| ObjectiveThe retrospective analysis and prostective observation methods used to observe the clinical informations of Childhood pnermonia asthma in the area, such as the epidemiology, the different TCM syndromes, the clinical characters, the pathogenic organismz and the treatments of TCM or the modern medicine, which was hoped to be helpful to know the clinical features and effect of the Childhood pnermonia asthma in the area, in the same time, to provide some thoughts of the development in the period ahead.MethodFirst, through the retrospective study, we choose100Pediatric cases iagnosed as bronchial pneumonia in the affiliated hospital of Guangzhou University of Chninese Medicine from Jan.2010to Dec.2010. After that, through the Prostective clinical research method, to observe80Pediatric cases from Sep.2011to Apr.2012, and to conclud the clinical informations of Childhood Bronchopeneumonia, to gather the epidemiological informations, the differentiation TCM syndromes, the clinical characters, the pathogenic organismz, the treatments of TCM or the modern medicine, the curative effect and the time, the expenses in hosptial. SPSS13.0and Excel ststistical software was used to analys those observations.Results1. Demography informations:The ratio beteewn male and female was1.5:1in the retrospective analysis,1-3years old was85%; and1.75:1in the prostective observation,1-3years old was80%. Nearly42.5%patients had dieseas history, such as recurrent pneumonia(23.8%), recurrent bronchitis (16.3%), recurrent upper respiratory tract infections (7.5%), and recurrent allergic rhinitis (6.25%)2. Syndromes:In the retrospective analysis, there were "wind and heat blocking the lung syndrome"(49%),"phlegm-heat obstructing the lung syndrome"(49%), and" wind-cold blocking the lung syndrome"(2%). But in the Prostective observation, It was classified in "wind and heat blocking the lung syndrome"(30%),"phlegm-heat obstructing the lung syndrome"(51%),"cold-heat combining"(15%) and" wind-cold blocking the lung syndrome"(4%). Thought out T test and rank sum test, Each syndrome had no relationships with turnnig up fever, cough, the score of clinical symptoms or syndrome in hospital (P>0.05all).3. Laboratory examinations:In the retrospective analysis,37.5%mycoplasrna pneumoniae antibody examinations were positive, and51.3%prostective observation. Mycoplasrna pneumoniae infecting correlated with sex and age,53%girls were positive, but35.8%in boys, thought out chi-square test, there was marked different (P=0.015>0.05).In the prostective observation,44.3%1-3years old patients were positive, but78.6%in4-6years old, there was marked different (P=0.021>0.05).However,thouhgt out the chi-square test and T test.it wasn’t marked different between diffrence syndrome, the time in fever or cough and the changes of white blood cell or C-reactive protein(P>0.05all).4.Symptoms and sign:It mainifested by cough (100%),breathlessness (88.8%), fever (86.3%).sneezing (71.3%).nasal obstruction (42%).polyphlegm (51.2%), poor appetite (65%), change of night soil or urine (46.3%) and profuse sweating (38.8%). The tongue color of pneumonia asthma at acute stage was main of red, with white and thick coating. And there were28.8%patients would catch diarrhea in hospital. After treatments, fever would relif in26.39+25.331hours, breathlessness relif in2.29+1.433days, the cough in4.61+-1.804days, and auscultation on the lung would relif in5.72+1.623days, the phlegm was most hardly to relif."phlegm-heat obstructing the lung syndrome" was longer than" wind-cold blocking the lung syndrome" by the disappearance of auscultation on the lung. And it had relationship with the score of clinical symptom before treatments, but the influence was mild.5. Therapy on TCM:In the retrospective analysis,81%of the pat ients took Chinese Medicine, there was98.75%in the prostective observation, and dissolving phlegm and stop coughing drugs(34.62%), relieve exterior drugs (17.58%).antipyretic drugs (14.63%), benefit deficiency drugs (10.91%), drugs for regulating QI flow (6.57%), diuresis Shenshi drugs (5.31%) and relieving dyspepsia drugs (4.10%) were the top7categories. Chinese patent drug by intravenous injection such as Tanreqing injection(separately69%and63.75%) and Ligustrazine Hydrochloride injection (separately28%and37.5%)were