重症医学科多重耐药菌肺炎病原菌、中医证候分布及其与病情转归预后的关系分析

Distribution of Pathogenic Bacteria,Traditional Chinese Medicine Syndromes and Their Relationship with Disease Outcome and Prognosis in Patients with Multiple Drug - Resistant Bacteria Pneumonia in Critical Care Medicine

目的分析重症医学科多重耐药菌肺炎患者病原菌、中医证候分布及其与病情转归预后的关系。方法回顾性收集2016年1月—2020年5月医院重症医学科收治的90例多重耐药菌肺炎患者的临床资料,统计患者多重耐药菌、中医证候、中医证候病性类证候要素分布情况及不同耐药菌中医证候分布、不同耐药菌感染患者预后情况、不同中医证候患者预后情况。结果90例多重耐药菌肺炎患者共检出病原菌97株,其中主要病原菌种类为革兰氏阴性菌(98.97%),显著高于革兰氏阳性菌(1.03%,χ^(2)=186.082,P<0.001),革兰氏阴性菌中,铜绿假单胞菌占比最高,为34.02%。90例多重耐药菌肺炎患者中医证候实证占比(85.56%)显著高于虚症(14.44%,χ^(2)=91.022,P<0.001),其中实证主要为痰热壅肺(57.78%)。90例多重耐药菌肺炎患者中医证候病性类证候要素主要为痰、气虚、热,占比分别为78.89%、61.11%、54.44%。不同耐药菌感染患者中医证候分布情况及转归预后情况比较,差异均无统计学意义(P>0.05),但所有耐药菌感染患者主要证候均为痰热壅肺。不同中医证候患者预后情况比较,早期证候患者好转占比(88.73%)高于晚期证候患者(57.89%,χ^(2)=9.751,P<0.05)。结论多重耐药菌肺炎患者感染病原菌类型主要为革兰氏阴性菌,患者中医证候以实证为主,其中主要证候为痰热壅肺,主要病性类证候要素为痰、气虚、热,早期证候患者预后较好。

Objective To analyze the distribution of pathogenic bacteria,traditional Chinese medicine syndromes and their rela-tionship with disease outcome and prognosis in patients with multiple drug-resistant bacteria pneumonia in department of critical care medicine.Methods The clinical data of 90 patients with multiple drug-resistant bacterial pneumonia treated in the depart-ment of critical medicine of the hospital from January 2016 to May 2020 were collected retrospectively,and the distribution of multiple drug-resistant bacteria,TCM syndromes,TCM syndrome elements,TCM syndrome distribution of different drug-resist-ant bacteria,prognosis of patients infected with different drug-resistant bacteria and prognosis of patients with different TCM syn-dromes were counted.Results A total of 97 strains of pathogens were detected in 90 patients with multiple drug-resistant bacte-rial pneumonia,of which the main types of pathogens were Gram-negative bacteria(98.97%),which was significantly higher than Gram-positive bacteria(1.03%,χ^(2)=186.082,P<0.001).Among Gram-negative bacteria,Pseudomonas aeruginosa accounted for the highest proportion(34.02%).The positive proportion of TCM syndromes in 90 patients with multiple drug-re-sistant bacterial pneumonia(85.56%)was significantly higher than that of deficiency syndrome(14.44%,χ^(2)=91.022,P<0.001),in which the empirical evidence was mainly phlegm-heat blocking the lung(57.78%).The TCM syndrome elements of 90 patients with multiple drug-resistant bacterial pneumonia were mainly phlegm,Qi deficiency and heat,accounting for 78.89%,61.11%and 54.44%,respectively.There was no significant difference in the distribution of TCM syndromes or prog-nosis among patients with different drug-resistant bacteria infection(P>0.05),but the main syndrome of all patients with drug-resistant bacteria infection was phlegm-heat blocking lung.The prognosis of patients with early period syndrome was higher than that of patients with later period syndrome(88.88%,χ^(2)=9.751,P<0.05).Conclusion The pathogenic bacteria of patients with multiple drug-resistant bacterial pneumonia are mainly Gram-negative bacteria.The TCM syndrome of patients is mainly excessive,in which the main syndrome is phlegm-heat blocking lung and the main pathogenic syndrome elements are phlegm,Qi deficiency and heat.The prognosis of patients with early period syndrome is better.