Study On The Factors Related To Respiratory Pathogens And Prognosis Of The Chinese Medicine Certificate Type Of Severe Pneumonia In ICU

Research PurposeThis paper discusses the distribution characteristics of Chinese medicine certificate type and respiratory pathogens of ICU severe pneumonia,observes the analysis of the death rate and prognosis-related factors of chinese medicine certificate type of ICU severe pneumonia,and observes the analysis of respiratory pathogens and prognostic factors of chinese medicine-certificate type of ICU severe pneumonia.Research MethodsUsing retrospective analysis,patients who met the diagnostic criteria of Chinese and Western medicine for severe pneumonia were screened according to the criteria of the nattosis from September 01,2018 to December 31,2020 at the ICU of Chengdu University of Traditional Chinese Medicine.Collect general data（Name,gender,age,ICU length of stay,TCM clinical four-diagnosis data）,pathogenic results（sputum culture,BALF culture and PCR result）,physiochemical indicators（Pa O₂/Fi O₂,Lac,Lac/Alb,NLR）,critical illness scores（APACHE II,SOFA scores）,outcomes after 28days of hospitalization.（1）In accordance with the standard of Chinese medicine dialectics of severe pneumonia,the patient’s Chinese medicine certificate type is summarized,and the death rate of each Chinese medicine certificate type is summarized.Analysis of respiratory pathogens medical examination,sum up its distribution characteristics.（2）Divide the included cases into a survival group and a death group according to their outcome,and compare the index differences between the two groups.Perform prognostic correlation analysis and summarize the risk factors that affect the patient’s prognosis.（3）Divide the included cases into four groups according to TCM syndrome types,analyze the distribution of respiratory pathogens in each group,and summarize the dominant pathogens of each TCM syndrome type;conduct prognostic correlation analysis for each group to summarize the prognosis of patients with each TCM syndrome type Risk factors.Results1.The study included a total of 112 patients,of whom 69 were men（61.61%）and 43 were women（38.39%）.Age 25-93,average age 70.23±14.74 years.The average length of hospital stay in the ICU was 16.18±16.76 days.75 deaths,with a total mortality rate of 66.96 percent.2.The distribution ratio of TCM syndrome types from high to low is the syndrome of evil trapping and positive deprivation（49.11%）>phlegm turbidity obstructing lung syndrome（31.25%）>heat sinking pericardium syndrome（16.07%）>phlegm-heat accumulating lung syndrome（3.57%）.The mortality rate from high to low was the syndrome of phlegm-heat accumulation in the lung（80.00%）>phlegm-heat accumulation in the lung syndrome（75.00%）>heat-trapped pericardium syndrome（66.67%）>phlegm-turbid obstructive lung syndrome（45.71%）.3.In this study,31 patients（27.68%）were not detected with respiratory pathogens,32 patients（28.57%）were detected with 1 pathogen,49 patients（43.75%）were detected with 2 or more pathogens,and the total positive test was The exit rate was 72.32%.A total of 154 strains of pathogens were detected,including bacteria（G+bacteria,G-bacteria）,fungi,and viruses.The most detected is G-bacteria.The most detected strains of a single pathogen were Acinetobacter baumannii,Candida albicans,Klebsiella pneumoniae,Burkholderia cepacia,and Epstein-Barr virus.4.Univariate analysis of overall prognosis revealed that gender,age,Pa O₂/Fi O₂,Lac,Lac/Alb,APACHEⅡscore,SOFA score,TCM syndrome type and prognosis were correlated（p<0.05）.The correlation coefficients are-0.187,0.241,-0.201,0.248,0.239,0.310,0.321,0.274.Multivariate regression analysis of the overall prognosis found that Pa O₂/Fi O₂and TCM evils were positive and deprived of syndromes were statistically significant（p<0.05）,the regression coefficients were-0.006 and 1.257,and the estimated odds ratios were 0.994 and 0.284.5.Patients with phlegm-heat accumulating lung syndrome are mainly respiratory tract mixed infections,and the main pathogen is G^-bacteria;patients with phlegm-turbid lung obstruction syndrome are mainly respiratory tract infections with a single pathogen,the main pathogen is G^-bacteria,and the most detected strain is abalone Acinetobacter mannae and Candida albicans;patients with heat-trapped pericardial syndrome mainly have mixed respiratory tract infections.The main pathogens are G-bacteria and/or fungi.The most detected strains are Candida albicans,Acinetobacter baumannii,Klebsiella pneumoniae:The main pathogen is mixed respiratory tract infection,the main pathogen is G^-bacteria,and the most detected pathogens are Candida albicans and Acinetobacter baumannii.6.The single-factor correlation analysis of the prognosis of phlegm obstruction lung syndrome found that Pa O₂/Fi O₂,Lac,Lac/Alb,SOFA scores were correlated with the prognosis（p<0.05）,and the multi-factor correlation analysis did not find independent prognostic factors;heat sinking The single-factor correlation analysis of the prognosis of pericardium syndrome found that APACHEⅡscore was correlated with the prognosis（p<0.05）;the single-factor correlation analysis of the prognosis of Evil Depression and Positive Out-of-Syndrome found that Pa O₂/Fi O₂,respiratory pathogen infection and prognosis were correlated（p<0.05）,Multivariate regression analysis found that the detection of a single pathogen,two or more pathogens was statistically significant（p<0.05）,the regression coefficients were-1.879,-2.205,and the estimated odds ratios were 0.153 and 0.110,respectively.Due to the small sample size of patients with phlegm-heat accumulating lung syndrome,no prognostic factors have been found yet.Conclusions1.In ICU patients with severe pneumonia,the distribution of TCM syndromes is mainly deficiency syndrome,and the most common syndromes are the syndromes of evil sinking and positive diseases,Phlegm-heat accumulating lung syndrome is the least.The mortality rate from high to low is the syndrome of evil trapping and positive deprivation>syndrome of phlegm-heat accumulating lung>syndrome of heat-trapping pericardium>syndrome of phlegm obstructing lung.2.ICU patients with severe pneumonia are mainly respiratory mixed infections,and the pathogen is mainly G^-bacteria.The most common respiratory pathogens are Acinetobacter baumannii,Candida albicans,Klebsiella pneumoniae,Burkholderia cepacia,EB virus.3.Gender,age,Pa O₂/Fi O₂,Lac,Lac/Alb,APACHEⅡscore,SOFA score,TCM syndrome type are correlated with the prognosis of patients with severe pneumonia in ICU.Pa O₂/Fi O₂and syndrome of evil trapping are independent factors influencing the prognosis of patients.4.ICU patients with severe pneumonia with phlegm turbidity obstructing the lung syndrome tend to be infected with a single G^-bacteria,and the dominant pathogen is Acinetobacter baumannii.Patients with febrile pericardial syndrome tend to be infected by G^-bacteria and/or fungi.The dominant pathogens are Acinetobacter baumannii,Klebsiella pneumoniae and Candida albicans.There is a tendency for multiple pathogenic bacteria to be infected by the syndrome of evil trapping and the predominant pathogens are Acinetobacter baumannii and Candida albicans.5.Respiratory pathogen infection is an independent factor influencing the prognosis of patients with severe pneumonia in ICU.