| Pneumonia is one of the most common infectious diseases in clinic.Anti-infective treatment is the main treatment.However,drug resistance has become a global phenomenon threatening public health.As a great treasure of the motherland's culture,TCM embodies its advantages and characteristics of long history,simplicity,convenience,cheapness and effectiveness in the treatment of many diseases.Cultivating Soil and Generating Gold is a common therapeutic principle for the treatment of lung and spleen in TCM.This study explored the application of the method of cultivating soil and generating gold in clinical treatment of pneumonia patients by Meta-analysis;explored the Clinical efficacy of the treatment of cultivating soil and generating gold in the adjuvant treatment of drug-resistant bacterial pneumonia by clinical randomized controlled study;analyzed the clinical characteristics,pathogenic bacteria distribution and drug resistance of pneumonia patients by observational study.Through the above research,it provided a new idea for the treatment of drug-resistant bacterial pneumonia patients with integrated traditional Chinese and Western medicine,and provided reference for clinicians to formulate and optimize empirical anti-infective treatment programs.The main contents are summarized as follows:1.Meta-analysis on the treatment of pneumonia with the method of Cultivating Soil and Generating Gold.OBJECTIVE:To systematically evaluate the clinical effect of the method of cultivating soil and generating gold in the treatment of pneumonia by using Meta-analysis method in evidence-based medicine,and to provide reference for guiding the treatment of pneumonia by the method of cultivating soil and generating gold in TCM.METHODS:The search terms,search strategies,inclusion and exclusion criteria of literatures were designed.Randomized controlled studies on the treatment of pneumonia with the method of cultivating soil and generating gold were comprehensively searched in biomedical databases at home and abroad.The control group was treated with Western medicine,while the experimental group was added the herbs of cultivating soil and generating gold.The databases included Pubmed,EMBASE,Cochrane library,web of science,CNKI database,Wanfang database,Vip Database,and the Chinese Biomedical Literature?CBM?.According to the bias risk assessment tool recommended by Cochrane Collaboration Network,the quality of the literatures was evaluated,and the data of the literatures was extracted.The Rev Man5.3 software was used for data analysis of outcome indicators,which included efficiency,TCM syndrome score,PCT,CRP,clinical pulmonary infection score,ventilator off-line time.dichotomous data were analyzed by risk ratio and continuous variable data were analyzed by standard mean difference,both of which were expressed by 95%confidence interval.RESULTS:1.Efficiency:A total of 23 research papers reported the effective rate,with 2142cases,1086 cases in the observation group and 1056 cases in the control group.The results showed that the effective rate of TCM combined with western medicine was significantly better than that of the control group.2.Integral of TCM syndromes:There are 5 articles analyzed,the total number of404 cases,in which 203 cases in the observation group and 201 cases in the control group.The results show that TCM has obvious advantages in relieving symptoms and reducing the integral of TCM syndromes.3.PCT:There are 6 literatures to observe procalcitonin with 554 cases,in which278 cases in observation group and 276 cases in control group,respectively.The results of data combination show that the observation group has obvious advantages in reducing procalcitonin index.4.CRP:Four papers analyzed C-reactive protein in 350 cases,175 cases in the observation group and 175 cases in the control group,respectively.The results showed that the observation group also has obvious advantages in reducing CRP in patients.5.CPIS score:2 papers were analyzed with 142 cases in total,71 cases in observation group and 71 cases in control group,respectively.The combined data showed that the method of cultivating soil and generating gold had advantages in reducing CPIS score.6.Ventilator off-line time:There are 2 literatures to analyze ventilator offline time,the total number of cases is 182.And the observation group and the control group are 91 cases,respectively.The results show that the observation group and the control group offline time is also statistically significant,indicating that the observation group also has advantages in shortening offline time.7.Safety:Among the 30 articles included in this study,there were 6 reports of adverse reactions,77 in the observation group and 130 in the control group.The main adverse reactions were gastrointestinal reactions and abnormal aminotransferase.The incidence of adverse reactions in the observation group was significantly lower than that in the control group,which indicated that adding TCM had advantages in decreasing the adverse reactions in the conventional treatment of gastrointestinal tract.CONCLUSION:The method of cultivating soil and generating gold in TCM has a good effect in the treatment of pneumonia,lung-qi deficiency syndrome.It has obvious advantages in efficiency,TCM syndrome score,PCT,CRP,CPIS score and ventilator off-line time.And the safety is better than the control group.2.Clinical Randomized Controlled Study on Supplementary Treatment of Drug-Resistant Bacterial Pneumonia by Reinforcing Earth to Strengthening Mental in TCMOBJECTIVE:To observe the clinical efficacy of Chinese herbal medicine in the adjuvant treatment of drug-resistant bacterial pneumonia in order to provide reference for the treatment of drug-resistant bacterial pneumonia in TCM.METHODS:64 patients with drug-resistant bacterial pneumonia,who met the inclusion criteria,were selected in a randomized and controlled study.They were assigned to the treatment group and the control group according to the random number table method,with 32 cases in each group.The control group was treated with routine treatment of Western medicine,while the treatment group was treated with the decoction of Shenling Baizhu San for 14 days.The variations of TCM syndrome score,CPIS score,inflammatory index?blood routine,C-reactive protein,procalcitonin?,immune index and blood gas analysis were observed and recorded in each group.SPSS22.0 statistical software was used for statistical analysis to evaluate the comparability,clinical efficacy and safety of the two groups.RESULTS:1.Baseline