耐药鲍曼不动杆菌肺炎中医证型特点及预后相关危险因素研究

Study on Characteristics of TCM Syndrome Types and Prognostic Related Risk Factors of Drug-Resistant Acinetobacter Baumannii Pneumonia

目的探讨耐药鲍曼不动杆菌肺炎患者中医证型分布及预后相关危险因素。方法收集76例耐药鲍曼不动杆菌肺炎住院患者,其中存活组38例,死亡组38例。观察两组患者年龄分布、基础疾病、侵入性操作情况;观察两组患者的胃肠功能障碍评分、临床指标[白细胞计数(White blood cell count,WBC)、中性粒细胞百分比(Heutrophil percentage,NE%)、C反应蛋白(C-reactive protein,CRP)、人血白蛋白(Serum albumin,Alb)];观察中医证型分布情况与转归相关性及耐药鲍曼不动杆菌肺炎患者预后的相关危险因素。结果76例患者在75岁及以上年龄段人数最多,患者中医证型以痰热壅肺证43例(56.58%)、气阴两虚证19例(25.00%)多见,痰热壅肺证多预后较好,气阴两虚证预后多较差,患者证型和转归具有相关性,差异有统计学意义(P<0.05)。单因素分析显示,年龄≥75岁、冠心病病史、留置尿管、深静脉置管、WBC、NE、Alb、胃肠功能障碍评分与患者预后有一定关联,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,年龄≥75岁[OR=9.088,95%CI(2.082,39.678)]、深静脉置管[OR=14.505,95%CI(4.038,52.101)]、胃肠功能障碍评分高[OR=2.027,95%CI(1.046,3.929)]是与耐药鲍曼不动杆菌肺炎患者预后相关的独立危险因素。结论耐药鲍曼不动杆菌肺炎患者以痰热壅肺证、气阴两虚证多见,痰热壅肺证多预后较好,气阴两虚证预后多较差;年龄≥75岁、深静脉置管、胃肠功能障碍评分高是影响患者预后的独立危险因素。

Objective To explore the distribution of TCM syndrome types and risk factors of prognosis in patients with pneumonia csused by drug-resistant Acinetobacter baumannii pneumonia.Methods A total of 76 inpatients with drug-resistant Acinetobacter baumannii pneumonia were collected,including 38 cases in the survival group and 38 cases in the death group.The patient's general information(age distribution,underlying diseases),clinical manifestations,tongue and pulse signs,invasive operation,auxiliary examination[white blood cell count(WBC),neutrophil percentage(NE%),C-reactive protein(CRP),serum albumin(Alb)],gastrointestinal dysfunction scores were recorded in detail to summarize the TCM syndrome types and analyze the risk factors of its prognosis by using univariate analysis and multivariate logistic regression analysis.Results 76 patients were the most in the age group of 75 years and above.The TCM syndrome type of the patients was 43 cases(56.58%)with phlegm-heat obstructing lung syndrome,19 cases(25.00%)with qi-yin deficiency syndrome were more common,and phlegm-heat obstructing lung was more common.The prognosis of multiple syndromes is better,and the prognosis of deficiency of both qi and yin is often worse.The syndrome type and outcome of patients are correlated,and the difference is statistically significant(P<0.05).Univariate analysis showed that age≥75 years,history of coronary heart disease,indwelling catheter,deep venous catheterization,WBC,NE,Alb,gastrointestinal dysfunction scores were associated with patient prognosis,and the difference was statistically significant(P<0.05);Multivariate logistic regression analysis showed that age≥75 years old[OR=9.088,95%CI(2.082,39.678)],deep venous catheterization[OR=14.505,95%CI(4.038,52.101)],gastrointestinal function High barrier score[OR=2.027,95%CI(1.046,3.929)]is an independent risk factor related to the prognosis of patients with drug-resistant Acinetobacter baumannii pneumonia.Conclusion Patients with drug-resistant Acinetobacter baumannii pneumonia are more common with phlegm-heat obstructing lung syndrome and qi and yin deficiency syndrome.Phlegm-heat obstructing lung syndrome has a better prognosis,but the latter has the opposite.Age≥75 years,deep vein catheterization and higher gastrointestinal dysfunction scores are independent risk factors that affect the prognosis of patients.