126例多重耐药菌感染肺炎患者中医临床特征回顾性分析

Clinical Features of Traditional Chinese Medicine Syndrome Elements in Patients with Multi-Drug Resistant Bacterial Pneumonia:A Retrospective Analysis of 126 Cases

【目的】总结多重耐药菌感染肺炎患者的中医证素分布特征。【方法】回顾性收集2020年5月~2022年7月青岛市中医医院肺病中心监护室收治的126例多重耐药菌感染肺炎患者的临床资料,包括患者的性别、年龄、基础疾病、烟酒嗜好、多重耐药菌、中医四诊等,提取并统计不同菌种耐药菌的病性类中医证素分布情况并进行虚实分类。【结果】(1)126例多重耐药菌感染肺炎患者中共检出201株多重耐药菌,其中主要病原菌种类为革兰氏阴性菌,占95.52%(192/201),显著高于革兰氏阳性菌的4.48%(9/201),差异有统计学意义(χ2=166.612,P<0.001)。革兰氏阴性菌中以肺炎克雷伯菌占比最高,为23.38%。(2)126例患者共提取证素12种,实证中以痰、热为主,虚证中以阴虚为主。阴虚、血虚、热、痰、饮、湿证素在不同菌种耐药菌感染患者中分布差异均无统计学意义(P>0.05)。(3)126例患者的中医证素特征可分为单纯实证62例(占49.21%)、单纯虚证1例(占0.79%)、虚实并存证63例(占50.00%)。126例患者中,单一证素19例、二证并见41例、三证并见49例、四证并见16例、五证并见1例,出现最高频次的组合为痰+热+阴虚(26次)。【结论】多重耐药菌感染肺炎患者感染病原菌类型主要为革兰氏阴性菌,患者的中医证素以虚实并存和单纯实证为主要特征,主要病性类证素为痰、热、阴虚。

Objective To explore the distribution of traditional Chinese medicine(TCM)syndrome elements in patients with multi-drug resistant bacteria-infected pneumonia.Methods Clinical data of 126 patients with multidrug resistant bacteria-infected pneumonia admitted to the intensive care unit of Lung Disease Centre of Qingdao Hospital of Traditional Chinese Medicine from May 2020 to July 2022 were retrospectively collected.The clinical data included the patients’gender,age,underlying diseases,history of bad additions of smoking and alcohol,multi-drug resistant bacteria,and the information of four diagnostic methods of TCM,etc.The disease-nature syndrome elements in patients with drug-resistance to various strains of drug-resistant bacteria were extracted,and then deficiency-excess syndrome differentiation was carried out.Results(1)A total of 201 strains of multidrug resistant bacteria were detected in 126 patients with multi-drug resistant bacterial pneumonia.The main pathogenic species were Gram-negative bacteria,and the proportion accounted for 95.52%(192/201),which was significantly higher than that of Gram-positive bacteria[4.48%(9/201)],with a statistically significant difference(χ2=166.612,P<0.001).Klebsiella pneumoniae accounted for the highest percentage of 23.38%in the gramnegative bacterium.(2)A total of 12 syndrome elements were extracted from the 126 patients.The excess syndrome elements were predominated by phlegm and heat,and the deficiency syndrome elements were predominated by yin deficiency.There was no statistically significant difference in the distribution of yin deficiency,blood deficiency,heat,phlegm,fluid-retention and damp syndrome elements among patients with different strains of drug-resistant bacterial infection(P>0.05).(3)Of the 126 patients,62 cases(49.21%)had simple excess syndrome,one case(0.79%)had simple deficiency syndrome,and 63 cases(50.00%)had concurrent deficiency-excess syndrome.Among the 126 patients,there were 19 cases of single syndrome element,41 cases of concurrent two-syndrome element,49 cases of concurrent three-syndrome element,16 cases of concurrent four-syndrome element,and one case of concurrent five-syndrome element.And the combined syndrome element of phlegm-heat-yin deficiency occurred most frequently for 26 times.Conclusion Gram-negative bacteria are the primary infectious pathogens for the patients with multi-drug resistant bacterial infections,and the TCM syndrome elements of the patients are characterized by the concurrence of deficiency and excess and simple excess syndrome,mainly manifesting as phlegm,heat,and yin deficiency.