瀘州地區(qū)支氣管擴(kuò)張癥住院患者臨床特征分析
發(fā)布時間：2018-07-29 15:56
【摘要】：目的:本研究通過回顧性總結(jié)瀘州地區(qū)支氣管擴(kuò)張癥(以下簡稱支擴(kuò))住院患者的臨床特征,為支擴(kuò)的防治提供循證學(xué)依據(jù),同時為制定及優(yōu)化臨床路徑提供思路。方法:用EXCEL制定信息采集表,采用回顧性研究法,利用西南醫(yī)科大學(xué)附屬中醫(yī)醫(yī)院電子病歷系統(tǒng)查詢,檢索出2014年10月至2016年10月期間在本院呼吸內(nèi)科住院,出院診斷為支擴(kuò)的瀘州本地患者,回顧性分析入選患者的年齡、性別、發(fā)病節(jié)氣、病程、既往史及合并疾病、臨床癥狀、肺功能、痰培養(yǎng)、抗生素使用、中醫(yī)病名、證型和病性分布規(guī)律及首劑中藥方劑使用等臨床資料。數(shù)據(jù)處理采用SPSS17.0統(tǒng)計(jì)學(xué)軟件進(jìn)行分析,其中定性資料用構(gòu)成比(%)進(jìn)行描述,用卡方檢驗(yàn)、Fisher確切概率法進(jìn)行檢驗(yàn);定量資料采用SX?進(jìn)行統(tǒng)計(jì)描述,用方差分析進(jìn)行檢驗(yàn),多組間的兩兩比較采用SNK法。以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1、一般情況:340例支擴(kuò)患者中男性176例,女性164例,男女比例:1.07:1,≥60歲(老年)患者74.12%,平均年齡:65.45±12.98(歲),平均病程18.75±13.16(年),平均住院天數(shù):10.34±5.53(天)。2、四季發(fā)病分布規(guī)律:春季組89例,夏季組89例,秋季組86例,冬季組76例。3、主要癥狀:咳嗽87.35%,咳痰73.82%,呼吸困難53.82%,咯血23.53%,發(fā)熱9.41%,胸痛2.35%。4、既往史及合并疾病:合并慢性阻塞性肺疾病(COPD)31.76%,既往有陳舊性肺結(jié)核13.24%、類風(fēng)濕性關(guān)節(jié)炎1.18%、麻疹0.88%、反流性食管炎0.59%、鼻竇炎0.29%。4、痰培養(yǎng)及抗生素使用:153例患者行痰培養(yǎng)檢查,39例痰培養(yǎng)陽性,其中71.79%為革蘭陰性菌,20.52%為真菌。細(xì)菌中銅綠假單胞菌陽性率為59.62%。抗生素哌拉西林舒巴坦使用率為58.86%。5、中醫(yī)病名:排前十位的命名為:肺絡(luò)張(32.75%),肺脹(30.51%),咯血(9.71%),肺咳(8.63%),哮病(6.48%),(風(fēng)溫)肺熱病(4.73%),肺積(2.12%),肺癰(1.53%),懸飲(1.19%),肺癆(0.88%)。6、中醫(yī)證型及病性分析:痰熱蘊(yùn)肺(56.48%),痰濁阻肺(7.66%),熱哮(4.42%),痰熱蘊(yùn)肺、氣虛血瘀(4.13%),肺腎虧虛(4.13%),肺脾兩虛(2.07%),痰熱蘊(yùn)肺、熱傷血絡(luò)(2.07%),熱傷血絡(luò)(2.07%),痰瘀阻肺(1.47%),肺脾氣虛(1.18%),風(fēng)熱犯肺(1.18%)。實(shí)證者272例,虛證者36例,虛實(shí)夾雜者32例。8、中藥方劑:340例患者中共有337例患者服用中藥方劑,使用頻次為:桑白皮湯(37.39%),芩連溫膽湯(7.42%),清金化痰湯(5.93%),二陳湯(5.04%),定喘湯(4.75%),溫膽湯(4.75%),金水六君煎(4.15%),千金葦莖湯(2.37%),二陳湯合三子養(yǎng)親湯(2.37%),參苓白術(shù)散(2.08%)。結(jié)論:1、本研究中支擴(kuò)患者男性多于女性,且以老年患者為主。2、支擴(kuò)以春夏秋三季發(fā)病居多。3、隨著抗菌藥物的廣泛使用,支擴(kuò)患者的癥狀表現(xiàn)不典型。4、c0pd是支擴(kuò)最常見合并疾病,二者相互影響,加重疾病損害。既往患有肺結(jié)核、惡性腫瘤、類風(fēng)濕性關(guān)節(jié)炎、麻疹、反流性食管炎、鼻竇炎等相關(guān)易感因素的支擴(kuò)患者,要注重病因排查。5、痰培養(yǎng)陽性率低,標(biāo)本培養(yǎng)陽性者以革蘭陰性菌為主,其中又以銅綠假單胞菌陽性率最高,在沒有藥敏結(jié)果前,可經(jīng)驗(yàn)性選擇對革蘭陰性菌(特別是銅綠假單胞菌)有效的廣譜抗生素。真菌感染逐年上升,成為支擴(kuò)急性期致病菌之一。6、中醫(yī)病名及證型診斷缺乏統(tǒng)一標(biāo)準(zhǔn),本研究中瀘州地區(qū)支擴(kuò)住院患者以痰熱蘊(yùn)肺最多見,并以實(shí)證居多,瘀證、虛癥多見于老年患者。在中藥方劑上以清熱化痰類方藥使用頻次最多,其中桑白皮湯可作為痰熱蘊(yùn)肺型支擴(kuò)的經(jīng)驗(yàn)方運(yùn)用。
[Abstract]:Objective: to provide evidence-based evidence for the prevention and treatment of bronchiectasis in Luzhou by reviewing the clinical features of the patients with bronchiectasis in Luzhou, and providing ideas for the formulation and optimization of the clinical pathway. The medical hospital electronic medical record system inquires, retrieves the Luzhou local patients who were hospitalized in the respiratory medicine department of our hospital from October 2014 to October 2016. The patients were diagnosed as the local patients with bronchiectasis. The age, sex, onset of throttle, course of disease, past history and combined disease, bed symptoms, lung function, sputum culture, antibiotic use, Chinese medicine name were retrospectively analyzed. The clinical data of the pattern of syndrome