| Objective:Collect the clinical data of elderly patients with community-acquired pneumonia,use the statistical methods of factor analysis and cluster analysis,combined with Professor Zhu Wenfeng's syndrome factor differentiation system,explore the syndrome classification and syndrome element distribution characteristics of elderly community-acquired pneumonia,and analyze the pathogenesis of the disease,so as to provide some ideas for the clinical syndrome classification and prescription of the diseaseMethods:This study was a single-center,cross-sectional study,which included 167 elderly CAP patients who were admitted to Dongzhimen Hospital of Beijing University of traditional Chinese Medicine from January 2019 to January 2020.The clinical data collected included demographic data,past medical history and four diagnostic information.The distribution characteristics of clinical data such as sex,age,basic diseases,predisposing factors,prevalence of pneumonia in the past year,smoking history,vaccination history,medication before admission,clinical manifestations and information of four diagnoses were described by using SPSS 20.0 software and frequency statistics.Statistical methods of systematic clustering and factor analysis were used,combined with the scale of syndrome differentiation in"Syndrome Factor differentiation",to summarize the types and elements,explore the syndrome classification and syndrome element distribution in elderly patients with CAP,and analyze the etiology and pathogenesis.Results:1.General data:167 elderly patients with CAP were collected in this study,including 90 males(53.9%)and 77 females(46.1%).The average age was 77.63±7.658 years old,of which 69 patients were 75-84 years old,accounting for the most(41.3%).In terms of smoking,70 patients have a history of smoking,of which 55 patients quit smoking for more than 6 months.In terms of the prevalence of pneumonia in the past year,46 patients suffered from pneumonia in the past year,of which 10 cases suffered from pneumonia once,3 cases suffered from pneumonia twice and 6 cases suffered from pneumonia for three times or more Chi-square test was carried out between the patients' smoking history and the prevalence of pneumonia in the past year,and no significant diference was found between the two groups Among the basic diseases,152 patients were accompanied by basic diseases,the common ones were hypertension(60.5%),coronary heart disease(39.5%),chronic obstructive pulmonary disease(38.9%)and diabetes(29.9%).In the history of vaccination,28 patients were vaccinated with influenza vaccine and 27 patients with pneumococcal vaccine2.Pneumonia related situations:In terms of the inducement of pneumonia,66 patients had no obvious inducement,95 patients(56.9%)were caused by being exposed to wind or cold evil,which was the main inducement.In clinical manifestations,the main symptoms were cough,expectoration,fatigue,dyspnea and pharyngeal discomfort.In terms of body temperature,140 patients had normal body temperature,15 patients had low fever and 12 patients had moderate fever.In terms of pre-admission medication,59 patients were treated with anti-pathogenic microorganism drugs,mainly antibiotics,of which ?-lactam antibiotics were the most frequently used(37 cases),followed by quinolone antibiotics(22 cases).In terms of PSI score,135 patients were low-risk group and 32 patients were medium-risk group3.Syndrome and syndrome elements:A total of 9 disease location syndrome elements were extracted according to factor analysis,the excretion from high to low were lung,kidney,heart,mind and spirit,liver,half-surface and half-li,spleen and stomach.And 21 disease syndrome factors extracted,the order from high to low is qi deficiency,heat,phlegm,yang deficiency,yin deficiency,dampness,food accumulation,yang excess,non-solid,blood heat,blood deficiency,qi stagnation,pus,blood stasis,drinking,qi depression,summer heat,essence loss,dryness,fluid deficiency and cold.According to cluster analysis,the syndromes of senile CAP were divided into six types:phlegm-turbid blocking lung syndrome,lung-yin deficiency and phlegm-heat syndrome,damp-heat internally accumulation syndrome,food stagnation stomach syndrome,liver depression and yin deficiency syndrome,lung-kidney deficiency syndrome.Conclusion:1.The clinical manife stations of elderly patients with CAP are mainly cough.expectoration,fatigue and dyspnea,but the clinical symptoms are not typical,fever is not obvious,and there are many basic diseases,so early diagnosis and treatment should be paid attention to.2.The CAP syndromes of the elderly are divided into 6 categories,namely,phlegm-turbid blocking lung syndrome,lung-yin deficiency and phlegm-heat syndrome,internal accumulation of dampness and heat syndrome,food stagnation and epigastric syndrome,liver depression and yin deficiency syndrome and lung-kidney deficiency syndrome.Among them,the syndrome of internal accumulation of dampness and heat,food stagnation and epigastric stagnation and liver depression and yin deficiency mostly exist in concurrent diseases.3.Most of the elderly CAP is the syndrome of deficiency and excess,which is located in the lung and is closely related to the kidney.The pathogenesis is mainly deficiency,phlegm and heat.Deficiency of qi,deficiency of yang and deficiency of yin are the basis of the disease,and phlegm and heat are the signs of the disease.The deficiency can lead to standard reality,which further aggravates this deficiency,making patients more susceptible to evil,and the course of disease is lingering and be difficult to cure.In terms of treatment,we should pay attention to the characteristics of the elderly and the nature of their pathogenesis,giving consideration to both supporting the positive and dispelling the evil,either strengthening the upright or dispelling pathogens.Moreover,the treatment of positive deficiency and evil excess should all be divided according to different aspects,different etiology,and the location of Zang-fu organs. |
PDF Full Text Request