The Research Of Distribution Law Of TCM Syndrome Elements And The Relationship With Prognostic Factors Of Severe Pneumonia

Objective: To research the distribution law of TCM syndrome elements of severe pneumonia in ICU, include the TCM syndromes elements of position part and character part, and TCM syndrome; analyze the death rate and clinical features; discuss the relativity of prognostics with the clinical features in different TCM syndromes.Method:A prospective study analyzed83cases with sever pneumonia in ICU of Xiyuan hospital between2011-10and2012-8, and collected data regarding background characteristics, syndromes, laboratory data, and prognostics.Part one:Find out the differentiation elements and the distributing pattern of the syndrome of SP, and further more dominant syndrome pattern with the determination of the differentiation elements and the diagnosis of the syndrome according to Calculating Differentiation of common symptoms by professor Zhu Wenfeng.Part two:The83patients were conforming to the diagnosis standard, past the muster of picking-up and abjuration. Marshaled the TCM syndromes_analysis_cases which are_distributed dominant, and analyzed_APACHE Ⅱ_score,_CPIS score,_serum albumin,_B type_natriuretic peptide,_C-reactive protein,_D-dimer,_blood lactic acid, blood platelet_{C-reactive protein andblood lactic acid arevariation of24hours after admission,} of the whole samples_and each group.Results:1General situation:Among the83cases, male have45cases and female38cases, the range of age is between49and89years, and mean age is75.88±9.33years. Among them46cases survived but37cases died, Mortality rate is44.6%. Survival group average age is74.50±9.35, and the mean age of the death group was78.27±8.16years old.2Features of TCM syndrome:The location of disease syndrome, lung appeared83times （100%）, kidney26times （49.40%）, spleen20times （24.10%）, heart9times （10.84%）, mind12 times（14.45%）, and colon4times （4.82%）.The property of disease syndrome:qi deficiency appeared72times （86.8%）, blood deficiency25times （30.1%）, Yin deficiency58times （69.9%）, Yang deficiency45times （54.2%）, phlegm77times （92.8%）, heat56times（67.5%）, blood stasis27times（32.5%）, Qi blockage22times（26.5%）, and bleeding5times （6%）.The types of syndrome were concluded through the location and property of disease syndrome combination:24cases of syndrome ofLung and kidney Yin deficiency phlegm heat indicates the lungs （29%）,21of Lung spleen kidney Yin and Yang are two virtual phlegm closed mind syndrome（25%）,17of syndrome of Lung deficiency of phlegm and blood stasis resistance pulmonary syndrome （21%）,11of Lung and spleen deficiency phlegm turbidity resistance pulmonary syndrome （13%）,6of Lung qi Yin deficiency heat syndromes （11%）. The above five kinds of syndrome types accounted for a total of95%for the main syndrome types of the disease.3Prognostic factors:3.1Lung and kidney Yin deficiency phlegm heat indicates the lungs:Between death and survival groups, there are significant difference in Pa02/FiO2, P=0.010; PAhave significant difference, P=O.012; APACHE II have significant difference, P=0.025. PA have significant difference, P=0.012. CHE have significant difference, P=0.007. In this group, PA associated with prognosis at the0.05level, the correlation coefficient is0.500; APACHE II is associated with prognosis at the0.05level, the correlation coefficient is0.355. Multi-factor regression of PA and the prognosis shows that the regression coefficient is0.355, the OR value is1.537, P<0.05.3.2Lung spleen kidney Yin and Yang are two virtual phlegm closed mind:Between death and survival groups, PA have significant difference propagated, P=0.021; CHE have significant difference, P=0.022; APACHE Ⅱ have significant difference, P=0.049. In this group, PaO2/FiO2associated with prognosis at the0.05level, the correlation coefficient is-0.428; APACHE Ⅱ in0.01level associated with the prognosis, the correlation coefficient is0.725. Multi-factor regression of PaO2/FiO2and the prognosis shows that the regression coefficient