The Study Of The Correlation Between TCM Syndromes And Prognosis Of Hospital Acquired Pneumonia With Multidrug Resistance Bacteria Infection

ObjectiveIn this study,through the observation and analysis of the two cohorts of patients with hospital acquired pneumonia complicated with multidrug-resistant bacteria infection and patients with hospital acquired pneumonia not combined with multidrug-resistant bacteria infection,we can get the TCM syndrome elements and the prognosis characteristics of the two groups of patients,hoping to provide the basis for the clinical development of targeted Chinese and Western medicine treatment programs,and improve the quality of life of patients Improve the prognosis of patients to provide reference.MethodsThe study were a retrospective survey of hospital acquired pneumonia patients hospitalized in Guangdong Hospital of Traditional Chinese Medicine from January 1,2017 to February 1,2019.The general data,main physical signs,intervention measures,blood sampling indexes,relevant pathogenic indexes during hospitalization and imaging examinations were collected。Patients were assessed with the Charlson comorbidity index(CCI),Acute Physiology and Chronic Health Evaluation(APACHE-Ⅱ),Sepsis-related Argan Failure assessment(SOFA),and the outcome.According to the symptoms and signs of the patients,the syndrome types were classified and the TCM syndrome elements were recorded.The data of clinical data were sorted out by Excel software,the data of measurement data were input normally,and the data of count data were re sorted after assigning value.According to the survey results,the database was established,and spss20.0 statistical software was used to analyze and process the data.In single factor analysis,t test was used for normal distribution measurement data,rank sum test was used for non normal distribution measurement data,and χ2 test was used for count data.The variables with statistical significance in the single factor analysis group were included in the multi factor Logistic regression analysis.The odds ratio(OR)and 95%confidence region were calculated.The statistical analysis value was P<0.05.Then results were summarized and the conclusion was drawn.Results(1)There was no significant difference in the sex ratio of patients with HAP in the multidrug resistance group and the non-multidrug resistance group(P>0.05).There was no significant difference in the sex ratio between HAP patients in the death group and HAP patients in the survival group(P>0.05).(2)There was no significant difference in age distribution between patients with HAP in the multidrug resistance group and those in the non-multidrug resistance group(P>0.05).The age distribution of HAP patients in the death group was significantly different from that in the survival group(P<0.05).(3)The top five departments of patients with hospital acquired pneumonia were ICU(25.9%),Neurology(18.9%),general medicine(6.48%),Nephrology(6.48%),and general disease area(5.95%).(4)There was a significant difference in the total length of stay between patients with HAP in the multidrug resistance group and the non-multidrug resistance group(P<0.05).The total length of stay in hospital of patients with HAP in the death group and the survival group was significantly different(P<0.05).(5)There was no significant difference in CCI score between patients with HAP in the multidrug resistance group and the non-multidrug resistance group(P>0.05).There was a significant difference in CCI score between patients with HAP in the death group and the survival group(P<0.05).(6)There was no significant difference in Apache-Ⅱ score between patients with HAP in the multidrug resistance group and the non-multidrug resistance group(P>0.05).There was a significant difference in Apache-Ⅱ score between patients with HAP in death group and the survival group(P<0.05).(7)There was no significant difference in SOFA score between patients with HAP in the multidrug resistance group and the non-multidrug resistance group(P>0.05).There was no significant difference in SOFA score between patients with HAP in death group and the survival group(P>0.05).(8)During the period of hospitalization,there were 32 patients with surgical operation,119 patients with mechanical ventilation,26 patients with tracheotomy,56 patients with endotracheal intubation,24 patients indwelling with gastric tube,30 patients with indwelling urinary tube,10 patients with indwelling PiCCO,41 patients with CRRT and 31 patients with cardiopulmonary resuscitation.There were significant differences in mechanical ventilation,endotracheal intubation and indwelling urinary tube between patients with HAP in the multidrug resistance group and the non-multidrug resistance group(P<0.05).There were significant differences in CRRT between patients with HAP in the death group and the survival group(P<0.05).(9)The main syndrome elements of hospital acquired pneumonia patients during hospitalization were Qi deficiency syndrome,yin deficiency syndrome,blood stasis syndrome,phlegm turbidity syndrome,heat syndrome,internal wind syndrome,deficiency of health syndrome and food accumulation syndrome.There was no significant difference between patients with HAP in the multidrug resistance group and the non-multidrug resistance group(P>0.05).There were significant differences in Yin deficiency syndrome and external wind syndrome between patients with HAP in the death group and the survival group(P<0.05).(10)A total of 87 patients in the death group and 98 in the survival group were collected.The 30 day mortality rate after infection of HAP patients was 57.3%in the multi drug resistance group,37.5%in the non-multidrug resistance group,and 47.0%in general.There was a significant difference in Multi drug resistant bacteria infection between patients with HAP in the death group and the survival group(P<0.05).(11)Survival outcome was the dependent variable(Survival was zero,Death was one).Multivariate regression analysis showed that age(OR=1.035,95%CI was 1.008-1.064,P=0.012),CCI score(OR=1.261,95%CI was 1.092-1.458,P=0.002),APACHE-Ⅱ score(OR=1.112,95%CI was 1.035-1.196,P=0.004),deficiency of health syndrome(OR=2.167,95%CI was 1.040-4.514,P=0.039)were risk factors for the death of patients with hospital acquired pneumonia.Conclusions(1)Patients with HAP are older,usually have at least one basic disease,and their multiple drug resistance rate was 48.1%.(2)The TCM syndrome elements of patients with HAP were mainly phlegm syndrome,blood stasis syndrome and Qi deficiency syndrome.The top three syndrome elements of patients with HAP with in the multidrug resistance group and the non-multidrug resistance group were consistent with the overall.(3)Old age,high CCI score,high apache II score and deficiency of health syndrome are independent factors of patients with HAP,which will affect the prognosis of patients with HAP.