comparison:There was no significant difference between the two groups in age,vital signs,syndrome scores,laboratory examination indicators and other aspects of the baseline,thus the baseline was comparable in statistic.2.Therapeutic effect comparison:?1?There was no significant difference between the two groups in the curative effect of TCM syndromes,but the curative rate and total effective rate of the treatment group were higher than those of the control group.?2?The scores of TCM syndromes in the two groups were significantly lower than those in the control group,and the treatment group was superior to the control group in relieving cough,sputum,food deficiency,fatigue,abdominal distention,less of breath and and lazy speech.There was no significant difference in short-breath symptoms between the two groups.?3?After integral treatment,the CPIS of the two groups decreased.However,the treatment group did not show obvious advantages.Single comparison found that the treatment group was better than the control group in improving airway secretions.?4?Inflammatory indicators:white blood cells,neutrophils,CRP,PCT and other inflammatory indicators decreased after treatment,but there was no comparison between the two groups.?5?The comparison of immune indicators showed that the treatment group was better than the control group in improving CD4+,Ig M and other immune indicators.?6?Blood gas analysis:Pa O2 of the two groups were significantly improved after treatment.The treatment group was better than the control group for 7 days.There was no significant difference between the two groups.The Pa CO2 and PH values of the two groups were not significantly different before and after treatment.3.Safety:There were no serious adverse reactions in the two groups.There was no significant difference in respiratory,blood pressure,liver and kidney function between the two groups before and after treatment.CONCLUSION:Additive shenlingbaizhu decoction can decrease the clinical symptoms of cough,sputum expectoration,diet deficiency,fatigue,abdominal distention,lack of breath and laziness in drug-resistant bacteria patients,reduce airway secretions.It has a certain regulatory function on the body's immune function,with good safety.3.Observational study on the Clinical characteristics,etiology and drug resistance of patients with pneumoniaOBJECTIVE:To observe and analyze the clinical characteristics of pneumonia patients,the distribution and composition of pathogenic bacteria,and the drug resistance of common pathogenic bacteria.METHODS:A prospective observational study was conducted to include patients with pneumonia and sputum specimens were collected for sputum culture and routine drug sensitivity tests.General information of patients?including age,sex,smoking history,complications?,laboratory results,sputum culture results and antibiotic treatment programs were collected.All data were recorded by Epidata software.Statistical SPSS 22.0 software was used for statistical description and comparison.RESULTS:1.A total of 148 patients as General data were included.In which,females are more than males and mainly in the middle-aged and elderly,with an average age of59.8±16.5 years.2.Complicated diseases:84.5%of the patients were complicated with other diseases,mainly respiratory diseases.More than 50%of the patients had two or more diseases.3.Inflammatory indicators:the proportion of leukocyte abnormalities was only34.46%.The order of abnormal rate of the Inflammatory markers was as followed:WBC<neutrophil count<PCT<percentage of neutrophil<CRP.The proportion of C-reactive protein abnormalities was the highest?62.84%?,respectively.4.Blood gas analysis:The abnormal results of blood gas analysis were mainly the decrease of PO2.5.Distribution of pathogenic bacteria:The results showed that the main pathogenic bacteria were G-bacteria.The most common pathogenic bacteria were Pseudomonas aeruginosa?25.3%?,Klebsiella pneumoniae?15.4%?,Acinetobacter baumannii?14.8%?,Haemophilus influenzae?7.4%?and Escherichia coli?5.6%?.6.Drug resistance:The results of drug susceptibility showed that several main pathogenic bacteria had higher resistance to cephalosporin antibiotics among cephalosporin antibiotics.The resistance rates of Escherichia coli to cefazolin and ceftriaxone were as high as 88.9%.The resistance of several pathogenic bacteria to ceftazidime and cefepime was relatively low.The resistance to quinolone antibiotics was also high,mainly in Escherichia coli.Among carbapenem antibiotics,imipenem was more resistant than Acinetobacter baumannii?77.8%?and Acinetobacter baumannii?58.3%?,respectively.Acinetobacter baumannii and Klebsiella pneumoniae were 58.3%and 36%respectively.Several pathogenic bacteria showed relatively low resistance to piperacitazobactam,cefoperazone sulbactam and ampicillin sulbactam,while no resistant strains were found to ertapenem,but to telapenem.The sensitivity of cyclohexane was also good.7.Regression analysis showed that age and whether or not to use invasive operation had significant influence on hospitalization time.The risk of hospitalization days>10 days for patients older than 60 years was 3.116 times that for patients younger than 60 years old,and 9.553 times that for patients with invasive operation was 9.553 times that for patients without invasive operation.There was also a correlation between hemoglobin and albumin and hospitalization time.It was negatively correlated.CONCLUSION:Pneumonia patients do not necessarily have elevated hemogram.Among the inflammatory indicators,the abnormal rate of C-reactive protein is the highest.It can be seen that the sensitivity of C-reactive protein is higher,but the specificity is not strong.Therefore,clinical diagnosis and treatment should be combined with symptoms,signs,laboratory examination and imaging examination.The pathogens causing pneumonia show a diversified trend,which deserves attention.The most common pathogens include Pseudomonas aeruginosa,Klebsiella pneumoniae,Acinetobacter baumannii,Haemophilus influenzae and Escherichia coli.Drug susceptibility analysis indicated that the drug resistance rates of ceftazidime,piperacillin/enzyme inhibitor,ertapenem and tigacycline were relatively low,and such antibiotics could be considered in empirical anti-infective therapy.The length of hospitalization may be affected by different antibiotic treatment regimens.In addition,Age,invasive operation,hemoglobin and albumin levels were also correlated with length of hospitalization. |
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