| BackgroundBacterial Pneumonia is one of the common and multiplex diseases in clinical practice. Antibiotics can’t completely solve the treatment of bacterial pneumonia. There is a good deal of evidence showing that the mortality rate did not decline obvious with the escalating of antibiotics. There are several reasons.1. Patients with chronic infectious underlying disease, often use antibiotics long-term and repeated. It is leading to the emergence of drug resistance, even drug-resistant strains.2. The main pathogens are gram-negative bacilli infections. Pseudomonas aeruginosa and Acinetobacter baumannii are common. They produce a variety of endotoxin.3Infection is mixed. Antibiotics don’t completely cover the pathogens. Nonresponding pneumonia is also aimed at this situation. The nonresponding pneumonia mortality is3to5times the ordinary pneumonia mortality and the total mortality rate can be as high as49%. Infection remains a major reason of nonresponding pneumonia. Resistant infections is a major component of infectious causes. The latest survey of respiratory pathogen distribution from14hospital of different parts of China in2010showed that PA was the most common pathogen in the general ward. The PA drug resistance problem:natural resistance to many antibiotics; less active antibiotics; there have been high-level drug resistance to Carbapenem antibiotics in recent years, which was activity to PA.A variety of pathogenic factors can be released at the course of PA infection, which increasing the difficulty of treatment. Bacterial pneumonia belongs to wind-warm lung-heat disease. Professor Wang Chengxiang proposed that drug-resistant related wind-warm lung-heat disease as refractory wind-warm lung-heat disease. There is few research on PA related wind-warm lung-heat disease. There is no TCM syndrome and evolvement rule theory on PA pulmonary infection.ObjectiveExplore the syndrome features, TCM syndrome and evolvement rule on PA lung infection. So that can provide a clinical basis of Chinese medicine interventions.Method1Design PA lung infection questionnaire. Choose PA lung infection as the research object from information accumulated by the Fever research team from Dongzhimen Hospital affiliated Beijing University of Chinese Medicine. Collect clinical data of PA lung infection. Establish Epidata database based on the acquisition information, entry and check data. Convert it into SPSS database.2Describe the clinical features on PA lung infection. Count the frequency of symptoms. Exraction and determine the evidence of PA lung infection syndrome elements by the using of cluster analysis and factor analysis.3Statistics the number of cases of Wei Qi Ying Xue and fever late stage of PA lung infection. Spearman rank correlation analysis can be used to compare the improvement and mortality of Wei Qi Ying Xue various stages. Statistics the syndrome elements of various stages of Wei Qi Ying Xue.4Using of univariate analysis and logistic regression analysis to study the clinical features of multi-drug resistant PA(MDRPA) lung infection.Result1PA lung infection general distribution law.285patients were collected. A total of219cases over the age of65, accounting for76.84%of the total number of patients. The clinical features of distribution from more to less were Immobilization, nasogastric catheter, acid-suppress ing drugs, gastrointestinal drugs, glucocorticoids, calm drugs. Male patients with smoking and drinking significantly higher proportion of women (p<0.05).2Law of distribution of the underlying disease.≥20%of the underlying disease were hypertension (49.12%), coronary atherosclerotic heart disease (41.40%), chronic bronchitis (34.39%), heart failure (29.82%), the tumor (25.26%), chronic obstructive pulmonary disease (24.91%), the sequelae of cerebral infarction (24.92%), arrhythmia (22.46%) diabetes (21.40%)3Finale distribution law. PA lung infection longer hospital stays, which accounted for only14.74%of the total of the total number of hospital days2weeks; overall mortality rate was17.54%; March readmission patients (including hospital stay of3months or more)27.72%.4Isolated PA before the use of antibiotics:285cases of PA lung infection total of202patients isolated PA within the previous month continuous use of antibiotics