and the distribution of the disease and the use of the first prescription of traditional Chinese medicine. The data processing was analyzed by SPSS17.0 statistics software, in which the qualitative data were described by the constituent ratio (%), the chi square test and the exact probability of Fisher were used to test it; the quantitative data were described by SX? The 22 comparison used the SNK method. The difference was statistically significant with P0.05. Results: 1, general situation: 340 cases of bronchiectasis were male 176, female 164, male and female ratio: 1.07:1, 60 years old (aged) 74.12%, average age of 65.45 + 12.98 (year), average course 18.75 + 13.16 (year), average hospitalization days: 10.34 + 5.53 (day).2, seasonal distribution Rule: 89 cases in spring group, 89 in summer group, 86 in autumn group and 76 in winter group.3, the main symptoms are: cough 87.35%, expectoration 73.82%, dyspnea 53.82%, hemoptysis 23.53%, fever 9.41%, chest pain 2.35%.4, history and complication: chronic obstructive pulmonary disease (COPD) 31.76%, past old pulmonary tuberculosis 13.24%, rheumatoid arthritis 1.18%, numb, anesthesia Rash 0.88%, reflux esophagitis 0.59%, sinusitis 0.29%.4, sputum culture and antibiotic use: 153 cases of sputum culture examination, 39 cases of sputum culture positive, of which 71.79% were Gram-negative bacteria and 20.52% were fungi. The positive rate of Pseudomonas aeruginosa was 59.62%. antibiotic piperasine sulbactam use rate was 58.86%.5, Chinese medicine name: pre row ten position Nomenclature of lung collaterals (32.75%), hemoptysis (9.71%), lung cough (8.63%), asthma (6.48%), pulmonary fever (4.73%), pulmonary accumulation (2.12%), lung carbuncle (1.53%), suspension (1.19%), tuberculosis (0.88%).6, TCM syndrome type and disease analysis: phlegm heat accumulation (56.48%), phlegm obstructing lung (7.66%), thermal asthma (4.42%), phlegm heat accumulation, Qi deficiency and blood stasis (4.13%), lung kidney deficiency deficiency (4.13%) lung spleen two deficiency (2.07%), phlegm heat accumulation (2.07%), hot wound blood collaterals (2.07%), phlegm and blood stasis (1.47%), lung and spleen qi deficiency (1.18%), wind and spleen qi deficiency (1.18%), lung and spleen qi (1.18%). 272 cases, 36 cases of deficiency syndrome, 32.8 of false and solid inclusions, Chinese medicine prescription: 340 cases of patients taking Chinese medicine prescription, use frequency as mulberry white soup (37.39%), Qin Lian Wendan soup (7.42%), 5.93%, two Chen Tang (5.04%), fixed Asthma Decoction (4.75%), Wendan Decoction (4.75%), Jinshui six Jun Decoction (4.15%), Qianjin reed stem soup (2.37%), two Chen Decoction (2.37%), three Zi Yang Shu Tang (2.37%), Shen Ling Baizhu powder (2.08%). Conclusion: 1, in this study, more men were enlarged than women, and the elderly patients were mainly.2, and the bronchitis was extended in spring summer and autumn. The incidence of the three season is.3. With the extensive use of antibiotics, the symptoms of the