| This research is divided into two parts.The first part is the clinical study of AAD,and the second part is the literature analysis of the medication law of AAD.1 Clinical study of AADObjective: to investigate the characteristics of AAD and the distribution of syndromes,and to provide ideas for the prevention and treatment of AAD.Methods: 70 cases of patients diagnosed with AAD in the emergency ward of the north hospital of the first affiliated hospital of tianjin university of traditional Chinese medicine from July 2018 to December 2019 were collected(in this study,the faecal flora distribution of the patients needed to be determined,and the specific bacterial flora distribution ratio was not reported in the bacterial culture results of the hospital before,so the selection of cases was limited).Retrospective analysis was performed on the clinical data of 70 patients with AAD,including gender,age,length of stay,underlying disease,antibiotic use,co-application of PPI,invasive operation,severity of diarrhea,laboratory tests and types of TCM syndromes.SPSS20.0 software was used for statistical analysis.Statistical data were analyzed by test,and P <0.05/0.017 was statistically significant.Measurement data were expressed as mean ± standard deviation((?) ±S).Results:(1)among the 70 AAD patients in this study,40 were males and 30 were females,with no statistical difference.The age of onset was 46-97 years,with an average age of 77.53±10.43 years,56(80%)patients aged ? 70 years,and 14(20%)patients aged < 70 years,showing statistical differences.(2)the length of hospital stay was 3-47 days,with an average of 29.91±10.09 days,6cases ?14 days,21 cases 15-28 days and 43 cases > 28 days,showing statistical differences.(3)each AAD patient was associated with 1-10 basic diseases,with an average of 4.83±1.74,of which coronary heart disease,hypertension and cerebral infarction were the most common.(4)the reasons for the use of antibiotics include 6 infectious diseases,among whichpneumonia and urinary tract infection are the most common.There are 7 types of antibiotics causing AAD,which basically cover the commonly used types in clinical practice.Among them,enzyme complex inhibitors,carbapenems,tegacycline and fluoroquinolones are the most commonly used antibiotics,and they are all broad-spectrum antibiotics,which are related to the varieties of antibiotics in hospitals.The duration of antibiotic use was 3-21 days,with an average of 9.64±4.42 days,25 cases were ?7 days,31 cases were 8-14 days,and14 cases were ? 15 days.It was not shown that the prolonged duration of antibiotic use would increase the incidence of AAD.The possibility of a small sample size was not excluded.There were statistical differences in 47 cases with combined antibiotics and 23 cases with single antibiotics.(5)there was a statistical difference between 53 AAD patients who received combined use of PPI and 17 who did not.(6)in 58 patients with AAD,invasive operations were performed during hospitalization,while 12 patients did not,showing statistical differences.There are 6 kinds of operations,among which nasogastric tube implantation,urinary tube implantation and deep vein puncture are the most frequent.(7)41(58.6%)AAD patients had moderate diarrhea,15(21.4%)had severe diarrhea,and the remaining 14(20%)had mild diarrhea.(8)in the routine stools,36 patients with AAD had soft stools,and 34 patients had thin stools.There was no visual blood stools,mucous stools,and no pseudomembrane.19 cases had positive faecal occult blood and negative faecal occult blood.1 case red,leukocyte heighten,residual negative.In faecal culture,1 case was positive for clostridium difficile and negative for others.All the 70 cases were abnormal flora growth.(9)syndrome distribution,spleen and kidney Yang deficiency syndrome(31 cases)>syndrome of spleen and stomach weakness(21 cases)> syndrome(13 cases)> dampness-heat syndrome(5 cases).Conclusion: coronary heart disease,hypertension and cerebral infarction are the most common basic diseases in AAD patients.Pneumonia and urinary tract infection are the most common causes of antibiotic use in AAD patients.Enzyme complex inhibitors,carbapenems,tegacycline,and fluoroquinolones are the most commonly used antibiotics to induce AAD.Advanced age(?70 years),prolonged length of stay(> 14 days),combination of underlying diseases,combination of antibiotics,broad-spectrum antibiotics,combination of PPI,and invasive operations all increased the incidence of AAD.The main syndromes of AAD are spleen-kidney Yang deficiency and spleen-stomach weakness.2 Literature analysis of the medication law of AADObjective: to study the law of medication for AAD and provide evidence for the prevention and treatment of AAD.Methods: advanced retrieval was conducted for all journals in CNKI,wanfang database and VIP from 2010 to 2019,and the AAD treatment,traditional Chinese medicine and its efficacy,efficacy,taste and regression in the documents meeting the requirements were standardized.The database was established with Excel and frequency statistics were conducted with SPSS 20.0 software.Results: a total of 22 literatures were included,including 1889 AAD patients,13 basic prescriptions(8 classical prescriptions: fuzi lizhong decoction,weiguan decoction,ginseng fudu powder,shenling baishu powder,sijunzi soup,xianglian pill,sishen soup,peach blossom soup,5 self-designed prescriptions)and 62 traditional Chinese medicines.(1)there are 13 kinds of treatment methods for AAD,of which 68.2% are spleen strengthening,dampening,qi replenishing,astringency and Yang warming,which are the main treatment methods for AAD.(2)the 62 traditional Chinese medicines for the treatment of AAD can be divided into 13 categories according to their efficacy,among which the proportion of tonic for asthenia,tonic for water infiltration,tonic for warm and astringent,and tonic for astringency accounts for65.3%.As the main medicine for the treatment of AAD,tonic for asthenia is mainly composed of tonic for qi(88.5%).(3)in the treatment of AAD frequency of usage of the top 10,in traditional Chinese medicine licorice,atractylodes,poria cocos,dangshen,dried ginger,yam,white hyacinth bean,aconite,coix seed,rhizoma coptidis,radix platycodi,amomum fruit,fruit of Chinese magnoliavine,lotus seed,rhizoma atractylodis,dried tangerine or orange peel,radix scutellariae,radix astragali,accounted for 59.7%,the use frequency of a herbs are 5 or more times,is a commonly used drugs in the treatment of AAD.(4)among the traditional Chinese medicine(TCM)for the treatment of AAD,69.8%were normal,mild and mild.In the medicine taste,the gan,xin,bitter accounted for 79.2%;Spleen,stomach and lung accounted for 57.8 percent of the meridians.Conclusion: Invigorating spleen,dampening,invigorating qi,fixing astringency and warming Yang are the main treatments for AAD.The main drugs for the treatment of AAD are qi tonic,hydrolytic wet tonic,warm tonic and astringent tonic.Licorice root,atractylodes,pachyderm,codonopsis codonopsis,dried ginger,Chinese yam,white hyacinth bean,aconite,coix seed,rhizoma coptidis,radix platycodonis,radix platycodonis,fructus schisandrae,lotus seed,atractylodes,tangerine peel,radix scutellariae and astragalus are commonly used drugs for the treatment of AAD.In the treatment of AAD,the medicinal properties are mainly plain,warm and lukewarm,and the medicinal tastes are mainly sweet,spicy and bitter.The spleen,stomach and lung meridians are the main meridians. |
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