for7days or7days or more, accounting for70.88%of the total. Only use antibiotics only28.42%. Commonly used antibiotics for third-generation cephalosporin or enzyme inhibitors, broad-spectrum penicillin or enzyme inhibitors, carbapenems, quinolones, aminoglycosides.5Etiological result. Within7days of the admission of isolated PA accounted for only45.61%of patients. PA-sensitive top five antibiotics amikacin, imipenem, piperacillin/tazobactam, tobramycin, ceftazidime; the low PA resistant top five cefoperazone ceftazidime and amikacin, imipenem, netilmicin.6TCM symptom distribution law. PA lung infection appear in the top10symptoms of cough, phlegm, wheezing, white sputum, hold your breath, dry stool, poor sleep, fever, poor appetite, eat less, phlegm; Tongue of the most common is a dark red tongue, red tongue, yellow greasy moss; pulse performance of composite veins, containing slippery pulse characteristics of the pulse, followed by Wiry, veinlets, rapid pulse, deep pulse.7Based on cluster analysis, factor analysis of PA lung infection syndrome elements phlegm, lungs, mind; syndromes of phlegm obstruct the lung and sputum disturbance of mind Certificate.8There is a significant difference of the number of cases of Wei Qi Ying Xue the various stages when PA was isolated (p=0.000).The number at the stage of qifen and yingfen was185,64.91%. In the process of changes, a total of294different stages:Weifen syndrome(6); qifen syndrome(162); yingfen syndrome(68); xuefen syndrome(32); later stage(26). The mortality of experienced xuefen stage, yingfen stage, xuefen state was gradually reduced (Spearman correlation coefficient=0.588, p=0.000). The recovery rate of xuefen stage, yingfen stage, xuefen state was gradually increased (Spearman correlation coefficient=0.376, p=0.000). Syndrome elements of excess syndrome:the disease syndrome factors at the weifen stage were wind and heat. The disease syndrome factor at the qifen, yingfen and xuefen stages were hot, phlegm and blood stasis; besides the disease syndrome factor at the xuefen stage were stirring blood and endogenous wind. The disease location syndrome factor at the qifen stage was lung. The disease location syndrome factors at the qifen stage were lung, stomach, large intestine. The disease location syndrome factors at the yingfen stage were heart spirit, lung, stomach and skin. The disease location syndrome factor at the xuefen stage were blood, lung, heart spirit, spleen, stomach. Deficiency syndrome:the main syndrome factors were qi and yin.8Clinical characteristics of MDRPA. Multivariate analysis results showed that:the na so gastric MDRPA infection was positively correlated (p=0.008), the relative risk (OR) values were4.244,95%CI (1.460to12.339); catheter MDRPA of infection was positively correlated (p=0.005), the relative risk (OR) values were4.540,95%CI (1.565to13.174). The other factors MDRPA infection no significant relationship. Symptoms features:single factor chi-square analysis by the MDRPA group cough, wheezing, poor sleep, chest tightness, the bloody sputum frequency significantly lower than the the non-MDRPA group (p<0.05); the throat phlegm MDRPA group, coma, drowsiness appears frequency significantly higher than the non-MDRPA group (p<0.05); the rest of the onset of symptoms was no significant difference in frequency between the two groups (p≥0.05).The outcome aspects:hospitalized with MDRPA group for more than28days proportion, March readmission ratio than non-MDRPA group (p<0.05). Two groups CFR there was no significant difference (p≥0.05).Conclusion1The number of male of advanced age is more than female’s number. They had a lot’s of foundation disease. The patients’ condition are sever.2Qifen and Yinfen syndromes are common. Fever, Qi deficiency and Yin deficiency are the basic syndrome of PA lung infection. Plegm, fever and are the joint syndromes at the stages of Qifen, Yinfen and Xue fen.3The result from Qifen stage was good. The mortality of experienced xuefen stage, yingfen stage, xuefen state was gradually reduced. The recovery rate of xuefen stage, yingfen stage, xuefen state was gradually increased. Qifen stage is the crucial stage of medical treatment of refractory wind-warm lung-heat disease. |
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