Research On TCM Syndromes Of Lobular Pneumonia In Children And Analysis Of Prescription Regularity

Objective:Based on a retrospective investigation and analysis of characteristics of lobar pneumonia in children,we discussed the correlation between TCM syndromes and clinical characteristics,and prescription regularity.So as to enhance the understanding of lobar pneumonia in children and improve the accuracy of syndrome differentiation.Methods:257 children with lobar pneumonia admitted to the pediatric ward of Shandong Provincial Hospital of Traditional Chinese Medicine from October 2015 to October 2020 were selected as the research objects.The general situation,TCM syndrome types,clinical symptoms,signs,laboratory indexes,imaging examination,prescription of TCM were collected by retrospective investigation.Spss24.0 software and Traditional Chinese Medicine Inheritance Assistant System were used for statistical analysis.Results:1.In this study,there was no difference in the sex ratio(P>0.05).In the age of onset,preschool children(3~+～7 years old)had the highest prevalence(P<0.05).The number of patients in winter and autumn was significantly higher than that in spring and summer(P<0.05).In TCM syndrome type distribution,the number of cases of damp heat obstructing lung syndrome was the largest,followed by phlegm heat obstructing lung syndrome and wind heat obstructing lung syndrome(P<0.05).The average length of hospital stay was 11.34±2.53 days.There were differences in the length of hospital stay among different syndrome types,damp heat obstructing lung syndrome>phlegm heat obstructing lung syndrome>wind heat obstructing lung syndrome(P<0.05).2.In the degree of fever,patients with moderate fever,high fever were more common.The heat potential of phlegm heat obstructing lung syndrome was the highest(P<0.05).But damp heat obstructing lung syndrome has the longest fever time(P<0.05).All the children had cough,the cough degree of phlegm heat obstructing lung syndrome was the most serious,followed by damp heat obstructing lung syndrome and wind heat obstructing lung syndrome(P<0.05).3.The most common secondary symptoms were fatigue,nasal obstruction and runny nose,nausea and vomiting,constipation,urinate urgent,abdominal pain,headache and diarrhea.Nasal obstruction and runny nose were more common in the syndrome of wind heat obstructing lung(P<0.05);nausea,vomiting and abdominal pain were more common in the syndrome of damp heat obstructing lung(P<0.05);constipation and urinate urgent were more common in the syndrome of phlegm heat obstructing lung(P<0.05).4.The average value of WBC count was 9.59±5.12×10~9/L.There was no significant difference in WBC count among different syndrome types(P>0.05).The average value of CRP was19.26±17.14mg/L,and there was no significant difference in CRP level among different syndrome types(P>0.05).The average value of D-D was0.97±1.10mg/L.The level of D-D in wind heat obstructing lung syndrome was lower than that in phlegm heat obstructing lung syndrome and damp heat obstructing lung syndrome(P<0.05).The average value of LDH was267.16±69.90U/L,and there was no significant difference in LDH level among different syndrome types(P>0.05).The pathogens of lobar pneumonia in children were mixed infection,mycoplasma,bacteria,influenza A virus,influenza B virus.5.4%of the children did not know the source of infection.In the mixed infection,mycoplasma combined with other pathogens had the highest pathogenic rate,accounting for94.9%.There were 213 mycoplasma positive cases,accounting for82.9%.6.The most common sites of inflammation were multilobar infection in one lung and multilobar infection in both lungs,and multilobar infection was associated with damp heat obstructing lung syndrome(P<0.05).6.There were 14 kinds of core herbs for the treatment of wind heat obstructing lung syndrome,including almond,ephedra,gypsum,scutellaria,licorice,bupleurum,pueraria,platycodon grandiflorum,forsythia,honeysuckle,trichosanthes,belamcanda,peucedanum and houttuynia.There were 14 kinds of core herbs in the treatment of phlegm heat obstructing lung syndrome,which were ephedra,gypsum,almond,licorice,perilla,houttuynia cordata,scutellaria baicalensis,tinglizi,trichosanthes kirilowii,fritillaria thunbergii,peach kernel,polygonum cuspidatum,acorus tatarinowii and reed root.There were 17 kinds of core herbs for the treatment of damp heat obstructing lung syndrome,which were scutellaria baicalensis,artemisia capillaris,glycyrrhiza uralensis,acorus tatarinowii,agastache rugosa,fritillaria thunbergii,forsythia suspensa,belamcanda,houttuynia cordata,peach kernel,pinellia ternata,polygonum cuspidatum,bupleurum,pueraria,cardamom,magnolia officinalis and artemisia.Conclusion:1.The incidence of lobar pneumonia in children is not affected by gender.The age of onset is more common among preschool children(3~+～7years old),and the incidence rate is high in winter and autumn(Jinan area).2.The main TCM syndromes on admission are damp heat obstructing lung syndrome,phlegm heat obstructing lung syndrome and wind heat obstructing lung syndrome,among which damp heat obstructing lung syndrome is the most common.3.The duration of fever in the syndrome of damp heat obstructing lung is long,mostly≥8 days,or even≥11 days.The symptoms of damp heat obstructing lung syndrome often accompany by nausea,vomiting,abdominal pain and other spleen symptoms.The main symptoms of phlegm heat obstructing lung syndrome are high fever and severe cough,which often accompany by constipation and urinate urgent.The symptoms of wind heat obstructing lung syndrome are relatively mild,the duration of fever is short,cough is not serious,often accompany by nasal obstruction,runny nose and other symptoms of exogenous wind pathogens.4.Mycoplasma is the main pathogen of lobar pneumonia in children,and often causes mixed infection with other pathogens.It is difficult for some children to identify the source of infection during hospitalization,which should be paid enough attention to.WBC count is high in normal range;CRP,D-D and LDH are increased in varying degrees.The D-D level of damp heat obstructing lung syndrome and phlegm heat obstructing lung syndrome increase significantly.5.The lesion is diffuse,often causing multiple lobar infection.Compared with other syndrome types,damp heat obstructing lung syndrome has larger infection area,complicated condition and long hospital stay.6.In the early stage of hospitalization,clearing and purging lung heat is the main treatment.The treatment of wind heat obstructing lung syndrome focuses on clearing away lung heat,dispersing wind heat,and relieving cough and phlegm.The treatment of phlegm heat obstructing lung syndrome focuses on clearing away lung heat,relieving cough and phlegm,and promoting blood circulation and removing blood stasis.The treatment of damp heat obstructing lung syndrome should pay attention to clearing away heat and dampness,activating blood circulation,and relieving cough and phlegm.