重症医学科多重耐药菌肺部感染的中医证候特征研究

A study of TCM syndrome characteristics of pulmonary infection with multidrug-resistant organisms in Department of Critical Care Medicine

目的:总结重症医学科多重耐药菌(MDRO)肺部感染患者的中医证候要素、证型与病原学相关资料,分析两者联系。方法:临床分析2013年5月至2015年12月广州市番禺区中心医院及广州市番禺区中医院重症医学科就诊的MDRO肺部感染患者,采用描述性统计学方法,计算证候、症状的频数、构成比;总结分析其临床特征、病原学资料和中医辨证分型的异同。结果:纳入研究患者141例,分析145株多重耐药菌,在重症医学科肺部感染多重耐药菌分布中革兰氏阴性菌明显占优势,约占总耐药菌的77.93%,排前4位的依然是铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌及肺炎克雷白菌,共占革兰氏阴性菌的70.80%。革兰氏阳性菌只占22.07%,以金黄色葡萄球菌、表皮葡萄球菌为主。中医证型分析中实证占80.00%,而痰热壅肺证比例尤为突出,占38.62%;虚证占20.00%,其中以气阴两虚证为主,占15.17%。革兰氏阴性菌主要表现为痰热壅肺、气阴两虚、风热犯肺、肺胃热盛证,而革兰氏阳性菌以肺胃热盛、痰热壅肺为主要证型;铜绿假单胞菌感染多见痰热壅肺证(51.72%);大肠埃希菌感染以痰热壅肺证为主(35.29%);鲍曼不动杆菌感染主要以气阴两虚证为主(33.33%);肺炎克雷白菌感染则以痰热壅肺证(37.50%)及肺胃热盛证(31.25%)为主;耐药金葡菌感染以痰热壅肺证(28.57%)及肺胃热盛证(28.57%)为主。结论:多重耐药菌肺部感染的中医证型仍以实证为主,痰热壅肺证是多重耐药菌的主要中医证候,虚证以气阴两虚为主,亦不可忽视。ICU肺部感染多重耐药菌与中医辨证之间存在一定程度的交叉相关性,在治疗中要重视清热化痰及益气养阴药物和方法的运用。

Objective ： To summarize the traditional Chinese medicine （TCM） syndrome factors, TCM syndrome types, and related pathogen information in patients with pulmonary infection with multidrug - resistant organisms （MDRO） in the Depart- ment of Critical Care Medicine, and to analyze the relationship between them. Methods：We clinically analyzed patients with pulmonary infection with MDRO who were treated in the Department of Critical Care Medicine in Panyu District Central Hos- pital and Panyu District Hospital of Traditional Chinese Medicine from May 2013 to December 2015. The descriptive statisti- cal method was used to calculate the frequency of syndromes and symptoms and the constituent ratio. We summarized and an- alyzed the similarities and differences in its clinical features, pathogen information, and TCM syndromes. Results：A total of 141 patients were included in the study, and 145 strains of MDRO were analyzed. Gram - negative bacteria were dominant a- mong MDRO in the Department of Critical Care Medicine ,accounting for 77. 93% of all drug - resistant bacteria. The top four bacteria were Pseudomonas aeruginosa, Acinetobacter baumannii, Escheriehia coli, and Klebsiella pneumoniae, accounting for 70. 80% of Gram - negative bacteria. Gram - positive bacteria accounted for only 22. 07% of all drug - resistant bacteria, mainly including Staphylococcus aureus and Staphylococcus epidermidis. Excess syndrome accounted for 80. 00% of all TCM syndromes, and the syndrome of phlegm - heat obstructing the hmg was particularly prominent, accounting for 38. 62%. Defi- ciency syndrome accounted for 20. 00% of all TCM syndromes,and the syndrome of dual deficiency of qi and yin accounted for 15. 17%. Infection with Gram - negative bacteria mainly manifested as the syndromes of phlegm - heat obstructing the lung, dual deficiency of qi and yin ,wind- heat invading the lung, and exuberant heat in the lung and stomach, while infec- tion with Gram - positive bacteria mainly manifested as the syndromes of exuberant heat in the lung and stomach and phlegm - heat obstructing the lung. Pseudomonas aeruginosa infection was commonly related to the syndrome of phlegm - heat ob- structing the lung（51.72% ） ;Escherichia coli infection was also mostly related to the syndrome of phlegm- heat obstructing the lung （35.29%） ; Acinetobacter baumannii infection mainly involved the syndrome of dual deficiency of qi and yin （33.33%） ;Klebsiella pneumoniae infection predominantly manifested as the syndromes of phlegm- heat obstructing the lung（37.50% ）and exuberant heat in the lung and stomach （31.25%） ;drug -resistant Staphylococcus aureus infection also mostly manifested as the syndromes of phlegm - heat obstructing the lung（28.57% ）and exuberant heat in the lung and stom- ach （28.57%）. Conclusion：Most TCM syndromes of pulmonary infection with MDRO belong to excess syndrome, and phlegm - heat obstructing the lung is the main TCM syndrome ;dural deficiency of both qi and yin is the main type of deficiency syn- drome,which should not be overlooked. There is a certain association between pulmonary infection with MDRO in the inten- sive care unit and TCM syndromes. During the treatment, the drugs and methods that are heat -clearing, phlegm -dispelling, qi -tonifying,and yin- nourishing should be taken seriously.