耐药鲍曼不动杆菌肺炎临床发病特点和中医证候相关性研究

Study on clinical characteristics of onset and relevant TCM syndrome in drug-resistant acinetobacter baumannii pneumonia

目的探讨耐药鲍曼不动杆菌肺炎的临床发病特点和中医证候相关性临床分布规律。方法记录首都医科大学附属北京中医医院(以下简称我院)2010-2012年共183例耐药鲍曼不动杆菌肺炎患者的耐药情况,比较ICU和普通病房的耐药情况,对患者的中医四诊资料进行辨证,判断其中医证候要素,分析其证候相关性。结果我院耐药鲍曼不动杆菌肺炎感染患者均具有危险因素,半数以上的患者伴有其他细菌、真菌感染,死亡率高。3年来耐药率总体呈上升趋势,但程度有差异。而在ICU,耐药率总体高于普通病房,中医证候出现的频率从高到低依次为虚实夹杂证、单纯实证、单纯虚证。虚证的基本证候要素出现的频率从高到低依次为气虚证、阴虚证、阳虚证、血虚证。实证的基本证候要素出现的频率从高到低依次为痰证、血瘀证、火热证、水饮证、气滞证。结论我院耐药鲍曼不动杆菌的特点为患者的危险因素多,伴有其他细菌、真菌感染多,病死率高。3年耐药率总体呈上升趋势,但程度有差异。ICU耐药率总体高于普通病房。中医证候分布以虚实夹杂证多见,气虚证、阴虚证、痰证、火热证、血瘀证多见。

Objective To explore the clinical characteristics of onset in drug-resistant acinetobacter baumannii pneumonia and the distributed law of relevant TCM syndromes.Methods The drug resistance condition of one hundred and eighty-three cases with drug-resistant acinetobacter baumannii pneumonia,in Beijing TCM Hospital affiliated to Capital Medical University（our hospital for short） were recorded from 2010 to 2012,which were compared between that of ICU and that of general ward.Syndrome differentiation was carried out with patients’information of TCM four diagnostic methods and syndrome factors of TCM were evaluated to analyze the relevant TCM syndromes.Results In our hospital,the patients with drug-resistant acinetobacter baumannii pneumonia all had dangerous factors,and more than half of them were accompanied by bacterial and fungal infection with high mortality.Over 3 years,the drug resistance rate,generally,showed an upward trend with differences in degree.Of the ICU,the drug resistance rate was higher than that of the general ward in general.The frequency of TCM syndromes from high to low in turn was： syndrome of intermingled deficiency and excess,excess syndrome,and deficiency syndrome.The frequency of basic syndrome factors in deficiency syndrome from high to low in turn was： qi-deficiency syndrome,yin-deficiency syndrome,yang-deficiency syndrome,and blood-deficiency syndrome.The frequency of basic syndrome factors in excess syndrome from high to low in turn was： phlegm syndrome,blood-stasis syndrome,fire-heat syndrome,fluid-retention syndrome,and qi stagnation syndrome.Conclusion The characteristic of drug-resistant acinetobacter baumannii pneumonia in our hospital were that patients had many dangerous factors and most of them were accompanied by bacterial and fungal infection with high mortality.Over 3 years,the drug resistance rate showed an upward trend with differences in degree generally.Of the ICU,the drug resistance rate was higher than that of the general ward in general.The syndrome of intermingled deficiency and excess was more seen in TCM syndrome distribution.Also qi-deficiency syndrome,yin-deficiency syndrome,phlegm syndrome,fire-heat syndrome and blood-stasis syndrome were more prevalent.