| Objective:To investigate the distribution of TCM syndrome elements in patients with pulmonary infection in the sequelae of cerebral infarction,analyze the correlation between TCM syndrome elements and general data,laboratory examinations,and chest CT,so as to provide references for the clinical diagnosis and treatment of patients with lung infection in the sequelae of cerebral infarction in accordance with.Methods:Using a retrospective research method,by searching the electronic medical record system of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine,patients who were admitted to the hospital from October 2017 to October 2020 who met the diagnostic criteria for pulmonary infection in the sequelae of cerebral infarction were selected.Collect the patient’s general information,clinical symptoms and signs,laboratory examinations,chest CT and other data,formulate and fill in the pulmonary infection syndrome differentiation scale during the sequelae of cerebral infarction.Use SPSS23.0 software for statistical analysis to summarize the distribution law of TCM syndrome elements and the correlation between syndrome elements and general data,laboratory examinations,and chest CT.Results:General information:A total of 108 effective cases were collected in this study,including 73 males(67.6%)and 35 females(32.4%).The ratio of male to female was 2.09:1.The age distribution is mostly between 75-84 years(41.7%)and 85-94 years(38.9%).The course of cerebral infarction in patients with pulmonary infection is mostly 1-5 years(56.5%),often complicated by 4-6diseases(40.7%),among the common underlying diseases,hypertension(78.7%),coronary heart disease(54.6%),Diabetes(38.9%)has a higher proportion.The incidence was mainly in autumn(36.1%)and winter(28.7%).There were 81 cases of rales on lung auscultation,of which 51 cases(47.2%)were wet rales,9cases(8.3%)were dry rales,and 21 cases(19.4%)coexisted with dry and wet rales.There were 66 cases(61.1%)with normal body temperature.Among the patients with abnormal body temperature,low fever was the main one(25.0%),followed by moderate fever(12.0%)and high fever(1.9%).There were no patients with ultra-high fever.2.Laboratory examination:The white blood cell count in peripheral blood was in the range of(3.63-22.66)×10~9/L,with an average value of(7.99±3.62)×10~9/L,of which 20 cases(18.5%)were elevated.One case(0.9%)decreased.The percentage of neutrophils was in the range of(39.5-97%),with an average value of(71.60±13.53)%,of which 67 cases(62.0%)increased and3 cases(2.8%)decreased.The percentage of lymphocytes is in the range of(2.4-47.6)%,with an average of(17.11±8.59)%.Among them,2 cases(1.9%)increased,and 75 cases(69.4%)decreased.CRP was in the range of(0.5-221.94)mg/L,with an average value of(29.98±36.93)mg/L,of which 76 cases(70.4%)were elevated.Albumin was in the range of(22-43.3)g/L,with an average of(33.23±4.14)g/L,of which 5 cases(4.6%)were normal and 103 cases(95.4%)were reduced.A total of 83 pathogenic bacteria were detected in sputum culture specimens,mainly Gram-negative bacteria(49.4%),including Pseudomonas aeruginosa(15.7%),Klebsiella pneumoniae(12.0%),and Escherichia coli(9.6%)more common.Gram-positive bacteria are mainly Staphylococcus aureus(13.3%).Candida albicans(10.8%)and Candida albicans(8.4%)are the main fungi(21.7%).3.Chest CT:imaging examination showed that the lesions mostly involved multiple lobes(92.6%),mainly in the right lower lobe(65.7%)and left lower lobe(63.9%);the imaging features were mainly manifested by actual changes.Patchy consolidation(75.0%),flaky consolidation(38.9%),followed by ground glass shadow(51.9%),and reticular shadow,interlobular thickening(49.1%)and cord-like shadow(41.7%);pleural effusion(37.0%)is the main manifestation involving the pleura.4.The distribution law of TCM syndrome elements:A total of 8 disease location syndrome factors are summarized,which are lung,spleen,meridian,liver,heart,heart(brain),kidney,and surface in order of occurrence frequency.The lung has the highest frequency.100%,indicating that the core disease of the disease is the lung,followed by the spleen,meridians,liver,heart,and mind(brain).The four disease positions(34.3%)and the five disease positions(25.0%)are the main disease position combinations.Among them,the combination of lung+spleen+heart+meridian,lung+spleen+mind(brain)+meridian has the highest proportion,both of which are 4.6%,13 disease-related syndrome elements,according to the frequency of occurrence,they are phlegm,qi deficiency,yin deficiency,blood deficiency,blood stasis,yang deficiency,dampness,heat,drinking,qi stagnation,closure,cold,and wind,among which phlegm appears The highest frequency,98.2%,is the main disease factor.The diseased combinations are mainly six diseased(25.9%)and seven diseased(26.9%),and are characterized by multiple diseased combinations.There were 107 cases of deficiency and excess,and 1case with empirical evidence.No pure deficiency syndrome was seen.5.Correlation between TCM syndromes and general data:With the increase of age,the more likely it is that the diagnosis of spleen and blood deficiency syndromes is established(P<0.05,OR>1).With the increase of body temperature,the more