used frequently. The prostective observation took the external treatmeant more seriously, like application of fubei plaster(34.64%), point application combined(28.10%), computer inter mediate frequency treatmeant meter treatment(20.92%) and acupoints injection (12.42%)6. Therapy of antibactery:There were over90%patients used the antibactery in retrospective analysis and prostective observation, and azithromycin was the most in common use (separately61%and62%), then ceftriaxone (separately16%and36.25%). In the prostective observation, ceftriaxone joint azithromycin was always used in union (52.4%). How to use the antibactery had no relationgship with disappearance of the auscultation on the lung and the time in hospital.7. The effect:The cure rate was62%, the effectual rate was37%, the effectless rate was1%, and the total effective rate was99%in the retrospective analysis;but the cure rate was82.5%, the obvious effectual rate was10%, the effectual rate was7.5%, and the total effective rate was100%in the prostective observation. There was marked different between the care rate(P=0.003<0.01). For TCM effect, The cure rate was76.3%, the obvious effectual rate was16.3%, the effectual rate was5.0%, the total effective rate was97.5%, but there was2.5%had no effect. The average time in hospital was6.04+2.224days, had no obvious relationship with syndrome, age, external treameant like application of fubei plaster or point application, and the score of clinical symptom or syndrome (P>0.05all).8. The expenses:The average expenses was3437.00+1630.943yuan in the prostective observation.Of which the "phlegm-heat obstructing the lung syndrome" might pay more than "wind and heat blocking the lung syndrome" and "wind-cold blocking the lung syndrome".The patients whoes had disease histotry (3932.85+2117.675in average) payed more than whoes did not (3437+1630.943in average), there was marked different (P=0.023<0.05). Besides, using antibactery unitly (3931.349+-2383.783in average) payed more than whoes did not (2285.374+344.051in average), there was marked different (P=0.002<0.008)Conclusion1. In the research, more male patients catch the childhood pnermonia asthma than female, the age was in1-3years old most.2. Heat syndromes was mostly in childhood pnermonia asthma in the reserch. And "phlegm-heat obstructing the lung syndrome" and"wind and heat blocking the lung syndrome" was the most common. There was15%of cases was "cold-heat combining". These results showed that the main causes of pnermonia asthma was wind, heat, dampness and dyspepsia in the area, the phlegm stagnated lung-Qi was the pathogenesis.3. Except the lung syndrome, the spleen syndrome is allways following. And we couldn’t ignore that deficiency of lung and spleen Qi was the base constitution in some of those children.4. The internal treatmeant joint the external treatmeant was the most important way of TCM in our research. Facilitating the flow of lung-Qi regulating QI flow and dissolving phlegm should be used as the main method, cooperating with relieving dyspepsia, clearing away dampness and removing blood stasis by promoting blood circulation, meanwhile, strengthen the spleen in order to develop the lung should be used in later stage or normal times.5. Mycoplasrna pneumoniae may be the main pathogenic organismzs in Childhood Bronchopeneumonia in hospital in the area. And4-6years old girls might be attacked more easily. However it had no correlation with using point application combined or external application of Fubei plaster, syndrome diffrence, the time in fever or cough and changes of WBC or CRP.6. The research shows that there might be unreasonably to use antibactery in clinical treatmeant. There were over90%patients used the antibactery in retrospective analysis and prostective observation, and azithromycin was the most in common use.Ceftriaxone joint azithromycin was always used in union,but it might not raise the clinical effect significantly.7. In the research,"phlegm-heat obstructing the lung syndrome" might pay more than "wind and heat blocking the lung syndrome" and "wind-cold blccking the lung syndrome".The patients whoes had disease histotry may pay more than whoes did not. Besides, using antibactery unitly may pay more than whoes did not. |
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