本文關(guān)鍵詞： 多重耐藥菌 肺炎 扶正祛邪法 臨床研究　出處：《成都中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：通過(guò)隨機(jī)對(duì)照試驗(yàn)的方法,觀察扶正祛邪法治療多重耐藥細(xì)菌性肺炎的有效性和安全性,探討扶正祛邪法治療多重耐藥細(xì)菌性肺炎的理論基礎(chǔ),為扶正祛邪法治療該病提供理論基礎(chǔ)。方法：1.理論研究：回顧中醫(yī)學(xué)關(guān)于“喘病”、“咳嗽”、“肺熱病”等類似疾病的研究和認(rèn)識(shí),總結(jié)其與現(xiàn)代醫(yī)學(xué)多重耐藥細(xì)菌性肺炎的聯(lián)系。探討中醫(yī)學(xué)關(guān)于多重耐藥細(xì)菌性肺炎的理論認(rèn)識(shí),探討扶正祛邪法治療多重耐藥性細(xì)菌性肺炎的理論和實(shí)踐基礎(chǔ)。2.臨床研究：選擇2014年01月至2016年02月在成都中醫(yī)藥大學(xué)附屬醫(yī)院EICU、急診科、呼吸科及老年病科的住院病人,隨機(jī)分為試驗(yàn)組與對(duì)照組；對(duì)照組按肺炎及多重耐藥預(yù)防和控制相關(guān)指南予以西醫(yī)治療,試驗(yàn)組在對(duì)照組的基礎(chǔ)上加用扶正祛邪法中藥湯劑治療。以治療前和治療第3、7、14天作為評(píng)價(jià)時(shí)間點(diǎn),觀察炎癥反應(yīng)指標(biāo)：血常規(guī)、C-反應(yīng)蛋白(CRP)、降鈣素原(PCT)；肺損傷指標(biāo)：臨床肺部感染評(píng)分(CPIS)；器官功能障礙指標(biāo)：急性生理和慢性健康評(píng)分(APACHEⅡ)和全身性感染相關(guān)器官功能衰竭評(píng)分(SOFA評(píng)分)；14日病死率；有創(chuàng)機(jī)械通氣發(fā)生率；耐藥病原菌清除率；中醫(yī)療效及中醫(yī)癥狀積分等指標(biāo)情況。結(jié)果：1.基線分析：兩組患者基線資料比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.安全性指標(biāo)：試驗(yàn)組和對(duì)照組在治療過(guò)程中的不良反應(yīng)發(fā)生率分別為12.5%和7.5%,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3.療效性指標(biāo)：治療第14天,兩組患者中醫(yī)療效率分別為87.2%與66.7%,耐藥菌清除率分別為53.8%與30.8%,有創(chuàng)機(jī)械通氣發(fā)生率分別為10.3%與30.8%,組間差異比較具有統(tǒng)計(jì)學(xué)意義(P0.05)；兩組患者死亡率分7.7%與15.4%,差異不具有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者中醫(yī)癥狀積分、炎癥反應(yīng)(WBC、NEUT%、CRP、PCT)指標(biāo)、肺損傷指標(biāo)(CPIS)評(píng)分及器官功能指標(biāo)評(píng)分(APACHE II評(píng)分、SOFA評(píng)分)比較,治療前及治療第3天,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),治療第7天及第14天差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論：1扶正祛邪法的理論適合臨床治療多重耐藥細(xì)菌性肺炎,根據(jù)扶正祛邪法擬定的理法方藥符合中醫(yī)學(xué)基本理論；基于扶正祛邪法擬定的中藥方劑安全可靠,不良反應(yīng)少。2與對(duì)照組相比,聯(lián)合扶正祛邪法的中西醫(yī)結(jié)合治療方案能有效提高多重耐藥細(xì)菌性肺炎患者的中醫(yī)療效及多重耐藥菌株清除率；能有效降低該患者的炎癥反應(yīng)水平、肺損傷評(píng)分、器官功能衰竭評(píng)分及有創(chuàng)機(jī)械通氣發(fā)生率等指標(biāo),具有療效優(yōu)勢(shì)。
[Abstract]:Objective: to observe the efficacy and safety of the method of nourishing qi and dispelling evil in the treatment of multidrug resistant bacterial pneumonia by randomized controlled trial, and to explore the theoretical basis for the treatment of multidrug resistant bacterial pneumonia with the method of nourishing qi and dispelling evil. Methods: 1. Theoretical study: review of the traditional Chinese medicine about "asthma", "cough", "lung fever" and other similar diseases research and understanding, To summarize its relationship with multidrug resistant bacterial pneumonia in modern medicine, and to explore the theoretical understanding of multidrug resistant bacterial pneumonia in traditional Chinese medicine. To explore the theoretical and practical basis of Fuzheng dispelling pathogenic method in the treatment of multidrug resistant bacterial pneumonia. 2. Clinical study: select the inpatients from January 2014 to February 2016 in EICU, emergency, respiratory and geriatric departments, affiliated hospitals of Chengdu University of traditional Chinese Medicine. The patients in the control group were treated with western medicine according to the guidelines for the prevention and control of pneumonia and multidrug resistance. On the basis of the control group, the experimental group was treated with traditional Chinese medicine decoction of the method of nourishing qi and dispelling evil. The inflammatory response indexes were: blood routine C-reactive protein (CRPN), procalcitonin (PCT); lung injury: clinical pulmonary infection score (CPISN); organ dysfunction: acute physiological and chronic health score (Apache 鈪，

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