likely it is that the diagnosis of mind,heat,and epidemiological elements is established(P<0.05,OR>1).The more types of comorbid diseases,the more likely it is that the diagnosis of mind and liver syndrome is established(P<0.05,OR>1).Compared with spring in the onset season,the diagnosis of Yang deficiency syndrome is less likely to be established in summer and spring(P<0.05,OR<1);compared with spring in summer and autumn,the diagnosis of renal syndrome is less likely to be established(P<0.05,OR<1).6.Correlation between TCM syndrome factors and laboratory examinations:The percentage of neutrophils was negatively correlated with Qi deficiency and Yang deficiency syndrome factors(P<0.05,r<0).Albumin was negatively correlated with blood deficiency syndrome factors(P<0.05,r<0),and was significantly negatively correlated with spleen and closed syndrome factors(P<0.01,r<0).C-reactive protein was positively correlated with epiphysin(P<0.05,r>0),and negatively correlated with renin(P<0.05,r<0).Gram-negative bacteria were statistically positively correlated with phlegm syndrome elements(P<0.01,r>0),and were statistically positively correlated with Yin deficiency(P<0.05,r>0).Gram-positive bacteria were statistically positively correlated with dampness,heat,and syndrome factors(P<0.05,r>0),and were significantly negatively correlated with Qi deficiency,blood deficiency,and Yang deficiency factors(P<0.01,r<0),was statistically negatively correlated with Yin deficiency syndrome elements(P<0.05,r<0).The fungus was statistically positively correlated with cold syndrome factors(P<0.05,r>0),and was significantly negatively correlated with heat and Yin deficiency syndrome factors(P<0.01,r<0).7.Correlation between TCM syndrome factors and chest CT:reticular shadow,increased lobular interval and Yin deficiency syndrome factors were statistically positively correlated(P<0.05,r>0).Pleural effusion was statistically positively correlated with Yinzhengsu(P<0.05,r>0).Conclusion:1.Patients with pulmonary infection in the sequelae of cerebral infarction are mainly elderly and male patients with 4-6 kinds of diseases.Lung infections usually occur in the course of cerebral infarction 1-5 years,and usually occur in autumn and winter.Lung auscultation Mainly wet rales,low body temperature rise or low fever mainly,chest CT manifestations are mainly bronchial pneumonia.In most patients,the white blood cell count is not significantly increased,and the percentage of neutrophils and C-reactive protein are significantly increased.At the same time,the percentage of lymphocytes and albumin are mostly decreased.The pathogenic bacteria are mainly Gram-negative bacteria.2.The etiology of patients with pulmonary infection during the sequelae of cerebral infarction includes external pathogen invasion,internal injury and depletion,chronic illness and physical weakness,etc.They have the pathogenesis characteristics of positive deficiency evil invasion,positive deficiency evil proliferation,and deficiency leading to solid.The disease position is manifested as multiple disease positions,with the lung as the core,and is closely related to the spleen,involving the meridians,liver,heart,mind(brain),kidney,and surface;the disease is manifested as a mixture of deficiency and excess,with deficiency(qi deficiency,yin deficiency)as the This book is based on phlegm,blood stasis,dampness,heat,and drinking,and the combination of multiple disease positions and disease forms a complex disease of deficiency and excess,both external and internal.3.Correlation analysis of syndrome factors suggests that age has an influence on spleen and blood deficiency syndrome factors,body temperature has an influence on mind(brain),heat,and episyndrome factors,and the types of combined diseases have influence on mind(brain)and liver syndrome factors,causing disease Season has an influence on kidney and Yang deficiency syndrome.The percentage of neutrophils was negatively correlated with Qi-deficiency and Yang-deficiency factors.Albumin was negatively correlated with blood deficiency,spleen,and occlusion factors.C-reactive protein is statistically positively correlated with epiphysin,and statistically negatively correlated with renin.Patients with gram-negative bacteria cultured have more severe lesions of sputum and yin-deficiency syndromes,and patients with gram-positive bacteria cultured have more severe lesions of dampness,heat,and absent syndromes,with qi deficiency,yin deficiency,blood deficiency,and yang deficiency syndromes.The disease is mild.Patients with cultured fungi have more severe pathological changes of cold syndrome elements,and milder pathological changes of heat and yin deficiency syndrome elements.In the chest CT findings,the reticulated shadow and the increase of lobular interval were statistically positively correlated with Yin deficiency syndrome factors,and pleural effusion was statistically positively correlated with Yin syndrome factors.This study did not find the correlation between the patient’s typical chest CT findings,such as consolidation,ground glass shadow,and TCM syndromes,and further research is needed to clarify. |
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