3096例慢性阻塞性肺疾病住院患者的临床及中医证候特征分析

Clinical Characteristics and Traditional Chinese Medicine Syndrome Types in Inpatients with Chronic Obstructive Pulmonary Disease:An Investigation of 3096 Cases

【目的】通过对广东省中医院的医院信息系统(HIS)中慢性阻塞性肺疾病(COPD)住院患者的信息分析,了解广州市COPD患者的临床特征及中医证候特征。【方法】以2015~2017年广东省中医院HIS系统中的3096例COPD住院患者信息为数据库,使用频数分析方法分析患者的临床特征及中医证候特征,以及急性加重住院的节气分布情况。【结果】(1)3096例COPD住院患者的年龄中位数为77岁,高峰年龄为75~89岁,男性患者是女性患者的4.86倍。(2)心血管疾病占合并病首位,肺部感染是COPD患者急性加重的主要原因,糖尿病是常见合并病。(3)COPD患者多表现虚实夹杂的证候,虚证前3位依次为肺脾肾虚证、肺脾两虚证和肺气亏虚证,实证前3位依次为痰湿阻肺证、湿热瘀阻证和痰热壅肺证。痰、虚、热、瘀是COPD患者的主要病性证素,肺、脾、肾是主要病位证素。(4)COPD患者急性加重入院的时间在各节气分布较均匀,其中较多的节气依次为雨水、冬至、芒种、夏至、惊蛰、小寒。【结论】COPD住院患者以高龄男性居多;痰、虚、热、瘀是本病的病机要点;在广州地区,COPD患者不仅在冬季容易出现急性加重,在夏季温度高、湿度大的节气也同样高发。

Objective The clinical information of the inpatients with chronic obstructive pulmonary disease(COPD)in the hospital information system(HIS)of Guangdong Provincial Hospital of Traditional Chinese Medicine was analyzed,so as to investigate the clinical characteristics and traditional Chinese medicine(TCM)syndrome types of COPD patients in Guangzhou city.Methods The information of 3096 cases of COPD inpatients in the HIS of Guangdong Provincial Hospital of Traditional Chinese Medicine from 2015 to 2017 was collected,and then the frequency analysis method was adopted for the investigation of the clinical characteristics and TCM syndrome types,as well as the distribution of solar terms when the COPD becomes acute exacerbation for hospitalization.Results(1)The 3069 cases of COPD inpatients had the median age of 77 years old,and the peak age was 75-89 years old.The amount of male patients was 4.86 times higher than that of the female patients.(2)The cardiovascular disease accounted for the leading complicated disease,pneumonia was the main cause of acute exacerbation of COPD,and diabetes was the commonly-seen complicated disease.(3)Most of the COPD patients were characterized by the syndrome of deficiency interweaved with excess.The leading 3 deficiency syndromes were the syndrome of deficiency of lung,spleen and kidney,syndrome of deficiency of both lung and spleen,and syndrome of lung qi insufficiency.The leading 3 excess syndromes were the syndrome of phlegm-damp obstructing the lung,syndrome of damp heat and blood stasis obstruction,and syndrome of phlegm-heat accumulation in the lung.Phlegm,deficiency,heat,and blood stasis were the primary syndrome elements of the nature of disease.Lung,spleen,and kidney were the main syndrome elements of the location of disease.(4)The hospitalization time of COPD patients was evenly distributed in each solar term.The COPD became acute exacerbation for hospitalization usually in the solar terms of Rain Water,the Winter Solstice,Bearded Grain,the Summer Solstice,the Waking of Insects and Slight Cold.Conclusion COPD inpatients are commonly seen in the male.Phlegm,deficiency,heat and blood stasis are the key elements of TCM pathogenesis of COPD.In Guangzhou area,COPD patients are prone to acute exacerbation not only in winter,but also in the solar terms of high temperature and humidity in summer.