Severe Pneumonia In Tcm Syndrome Type Distribution Characteristics And Related Factors Of Clinical Research

Objective①Search for the TCM syndrome distribution character of severe pneumonia patients base on the related information analyzation.②Determine the relationship between common TCM syndromes of severe pneumonia pa-tients and some related factors, such as age, gender, previous medical history, bacterial cultures of sputum, C-reaction protein, APACHEII score, clinical pulmonary infection score.MethodUse the retrospective research method; and collect the case information of all the severe pneumonia patients in ICU of Guang’anmen Hospital from Jan.2009to Dec.2012, including general information, TCM syndrome factors, laboratory results, bacteriology test results, prog-nosis condition, etc. Fulfill the case report form, build up an original clinical information data-base, import the information into SPSS17.0, and then statistic analyze the TCM syndrome fac-tors population distribution condition, TCM syndrome type distribution condition under differ-ent influence factor, find out the differences of age, gender and other clinical test results be-tween the common TCM syndrome types.Results1TCM syndrome factor and common TCM syndrome of severe pneumonia:The research shows that, there are4excess TCM syndrome factors (phlegm syndrome, heat syndrome, toxic-ity syndrome, blood state syndrome),5deficiency TCM syndrome factors (Yin deficiency syn-drome, Yang deficiency syndrome, Qi deficiency syndrome, blood deficiency syndrome, Qi prostration syndrome). There are5combination forms of syndrome factors, and the2-factor-combine form is the most in number. Amount the2-factor-combine forms, the phlegm syndrome combine heat syndrome has the most occurrence frequency. Amount the3-factor-combine forms, the Yin deficiency syndrome, Yang deficiency syndrome and the tox-icity syndrome combination has the most occurrence frequency. The result shows that there are6types of TCM syndrome factor combination, including phlegm and heat obstruct lung syn-drome, Yin and Yang deficiency with accumulated toxin syndrome, blood and heat state with accumulated toxin syndrome, heat and toxin accumulated inside syndrome, Qi and Yin defi-ciency syndrome, Qi deficiency with blood and phlegm state syndrome. The common TCM syndrome type is:phlegm and heat obstruct lung syndrome, Yin and Yang deficiency with ac-cumulated toxin syndrome, blood and heat state with accumulated toxin syndrome.2The general information of3TCM syndrome types:Comparing the in-ICU stay and the mortality, phlegm and heat obstruct lung syndrome has the shortest in-ICU stay and lowest mortality, Yin and Yang deficiency with accumulated toxin syndrome has the longest in-ICU stay and highest mortality; there is a significant difference between2syndrome types (P<0.01).3The bacterial culture result of3TCM syndrome types:The phlegm bacterial culture re-sult shows that Gram-negative bacterium has the major percentage about64.13%, and Gram-positive bacterium is35.87%. Amount the Gram-negative bacterium, the occurrence rate from high to low is:pseudomonas aeruginosa, acinetobacter baumannii, klebsiella pneumonia (include the subtypes), escherichia coli. Amount the Gram-positive bacterium, the occurrence rate from high to low is:staphylococcus aureus, enterococci (enterococcus faecalis and entero-coccus faecium). Amount the fungus mostly is Candida albicans. The research shows that, phlegm and heat obstruct lung syndrome patients’bacterial culture result is mostly Gram-positive bacterium, including37cases of staphylococcus aureus, that’s about51.38%; Yin and Yang deficiency with accumulated toxin syndrome patients’bacterial culture result is mostly Gram-positive bacterium, amount it there is66.67%of pseudomonas aeruginosa,28.21%of acinetobacter baumannii.4The relationship between the3TCM syndrome types and the laboratory results:The WCB and CRP of3TCM syndrome types patients are higher than normal, phlegm and heat ob-struct lung syndrome patients’WBC and CRP are significantly higher than the other2types pa-tients (P<0.05). The phlegm and heat obstruct lung syndrome patients’CPIS is significantly higher than the other2types patients (P<0.01). Comparing the APACHE Ⅱ score, the Yin and Yang deficiency with accumulated toxin syndrome has higher score than the other2types (P<0.01). The BNP of3TCM syndrome types is higher than normal, especially the phlegm and heat obstruct lung syndrome is significantly higher than the other2types (P<0.01). Comparing the PCT, the phlegm and heat obstruct lung syndrome is significantly higher than the Yin and Yang deficiency with accumulated toxin syndrome (P<0.05). The difference of limulus test re-sult of3TCM syndrome types is not statistically significant.5The usage of mechanical ventilation of severe pneumonia:There are121cases of inva-sive mechanical ventilation,24cases of non-invasive mechanical ventilation.87invasive me-chanical ventilation cases successfully weaning, the weaning rate is61.71%. The non-invasive mechanical ventilation patients have a lower weaning rate, it may relate to the long-term life with mechanical ventilation. The survival rate of invasive mechanical ventilation patients is lower than the non-invasive mechanical ventilation patients. The complication of severe pneu-monia mainly is septic shock, after that is gastrointestinal dysfunction, hypoproteinemia, and MODS.Conclusion1There are4excess TCM syndrome factors (phlegm syndrome, heat syndrome, toxicity syndrome, blood state syndrome),5deficiency TCM syndrome factors (Yin deficiency syn-drome, Yang deficiency syndrome, Qi deficiency syndrome, blood deficiency syndrome, Qi prostration syndrome). The syndrome factor combination mainly is the phlegm syndrome com-bine heat syndrome, after that is Yin and Yang deficiency syndrome with accumulated toxin syndrome. The common TCM syndrome type is:phlegm and heat obstruct lung syndrome, Yin and Yang deficiency with accumulated toxin syndrome, blood and heat state with accumulated toxin syndrome. Amount them, the phlegm and heat obstruct lung syndrome patients is younger than the other syndrome types, which means there may be some relationship between TCM syndrome types and age.2The WBC. CRP, PCT, LC and CPIS of phlegm and heat obstruct lung syndrome is high-er than the other2TCM syndrome types, which indicates that this type of syndrome has the most severe inflammatory reaction, the TCM theory believes it is because the patients has enough vital Qi to fiercely fight with the evil Qi. The APACHE Ⅱ score of Yin and Yang defi-ciency with accumulated toxin syndrome is much higher than the other syndrome types, which indicates that this type of syndrome is a critical condition, has a poor prognosis and high mor-tality.3The Yin and Yang deficiency with accumulated toxin syndrome patients has a longer in-ICU stay, which indicates this type of syndrome has a long course of disease, progress slowly and to be refractory.