基于因子分析的重症肺炎患者抗生素应用前后中医证候特征变化规律

Change rule of TCM syndrome characteristics in patients with severe pneumonia before and after antibiotic application based on factor analysis method

目的 采用因子分析法初步探讨重症肺炎(SP)患者抗生素应用前后中医证候特征变化规律。方法 纳入2020年1月至2022年6月该院重症医学科、肺病科、心病科等病房收治的SP患者335例,在不同时间点(入院、抗生素使用7 d、抗生素停用次日)均填写《SP中医证候采集表》,构建中医四诊信息数据库,应用因子分析法提取公因子。结果 SP患者抗生素应用前后的中医证候学主要特征均为本虚标实,涉及肺、脾、肾等多个脏腑,整体而言抗生素应用后的中医证候特点由实转虚。在入院、抗生素使用7 d、抗生素停用次日这3个不同时间点上依次提取11、14、15个公因子,入院时证候要点集中于热证、痰证等,抗生素使用7 d时证候要点集中于热证、毒证等,抗生素停用次日时证候要点集中于气虚、阴虚等,湿、热等可被视为SP的兼夹证。结论 SP的中医证型在抗生素应用前后呈动态演变特征,各证型在不同时间节点的分布有其各自特点。

Objective To explore the changes of traditional Chinese medicine(TCM)syndrome characteristics in patients with severe pneumonia(SP)before and after antibiotic application based on factor analysis method.Methods A total of 335 cases of SP admitted to the Department of Intensive Care Medicine,Department of Pulmonology,and Department of Cardiology of this hospital from January 2020 to June 2022 were included.At different time points(admission,7 days of antibiotic use,the next day after antibiotic discontinuation),the“SP TCM Syndrome Collection Form”was filled out,and the information database of the four diagnosis of TCM was constructed,and the common factors were extracted by factor analysis method.Results The main characteristics of TCM syndromes in SP patients before and after the application ofantibiotics were all type of deficiency in origin and excess in superficiality,involving multiple organs such aslung,spleen,kidney.Overall,the characteristics of TCM syndromes changed from excess to deficiency after the application of antibiotics.A total of 11,14,and 15 common factors were extracted in turn at three different time points:admission,7 days of antibiotic use,and the next day after antibiotic discontinuation.The key points of the syndromes at admission were concentrated on heat syndrome,phlegm syndrome.The key points of the syndromes at 7 days of antibiotic use were concentrated on heat syndrome and poison syndrome.The key points of the syndromes at the next day after antibiotic discontinuation were concentrated on Qi deficiency and Yin deficiency.Dampness and heat could be regarded as the a combination of SP.Conclusion The TCM syndrome types of SP show dynamic evolution characteristics before and after the application of antibiotics,and the distribution of each syndrome type at different time nodes has its own characteristics.