| This paper mainly includes 2 parts.Part Ⅰ contains 2 reviews.Review I focused on the pathogenesis,risk factors,diagnosis and treatment of PITS/PTTS in modern medicine.Review 2 from the perspective of methodology,discussed the connotation and basic characteristic of syndrome element differentiation,the establishment of syndrome element differentiation system,the advantages and disadvantages of this method,and its application in the field of respiratory diseases.Part Ⅱ is the clinical study:Objective:To observe the distribution of TCM syndrome elements in PITS/PTTS.To explore the correlation between TCM syndrome elements and main symptoms and electronic bronchoscopy findings.Methods:This cross-sectional study was conducted in the respiratory ward of Dongzhimen Hospital,Beijing University of Chinese Medicine from January 2020 to February 2023.Patients with PITS/PTTS were included.The general information,symptoms,physical signs,bronchoscopy findings of patients were collected.The syndrome elements of patients were determined according to the syndrome differentiation scale,and SPSS 25.0 software was used to analyze the data.Results:1.General information:a total of 72 PITS/PTTS patients were included in this study.There were more males than females,and most of them were young and middle-aged patients.The median time from tracheal intubation/tracheotomy was 9 months.The main causes of tracheal intubation/tracheotomy included cerebral hemorrhage,cerebral infarction,craniocerebral injury,and laryngeal surgery.Pulmonary infection,hypertension,type 2 diabetes mellitus and gastroesophageal reflux disease were the most common complications.2.Symptoms,syndromes and syndrome elements:2.1 The main symptoms of PITS/PTTS patients were wheezing,cough,and expectoration.2.2 A total of 111 syndromes and 21 syndrome elements were involved in the 72 patients.There were 7 syndrome elements of disease location,including lung,spleen,heart,kidney,liver,heart spirit and meridians.There were 14 pathological syndrome elements,including phlegm,yin deficiency,heat,dampness,fluid,qi deficiency,qi stagnation,bleeding,blood stasis,yang deficiency,non-consolidation,cold,blood deficiency and yang floating.2.3 According to the clustering analysis results of symptoms and syndrome elements,the TCM syndrome types of PITS/PTTS can be divided into 5 categories:qi stagnation,blood stasis and phlegm obstruction syndrome,lung-spleen qi deficiency syndrome,phlegm dampness obstruction syndrome,phlegm-fluid hidden in the lung syndrome and phlegm-heat with yin deficiency syndrome.(3)Electronic bronchoscopy findings:The most common stenosis site in PITS/PTTS patients was zone I,the main lesion type was scar contracture,the main degree was moderate stenosis,and the main length was 1～3 cm.4.Correlation analysis:4.1 Correlation analysis between syndrome elements and general information showed that spleen syndrome elements(P=0.023)and qi deficiency syndrome elements(P=0.008)were more common in women,and yin deficiency syndrome elements were related to age.No correlation was found between the other syndrome elements and gender,age and the time from tracheal intubation/tracheotomy.4.2 Correlation analysis between the distribution of syndrome elements and bronchoscope findings showed that spleen syndrome elements were related to the degree of stenosis(P=0.010),and heat syndrome elements were related to granulation hyperplasia(P=0.020).No correlation was found between the distribution of syndrome elements and the location and length of stenosis.4.3 Correlation analysis between the distribution of syndrome elements and the severity and score of symptoms showed that spleen syndrome elements were related to the self-care ability of daily living(P=0.004),but no correlation was found between the distribution of syndrome elements and the severity of cough and wheezing.4.4 The correlation analysis between the syndrome elements scores and the clinical data showed that the syndrome element scores of lung,heart and phlegm were positively correlated with the degree of cough and the amount of phlegm produced.The syndrome element scores of lung,spleen,heart,kidney,phlegm and qi deficiency were positively correlated with wheezing grade and shortness of breath score,and negatively correlated with KPS score and self-care ability.The syndrome element scores of lung,spleen,heart,liver,phlegm and qi stagnation were positively correlated with the degree of stenosis.4.5 Compared with tracheal intubation,tracheotomy was more likely to cause zone Ⅲstenosis and cartilage destruction.Conclusion:The core location element of PITS/PTTS was lung,in addition,it was also related to spleen,heart,kidney and liver.The disease was mainly characterized by asthenia healthy energy and sthenia pathogenic factors.The pathogenic factors mainly included phlegm,heat,dampness,drink and qi stagnation,and healthy energy deficiency mainly included yin deficiency and qi deficiency.Spleen syndrome element were related to the degree of stenosis and self-care ability,and heat syndrome element were related to granulation hyperplasia.In the TCM treatment of PITS/PTTS,clinicians should pay attention to support healthy energy to eliminate pathogenic factors.The treatment methods include clearing the lung and dissipating phlegm,invigorating the spleen and supplementing qi,promoting qi and soothing the liver.The application of clearing heat may help to delay the growth of granulation,thereby prolonging the time of restenosis. |