is-0.353, OR value of 1.424, P<0.05; multi-factor regression of APACHE II grading and prognosis shows that the regression coefficient is0.477, OR value of1.611, P<0.01.3.3Lung deficiency of phlegm and blood stasis resistance pulmonary:Between death and survival groups,△Lac have significant difference, P=0.012;△CRP have significant difference, P=0.029; D-Dimer have significant difference, P=0.005. In this group, APACHE II associated with prognosis at the0.05level, the correlation coefficient is0.459; D-Dimer in0.01level associated with the prognosis, the correlation coefficient is0.647; ALac associated with prognosis at the0.05level, correlation coefficient of0.504. Multi-factor regression of D-Dimer and the prognosis shows that the regression coefficient is0.216, the OR value of0.805, P＜0.05.3.4Whole cases:Among various factors, the PaO2/FiO2, D-Dimer, CHE at the0.05level associated with the prognosis, correlation coefficient were-0.583,0.225,0.283;△CRP, APACHE II,△Lac associated with prognosis at the0.01level, correlation coefficient were0.638,0.499, multi-factor regression shows that APACHE II as the factors affecting the prognosis of severe pneumonia, regression coefficient is0.477, the OR value of1.611, P<0.01;△Lac as the factors affecting the prognosis of severe pneumonia, regression coefficient is0.706, the OR value of0.494, P<0.01;△CRP as the factors affecting the prognosis of severe pneumonia, regression coefficient is0.074, the OR value of0.928, P<0.05. PA as the factors affecting the prognosis of severe pneumonia, regression coefficient is-0.283, the OR value of0.954, P<0.05. APACHE II,△Lac, ACRP,PA,CHE, PaO2/FiO2,for factors affecting the prognosis of severe pneumonia in the ICU.Conclusion:1Features of TCM syndrome: Location-syndromes were: lung, heart, kidney, spleen, mind, skin, and colon. Property-syndromes were:qi deficiency, blood deficiency, Yang deficiency, yin deficiency, phlegm, heat, blood stasis, Qi blockage, toxicity, and bleeding. TCM syndrome-types were:phlegm heat obstructing lung, pathogen-strong while vital Qi deficient, heat-toxicity blocking lung, heart lung Yang deficiency and phlegm, lung kidney yin deficiency phlegm heat, lung yin deficiency and blood stasis. 2Prognostic factors:APACHE Ⅱ score, PA, CHE,24hour CRP value change,24hours of Lac change values are related to the prognosis of severe pneumonia, and they are the factors affecting the prognosis of severe pneumonia. APACHE Ⅱ score is higher, the worse prognosis. The more obvious CRP decrease in24hours, the better the prognosis, whereas the worse prognosis; the more obvious Lac in24hours to reduce, the better the prognosis, whereas the worse prognosis.Lung and kidney Yin deficiency phlegm heat indicates the lungs: The lower PA is, the worse prognosis; the more obvious CRP decrease in24hours, the better the prognosis, whereas the worse prognosis; the more obvious Lac within24hours to reduce, the better the prognosis, whereas the worse prognosis, for the prognosis of severe pneumonia phlegm heat indicates pulmonary syndrome factors.Lung spleen kidney Yin and Yang are two virtual phlegm closed mind:The lower PaO2/FiO2is the worse prognosis; the more obvious Lac within24hours to reduce, the better the prognosis is, whereas the worse prognosis, for the prognosis of severe pneumonia. Factors of D-Dimer for Lung spleen kidney Yin and Yang are two virtual phlegm closed mind. Factors of APACHE Ⅱ score, PA, CHE,△Lac,△CRP, PaO2/FiO2, D-Dimer are positive imaginary evil of the factors affecting prognosis.Lung deficiency of phlegm and blood stasis resistance pulmonary:APACHE Ⅱ score is higher, the worse prognosis; propagated is lower, the worse prognosis; Lac in24hours to reduce, the more obvious, the better the prognosis, whereas the Lung spleen kidney Yin and Yang are two virtual phlegm closed mind syndrome of the factors affecting prognosis.APACHE Ⅱ, ALac, ACRP for factors affecting the prognosis of severe pneumonia in the ICU. PA, CHE for Lung and kidney Yin deficiency phlegm heat indicates the lungs.