Curative Effect Observation Of Qinghua Tuobu Prescription On Severe Pneumonia Patients With Phlegm-heat Obstructing Lung Syndrome

Objective:To observe the clinical effect of Qinghua Tuobu prescription for severe pneumonia patients with phlegm-heat obstructing lung syndrome by analyzing the demographic data,clinical characteristics and laboratory test results of the patients and evaluate the therapeutic effect of integrated traditional Chinese and western medicine on severe pneumonia patients,in order to improve the clinical efficacy and life quality of severe pneumonia patients and optimize the clinical treatment program.To provide the basis evidence of practice and theory for further clinical application of Qinghua Tuobu prescription.Methods:A retrospective cohort study was conducted by collecting the clinical data of severe pneumonia patients with phlegm-heat obstructing lung syndrome,admitted to Xiyuan Hospital of Chinese Academy of Traditional Chinese Medicine from February 2015 to September 2021.The patients were divided into TCM group and control group according to whether Qinghua Tuobu prescription was taken.The general data,clinical symptoms,vital signs and laboratory test results were recorded on day 0 and day 7 after inclusion.The main observation outcomes were 14-day mortality,length of stay and APACHE II score,the secondary observation outcomes were TCM symptoms score,inflammation indicators,blood gas analysis indicators,vital signs,coagulation function indicators,liver and kidney function indicators.The collected data was analyzed by SPSS 23.0 software.If the data was in normal distribution,the mean ± standard deviation was used to present,the independent sample t test was used to compare between groups,and the comparison within group used paired sample t test.If the data conformed to abnormal distribution,the measurement data is presented by the median(P25,P75),the non-parameter Mann-whitney U Test is used for the comparison between groups,and the Wilcoxon Rank Test is used for the comparison within group.The counting data is presented by number(percentage),and Chi-square Test,Fisher exact test and nonparametric rank sum test were used.Results:(1)124 patients were totally included in this study,including 37 cases in the control group and 87 cases in the TCM group.There were 24 males(64.9%)in the control group,aged 80.78 ± 8.02 years and 60 males(69.0%)in the TCM group aged 81.99 ±9.10 years.The overall male ratio was 67.7%and the age was 81.63± 8.78 years.There was no significant difference in the baseline data(age,gender)between groups(P>0.05).In past disease,there was no difference between the two groups except cerebral infarction and chronic renal dysfunction.And the proportion of acid-base balance disorder in the TCM group(12.6%)was lower than the control group(29.7%),the difference was statistically significant(P<0.05).The proportion of sedative-analgesic,physical cooling and enteral nutrition in TCM group was significantly higher than the control group(P<0.05).The proportion of pathogens detected in sputum culture in the TCM group(92.0%)was higher than the control group(64.9%).Baseline indicators including APACHE Ⅱ score,TCM symptom scores(cough,sputum,wheeze and total score),inflammation indicators(WBC,NEUT%,LYM%,MONO%,NEUT,LYM,MONO,NLR,CRP,PCT),blood gas analysis indicators(PH,PaCO2,OI,Lac),vital signs(T,HR,RR,SBP,DBP),coagulation indicators(D-D,PT,PTA,INR,APTT,FIB),liver and kidney function indicators(ALT,AST,TB,DB,IB,BUN)had no statistical significance(P>0.05).(2)Main observation outcomes:The 14-day mortality in the TCM group(25.3%)was significantly lower than the control group(59.5%)(P<0.05).The length of stay in the control group and the TCM group was 13(9,19)days and 20(15,29)days,respectively.The APACHE Ⅱ score of the control group was 16(13,17)and 15(12,17.5)in the TCM group,there was no significant difference between groups(P>0.05).(3)Secondary observation outcomes:The single score of cough and phlegm and the total score of TCM syndrome on day 7 were significantly lower than the control group(P<0.05).Compared with the control group,NEUT%,LYM%and NLR of the TCM group on day 7 were great significantly(P<0.05).Although there was no significant difference in WBC,NEUT,CRP and temperature between the two groups after treatment,the downward trend in the TCM group was more obvious than the control group.PaCO2,OI,Lac and temperature on day 7 were both improved in groups,there was no significant difference between groups(P>0.05).There was no significant difference in coagulation function between groups(P>0.05),and in the TCM group APTT was longer than that before treatment,and FIB level was lower than that before treatment.There was no significant fluctuation in liver and kidney function in the TCM group during treatment(P>0.05).Conclusion:1.The 14-day mortality of severe pneumonia patients with phlegm-heat obstructing lung syndrome in Qinghua Tuobu prescription group was lower than western medicine group,and the clinical outcome was improved.2.Compared with the simple western medicine group,the patients with severe pneumonia treated by Qinghua Tuobu prescription and western medicine had more obviously improvement syndromes,less cough symptom and lower sputum viscosity.3.The improvement of partial inflammatory indicators(NEUT%,LYM%,NLR)in the Qinghua Tuobu prescription group was better than western medicine group.4.The downward trend of WBC,NEUT,CRP and temperature in Qinghua Tuobu prescription group was more obvious than western medicine treatment group,although there was no significant difference in WBC,NEUT,CRP and temperature between the two groups.It suggests that Qinghua Tuobu prescription may have certain advantages in decreasing WBC,NEUT,CRP and temperature.It may be related to insufficient sample capacity,resulting in no statistical difference.