小儿细菌性肺炎2500例临床诊治分析

Clinical Diagnosis and Treatment Analysis of 2 500 Children with Bacterial Pneumonia

目的通过对2500例细菌性肺炎住院病例进行回顾性调查研究,分析其发病特点、中医证型、诊疗方案、治疗结果等.方法以长春中医药大学附属医院儿童诊疗中心2016年1月-2017年12月住院的细菌性肺炎病例为研究对象,提取患者的一般情况、临床主证、辅助检查、中医证型及中西药物治疗情况等进行回顾性分析。结果2500例肺炎患儿中,男1388例,女1112例,男女比1.248:1,平均年龄(3.37+2.18)岁。风热闭肺证2248例(89.92%)、痰热闭肺证252例(10.08%).以发热、咳嗽、有痰、喘促、食纳差、夜寐欠安为主要症状。实验室检查白细胞升高1647例(65.88%)、超敏CRP升高1556例(62.64%)、降钙素原升高率32.12%(713/2220).支原体抗体阳性率16.7%(385/2305),其他相关病原学检测结果,前3位分别为人副流感病毒IgG抗体阳性率75.28%(1438/1910)、人呼吸道合胞病毒IgG抗体阳性率36.07%(689/1910)、腺病毒IgG抗体阳性率21.15%(404/1910);中药治疗以疏风解毒、豁痰平喘为主要治法,后期注重补肺健脾,益气化痰;静点中成药以喜炎平、热毒宁、丹参、炎琥宁为主。1833例(73.32%)患儿进行了中医外治法治疗。住院患儿均使用抗生素静点治疗。平均住院天数为(9.29±2.18)d,与疾病证型、发病年龄存在相关性,与中医外治法的使用无显著的相关性.结论细菌性肺炎患者证型以风热闭肺,痰热闭肺为主,多采用中西医结合治疗,但中西医结合治疗小儿细菌性肺炎的优势尚未得到循证医学支持。

Objective Through the retrospective investigation from 2500 cases of bacterial pneumonia hospitalized records,analyzed the characteristics of the disease,treatment results,TCM syndromes,diagnosis and treatment programs,etc.Methods The study included cases of pediatric pneumonia from January 2016 to December 2017 in the affiliated hospital of Changchun University of Chinese Medicine.Retrospectively analyze the general conditions,clinical main symptoms,auxiliary examinations,TCM syndromes and Chinese and Western medicine treatment of the patients.Results Among 2500 children with pneumonia,1388 were males and 1112 were females,the ratio of males to females was 1.24&1,with an average age of(3.37±2.18)years.According to TCM syndrome differentiation, there were 2 248 cases (89.92%) of wind-heat syndrome and 252 cases (10.08%) of phlegmhearsyndrome. The main symptoms were fever, cough, phlegm, shortness of breath, poor food intake and sleepdisturbance. Leukocyte examination increased by 1647 (65.88%), hypersensitive CRP by 1 556 (62.64%) and ratioof procalcitonin increase is 32.12% (713/2 220). The positive rate of mycoplasma antibody was 16.7% (385/2 305),and the positive rate of other related pathogens was 75.28% (1 438/1 910) for human parainfluenza virus, 36.07%(689/1 910) for human respiratory syncytial virus, and 21.15% (404/1 910) for adenovirus. The main treatments oftraditional Chinese medicine are to relieving wind, detoxifying phlegm and relieving asthma. In the later stage, weshould pay attention to invigorating lung and spleen, invigorating qi and phlegm, and the main treatments of staticChinese medicine are Xiyanping injection, Reduning oral solution, the root of red-rooted salvia and PotassiumSodium Dehydroa. And 1833 cases (73.32%) were treated with external treatment of traditional Chinese medicine. Allhospitalized children were treated with intravenous antibiotics. The average length of hospitalization was (9.29±2.18)days, which was correlated with the type of syndrome and age of disease, but not with the use of external treatmentof traditional Chinese medicine. Conclusion The symptoms of bacterial pneumonia in Children's Medical Center ofThe affiliated hospital of Changchun University of Traditional Chinese Medicine are mainly stagnation of wind-heatcloses the lung and phlegm-heat closes the lung. Most of these patients were treated with the integration of traditionalChinese and Western medicine. However, the advantages of integration of traditional Chinese and Western medicine intreating bacterial pneumonia in children is still have not been supported by evidence-based medicine.