| Objective: This research through the retrospective analysis of respiratory general wards analysis acute aggravating period of elderly patients with chronic cor pulmonale susceptibility factors,the structure of the pathogen,resistance characteristics and its relationship with cardiac function,at the same time,this study deeply analyzes the characteristics of syndromes and the correlation with pathogen infection,aims to provide references for clinical rational use of antibiotics and traditional Chinese medicine syndrome differentiation.Methods: Using the electronic medical record system and medical order management system of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine,the case data of 194 patients who met the inclusion and exclusion criteria admitted to the respiratory department from October 1,2019 to December 31,2020 were retrospectively collected.SPSS25.0 software was used to analyze the characteristics of pathogenic bacteria in elderly patients with acute exacerbation of chronic pulmonary heart disease,the distribution pattern and characteristics of TCM syndromes,and to explore the relationship between pathogenic bacteria infection and TCM syndromes and cardiac function grading.Results: 1.A total of 194 elderly patients with acute exacerbation of chronic pulmonary heart disease were enrolled in this study,including 102 patients with negative sputum culture and 92 patients with positive sputum culture.2.There were significant statistical differences in C-reactive protein,neutrophil percentage and white blood cell count between sputum culture positive and negative groups in elderly patients with acute exacerbation of chronic pulmonary heart disease(P<0.05).3.Multiple Logistic regression analysis of pathogenic susceptibility factors showed that the number of previous acute exacerbations in 1 year was more than 2 times,long-term inhalation of glucocorticoids,recent use of more than or equal to 3 kinds of antibiotics(within 1 month),combined with hypoproteinemia and combined with bronchiectasis were independent risk factors for pathogenic bacterial infection(P<0.05).4.The positive rate of sputum culture in cardiac function class II,III and IV groups was 20.69%,25.0% and 80.25%,respectively.The positive rate of sputum culture among patients with different cardiac function grades was statistically significant(P<0.01).The positive rate of sputum culture in normal group,mild hypertension group,moderate hypertension group and severe hypertension group were 61.4%,36.51%,42.86% and 55.56%,respectively.There was statistical difference in sputum culture positive rate among different pulmonary arterial pressure groups(P<0.05).5.In this study,the syndromes of elderly patients with acute exacerbation of chronic pulmonary heart disease were followed by Cold drink ejecting lung syndrome(21.13%),phlegm stasis obstructing lung syndrome(13.4%),phlegm-heat stagnation lung syndrome(33.51%),phlegm-dampness obstructing lung syndrome(15.98%),Yang deficiency and water flooding syndrome(14.43%),Exhaustion of Yin and Yang(1.55%).There was no significant difference between positive and negative sputum culture among different TCM syndromes(P BBB 0 0.05).There was statistical difference in the white blood cell count between phlegm-heat stagnation of lung syndrome and non-phlegm-heat stagnation of lung syndrome(P<0.05).6.A total of 125 strains of bacteria were detected in this study,and 72 strains(57.6%)were cultured,including 8 strains of Gram-positive bacteria(G+ bacteria)(6.4%),5 strains of methicillin-resistant Staphylococcus aureus(4%),3 strains of Streptococcus pneumoniae(2.4%),64 strains of Gram-negative bacteria(G-bacteria)(51.2%),30 strains of Pseudomonas aeruginosa(24%),9 strains of Acinetobacter baumannii(7.2%),and 5 strains of Klebsiella pneumoniae(4%).Fifty-three strains of fungi(42.4%)were isolated,among which 29 strains of Candida albicans(23.2%)were isolated.7.The results of drug sensitivity in this study showed that the main G+ bacteria and G-bacteria had different degrees of drug resistance to commonly used antibiotics.G+bacteria were basically 100% resistant to tetracycline and erythromycin,and methicillin-resistant Staphylococcus were completely resistant to a variety of antibiotics.No G+ bacteria insensitive to tigacycline,vancomycin and linezolid were found.The drug resistance rate of Pseudomonas aeruginosa,Acinetobacter baumannii and Klebsiella pneumoniae to cefazolin in G-bacteria was relatively high,all of which were more than 50%.The resistance rate of Haemophilus influenzae to cefuroxime and ampicillin was 100%.The resistance rate of maltophilic oliotrophomonas to cefoperazone/sulbactam was more than 70%.Conclusion: 1.In this study,it was found that in the elderly patients with acute exacerbation of chronic pulmonary heart disease,the sputum culture-positive group was mainly bacterial infection,in which G-bacteria was the most common.2.Long-term inhalation of hormones,more than 2 times of acute exacerbations in the past 1 year,more than or equal to 3 kinds of antibiotics in the recent period(within 1 month),combined with hypoproteinemia and combined with bronchiectasis were independent risk factors for pathogenic bacterial infection.3.In this study,G-bacteria were the main pathogenic bacteria in elderly patients with acute exacerbation of chronic pulmonary heart disease.The most common TCM syndromes were phlegm-heat stagnation of lung syndrome,followed by cold drink injection of lung syndrome.There may be a certain correlation between phlegm-heat stagnation of lung syndrome and white blood cell count.4.There may be a certain correlation between cardiac function grade and pulmonary artery pressure grade and the positive rate of sputum culture.The sputum culture is more likely to be positive when the heart function grade IV is graded.5.This study found that Sichuan Provincial Hospital of Traditional Chinese Medicine respiratory common ward acute aggravating period of elderly patients with chronic cor pulmonale is located in the top three in the distribution of pathogenic bacteria G-bacteria were pseudomonas aeruginosa,acinetobacter baumannii,with klebsiella pneumoniae,G+ bacteria mainly for streptococcus pneumoniae,methicillin-resistant staphylococcus aureus.The fungi were mainly Candida albicans.6.The results of this study indicated that the G+ strain of this patient was completely resistant to tetracycline and erythromycin,and was still highly sensitive to vancomycin,linezolid and tegacycline. |
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