| Object i veIn observational studies, the objective evaluation of integrated traditional Chinese and Western medicine treatment of CAP rationality problem, traditional Chinese medicine and Western medicine clinical diagnosis and treatment of CAP for reference.MethodThrough a retrospective study, to2010January-2010December in Guangdong Province Traditional Chinese Medical Hospital in Department of respiration of439CAP patients as the object of study, diagnosis and treatment of patients with information collection, using SPSS17. Ostatistical analysis software, analysis of the patient’s hospitalization, diagnosis and treatment of traditional Chinese medicine, the first antibiotic use and pathogen detection, our hospital in CAP patients the treatment, to the national CAP guide for the guidelines, according to the clinical path specification, analysis of CAP clinical problem, for the CAP clinical decision-making provide a basis.Results1. Evaluation criteria in the CAP condition in China, our hospital community acquired pneumonia with criteria for hospitalization patients was67.2%, does not meet the criteria for hospitalization of patients for32.8%.2. In439patients the average length of time for the (9.46+3.29) days。3. Chinese medicine diagnosis and treatment aspects,the master distribution of TCM syndrome were stagnation of phlegm-heat in the lung, invasion of the lung by wind-heat and invasion of the lung by perverse trend. In terms of treatment, Phragmitis decoction and Lonicera and Forsythia Powder were commonly used prescriptions, Tanreqing injection and Qingkailing injection were commonly used traditional Chinese medicine injections, External-based Chinese medicine patching and sihuangshuimi topical.80%of the patients received external treatment, Characteristic of TCM therapy in traditional Chinese medicine sticking(34.6%), therapy of specialist features and sihuangshuimi topical(25.1%).4. The overall results of pathogenic bacteria detection positive rate was30.7%, of which the most common infection of mycoplasma pneumonia pathogenic bacteria,26.9%. Sputum culture,355cases of patients with sputum test, detection of pathogenic bacteria for17patients, the positive rate was4.9%(17/355), the gram negative bacteria in15cases,1cases of Gram-positive bacteria, fungi in1cases.5.(1) Initial antibiotic selection overall to quinolones ranked first (42.4%), followed by beta lactam (34.9%); the quinolone antibiotics to levofloxacin in the most commonly used (170/186), beta-lactam antibiotics to cefuroxime was the most commonly used (76/153), in combination, cephalosporin drugs in combination with other drugs in the first (55/63), of which the most common is cefuroxime and azithromycin United (39/63).(2) Remove the two cases with antibiotics in patients with initial antibiotic choice, follow the guidelines of the patients accounted for70.9%(310/437), did not follow accounted for29.1%(127/437); which do not follow the guidelines in group D patients using a single antibiotic, accounted for70.9%(90/127), followed by group A disease with combined medication, accounted for8.7%(11/127).(3) Initial antibiotic treatment failed in33cases (7.6%), wherein the beta-lactam antibiotic use (CEPH) accounted for45.5%, followed by cephalosporins with macrolides, quinolones and macrolide.(4) In33cases of initial antibiotic treatment failure patients, follow the guide in22cases, failure rate was7.1%(22/310), did not follow the guide in12cases, failure rate was8.7%(11/127).Conelusion1. According to China’s CAP evaluation standard, hospitalized patients with CAP in32.8%patients receiving outpatient treatment, but because a variety of reason while hospitalized, which may cause medical resources tension.2. Chinese medicine diagnosis and treatment aspects, the master distribution of TCM syndrome were stagnation of phlegm-heat in the lung, invasion of the lung by wind-heat and invasion of the lung by perverse trend. In terms of treatment, Phragmitis decoction and Lonicera and Forsythia Powder were commonly used prescriptions, Tanreqing injection and Qingkailing injection were commonly used traditional Chinese medicine injections, External-based Chinese medicine patching and sihuangshuimi topical.80%of the patients received external treatment, Characteristic of TCM therapy in traditional Chinese medicine sticking, therapy of specialist features and sihuangshuimi topical. Basically consistent with our hospital in2010community-acquired pneumonia treatment program " to develop the diagnosis and treatment plan.3. Common pathogenic bacteria in our hospital examination to Mycoplasma pneumonia, pathogen distribution and other domestic regions of similarity, as the doctors of our hospital clinical empirical rational drug use provides a theoretical basis. However, patients with sputum culture positive rate is low.4. Our hospital CAP treatment of initial antibiotic choice to quinolones ranked first, and guide the recommended scheme is basically consistent with the. Initial antibiotic selection did not follow the guide rate is high (29.1%), the reason is many sided, but the author thinks to strengthen the clinician to CAP guide to learn and apply for the primary task.5. Our hospital of initial antibiotic treatment failure rate of7.6%(33/437), the first antibiotic treatment failed to beta-lactam antibiotic use (cephalosporins), followed by cephalosporins with macrolides, quinolones and macrolide. After data analysis, consider the use of beta lactam, cephalosporins with macrolide failure possibility.6. Initial antibiotic treatment failed to follow the guide in22cases, including12cases of treatment failure for unknown reasons, the remaining lOcases of treatment failure with more than65years old, white blood cell reduction (<4x109/L) and sputum culture CAP unusual pathogens related. |
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