TCM Syndrome Distribution Regularity Of Severe Pneumonia And Risk Factor Analysis

Background:In recent years, although the anti-infection treatment has made significant progress, but still severe pneumonia is a respiratory infection is one of the important challenges faced in the clinical treatment, the main reason for the low immune function in patients with severe pneumonia, coupled with the widespread use of antibiotics and the change of the pathogen itself, easy to merge multiple drug-resistant bacteria infection, severe hypoxemia, even septic shock and multiple organ failure, leading to the difficulty of severe pneumonia in clinical treatment. Recently, severe pneumonia is still the main cause of death linked to a variety of infections, this study through study of severe pneumonia were retrospectively analyzed, study the traditional Chinese and western medicine clinical characteristics of severe pneumonia and associated risk factors, to guide Chinese and western medicine treatment, and cause to the attention of the related diseases develop into severe pneumonia clinically.Objectives:According to the clinical prognosis of severe pneumonia can be divided into improved group and deteriorating, retrospective analysis the clinical characteristics of two groups, auxiliary examination resuLts and the information such as the effect of clinical intervention, to research the Chinese and western medicine clinical features of severe pneumonia, provide help for clinical treatment and prevention.Methods:By retrospective survey method, information collection table design cases. Collect between December 2012 and December 2012 in guangdong hospital of respiratory and each branch and ICU inpatients in line with the diagnostic criteria and exclusion criteria of patients as the research object, its according to the final outcome in patients with severe pneumonia can be divided into improved group and deteriorating. Better group, judgement standard: relieve clinical symptoms and signs, X-ray chest radiograph prompt inflammatory lesions absorb 1/2 or more; Deterioration group, judgement standard:death or after symptomatic treatment the clinical judgment without improving clinical symptoms and signs, abandoning treatment of patients with automatic departure from the hospital. EXCEL is adopted to establish the database, collect information of patients, record their gender, age, hospitalization days, respectively, basic disease, complications, breathing machine usage, clinical findings, body temperature, sputum culture, TCM syndrome type and other information. Using SPSS18.0 sorts through the data and statistical analysis, the results and analysis.Result:In the collection included in the standard of 153 cases of severe pneumonia cases, improvement in group a total of 132 cases, deteriorating group a total of 21 cases, including deaths in 16 cases,5 cases treatment is invalid automatically give up. The study found that:(1) are more likely to suffer from severe pneumonia in the elderly, and the older the more bad prognosis. Studies show that the average age of the two groups were greater than 60, but deteriorated group of age was 71.5 years, more difference was statistically significant (Z=2.678, P<0.05). (2) basic pulmonary diseases, the higher the mortality in patients with severe pneumonia. Research shows that, with basic diseases, two groups of hypertension, cerebrovascular disease, diabetes, coronary heart disease, malignant tumor, bronchiectasis are all P>0.05, there was no statistically significant difference, COPD is similar between the two groups was statistically significant(Z=2.678, P<0.05). (3) in patients with severe pneumonia complications worse prognosis. Research shows that two groups in merger related diseases such as severe sepsis, severe sepsis with DIC and MODS, merge MODS ARDS, MODS>2 organs of f1 was P<0.05, the difference was statistically significant. (4) the deterioration in groups in the use of breathing machine and open high proportion of artificial airway, and withdraw machine less proportion. In the use of breathing machine, artificial airway open, withdraw machine more or less both in comparing the two groups (P<0.05, the difference was statistically significant. (5) inflammation index of deterioration group was obviously higher than improving group, malnutrition, renal injury worse prognosis. Two groups of experimental index of PCT, ESR, CRP, propagated, Urea, Crisall P<0.05, the difference was statistically significant, the rest of the experimental index comparing the two groups have no statistical significance. (6) In the imaging study, the right lung infection rate in the deterioration group was higher. The right lung infection, and only in the right lung infection between the two groups were all P<0.05, the difference was statistically significant. The rest of the left lobe of lung infection, two lung infection and multiple lung infection, there was no significant difference.(7) into the cases that deterioration of bacterial infection group better than many, statistically significant; Acinetobacter baumannii and pseudomonas aeruginosa in most frequency; Fungal infections in white candida multiple, comparing the two groups has no statistical significance. And smooth ball to candida infection, acinetobacter baumannii prognosis is not good, more or less both in comparing the two groups (P<0.05. (8) of traditional Chinese medicine, into the patients, phlegm, heat, blood stasis, deficiency in the highest frequency, and deterioration in stasis, wet stasis syndrome and Yang deficiency syndrome, gas to take off the ratio is higher than better group, better than the proportion of the heat deterioration group, two groups of fl was P<0.05. Deterioration group are more likely to appear two deficiency qi and Yin, phlegm and blood stasis resistance syndrome, lung spleen and kidney, blood stasis phlegm dampness syndrome, sun be the spirit to take off of syndrome, phlegm heat within the constant, improving group are more likely to appear phlegm heat huiyong, lung, more or less both in comparing the two groups (P<0.05). (9) in 153 patients, the main clinic symptoms of cough, fever, and shortness of breath, coughing up phlegm, consciousness disorder, lower extremity edema, among which the main clinic improvement in symptoms of cough, fever, and shortness of breath, coughing up phlegm, lower extremity edema, chest pain, deteriorating group main clinic symptoms of shortness of breath, cough, consciousness barrier sputum, fever, cough, fatigue, fever, and shortness of breath, consciousness disorder, lack of power, oliguria, no significant differences in the two groups to compare.Conclusion:(1) age, chronic obstructive pulmonary disease (COPD), complicated with severe sepsis and MODS, PCT, CRP, ESR, urea, Cr increased, decreased ALB, above all the risk factors of severe pneumonia; prognosis of MODS in two or more organs than those mods 2 organs. (2) imaging, right and pulmonary infection in patients and patients with simple right pulmonary infection, the prognosis is even worse, considering the repeated infection of patients with aspiration, so that the prognosis of severe pneumonia worse. (3) the main pathogenic bacteria affecting the prognosis of severe pneumonia were bacteria, while the smooth spherical pseudo Candida and Bauman Acinetobacter were the main pathogenic bacteria affecting the prognosis of severe pneumonia patients. (4) in traditional Chinese medicine, phlegm, heat, deficiency and blood stasis is the main pathological features of severe pneumonia, and to heat syndrome this empirical patients with a better prognosis, and the prognosis of the patients with blood stasis syndrome, Yang deficiency syndrome, dampness and blood stasis syndrome, Qi and removing stasis of difference. (5) syndrome, improved group of phlegm heat obstructing the lung syndrome is more common and the deterioration group for deficiency syndrome and pathological products the actual cornplex card, such as deficiency of both qi and Yin, stagnation of phlegm and blood stasis, deficiency of lung, spleen and kidney, Phlegm Blood Stasis Syndrome, Yang desire prostration syndrome, phlegm heat closed blinds our eyes. (6) in patients with severe pneumonia often cough, fever, shortness of breath, sputum, conscious disturbance, edema of lower extremity as the main symptoms and improvement group more easy to heat, and shortness of breath, conscious disturbance, fatigue, oliguria for the prognosis of the patients are the main symptoms of the difference.