is strong enough to fight with pathogenic factor. Due to small sample sizes and heavy condition, Qi deficiency withblood stasis and phlegm syndrome hasn,t found the prognosis risk factors from this study.