Classification And Prognosis Analyses Of TCM Syndrome Types Of Elderly Severe Community-acquired Pneumonia

Objectives(1)To explore the distribution law of TCM syndrome types in elderly patients with severe pneumonia,and to analyze the relationship between different TCM syndrome types and patients’ general conditions,laboratory indicators.(2)At the same time,the correlation between different TCM syndrome types and the prognosis of patients was analyzed.MethodsA retrospective analysis method was used to collect the information of 92 patients with severe pneumonia who were admitted to ICU in First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from January 2021 to March 2022,and then included elderly patients with severe pneumonia aged ≥ 60 years.The general condition,TCM diagnosis,auxiliary and laboratory examinations,clinical outcomes and other relevant data of the patients were collected,and the patients were divided into improvement group and death group according to the treatment outcome.Among them,auxiliary and laboratory examination data include pulse oxygen saturation,hematocrit,platelet count,platelet count,white blood cells,number of neutrophils,number of lymphocytes,percentage of neutrophils,percentage of lymphocytes,eosinophil percentage,rapid C-reactive protein,high-sensitivity C-reactive protein,D-dimer detection,procalcitonin,respiratory support,combined Sequential organ failure score,and Acute physiology and chronic health evaluation II score.ResultsA total of 92 elderly patients with severe pneumonia were included in this study,including35 cases of improvement and 57 cases of death.The results of the comparison and analysis of the general conditions of the two groups of patients showed that there were no significant differences in gender,smoking history,drinking history,age,body temperature,systolic blood pressure,diastolic blood pressure,pulse oxygen saturation,and length of hospital stay(all P values > 0.05).The difference in respiratory support between the two groups was statistically significant(P<0.05).The analysis results of comorbidities and main clinical symptoms showed that the two were associated with hypertension,type 2 diabetes mellitus,coronary atherosclerotic heart disease,cerebral infarction,respiratory failure,heart failure,as well as fever,wheezing,There was no significant difference in the proportions of disturbance of consciousness,cough and expectoration symptoms(all P values > 0.05).The results of blood routine index analysis showed that there was no significant difference between the two in hematocrit,platelet count,white blood cell count,lymphocyte count,lymphocyte percentage,and eosinophil percentage(P>0.05).The difference in the number of neutrophils was statistically significant(P<0.05).In addition,the levels of rapid C-reactive protein,highsensitivity C-reactive protein,D-dimer,and procalcitonin were all higher,but the difference was not statistically significant(all P values > 0.05).There was a statistically significant difference between the two in the distribution of TCM syndrome types(P<0.05).Analysis of the relationship between TCM syndrome types and laboratory indicators showed that there were statistically significant differences in hematocrit,platelet volume,lymphocyte count,eosinophil percentage,and high-sensitivity C-reactive protein between the two groups of patients(all P values < 0.05).The symptoms of severe pneumonia are lung,heart,mind,kidney,stomach,spleen,and lesser abdomen;solid symptoms are mainly phlegm,heat,blood stasis,and dampness;Yin Deficiency,Yang Deficiency,Kidney Deficiency,Spleen Deficiency,Qi Deprivation.The univariate and multivariate Logistic regression analysis of the relationship between TCM syndrome types and patient prognosis showed that,compared with the syndrome of evil trapping and rectification,the syndrome of phlegm-heat obstructing the lung and the phlegmturbidity-obstructing lung syndrome could reduce the risk of death from severe pneumonia in the elderly.Conclusions1.The traditional Chinese medicine certificate in elderly patients with severe pneumonia is distributed as the evil trap positive deconstruction> sputum turbidity obstruction lung certificate> sputum hot lung certificate> hot trap pericardial evidence.The patients in the death group were mainly deficient in evil and positive,and the patients in the survival group were mainly based on sputum fever lung evidence and sputum obstruction lung evidence.2.The symptoms of severe pneumonia are lung,heart,mind,etc.The solid symptoms are mainly phlegm,heat,blood stasis,and dampness;the deficiency syndromes are mainly lung deficiency,qi deficiency,and blood deficiency.3.Elderly patients with severe pneumonia of the syndrome of evil trapping and positive syndrome have higher platelet count and high-sensitivity C-reactive protein value,while the number of lymphocytes and SOFA score are lower;phlegm-heat obstructing the lung syndrome The proportion of patients with phlegm symptoms is high;the phlegm obstructing lung syndrome patients have phlegm and wheezing symptoms,and the proportion of concomitant heart failure is high.4.Compared with the syndrome of stagnation of evil and right to escape,the risk of the syndrome of phlegm-heat obstructing the lung and the syndrome of phlegm-turbid obstruction of the lung is lower.