patients with bronchiectasis are atypical.4, c0pd is the most common complication of the bronchiectasis, the two affects each other and aggravates the disease damage. The patients with previous tuberculosis, malignant tumor, rheumatoid arthritis, measles, reflux esophagitis, sinusitis and other related factors of susceptibility to the enlarging of the disease The positive rate of the sputum culture is low, the positive rate of the sputum culture is low, and the positive rate of the specimen culture is mainly Gram-negative bacteria. Among them, the positive rate of Pseudomonas aeruginosa is the highest. Before the drug sensitivity results, the effective broad-spectrum antibiotics for Gram-negative bacteria (especially Pseudomonas aeruginosa) can be empirically selected. Fungal infection has increased year by year to become an acute phase of bronchiectasis. The disease name and syndrome type diagnosis of Chinese medicine,.6, lacks unified standard. In this study, the most common patients in Luzhou area were sputum heat accumulation, and most of them were positive, stagnant and deficiency syndrome in the elderly patients. The frequency of clearing heat and phlegm was the most frequently used in Chinese Medicine prescription, and mulberry white peel soup could be used as the phlegm heat accumulation of lung type bronchiectasis. The test is used.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R259
本文編號：2153188
[Abstract]:Objective: to provide evidence-based evidence for the prevention and treatment of bronchiectasis in Luzhou by reviewing the clinical features of the patients with bronchiectasis in Luzhou, and providing ideas for the formulation and optimization of the clinical pathway. The medical hospital electronic medical record system inquires, retrieves the Luzhou local patients who were hospitalized in the respiratory medicine department of our hospital from October 2014 to October 2016. The patients were diagnosed as the local patients with bronchiectasis. The age, sex, onset of throttle, course of disease, past history and combined disease, bed symptoms, lung function, sputum culture, antibiotic use, Chinese medicine name were retrospectively analyzed. The clinical data of the pattern of syndrome and the distribution of the disease and the use of the first prescription of traditional Chinese medicine. The data processing was analyzed by SPSS17.0 statistics software, in which the qualitative data were described by the constituent ratio (%), the chi square test and the exact probability of Fisher were used to test it; the quantitative data were described by SX? The 22 comparison used the SNK method. The difference was statistically significant with P0.05. Results: 1, general situation: 340 cases of bronchiectasis were male 176, female 164, male and female ratio: 1.07:1, 60 years old (aged) 74.12%, average age of 65.45 + 12.98 (year), average course 18.75 + 13.16 (year), average hospitalization days: 10.34 + 5.53 (day).2, seasonal distribution Rule: 89 cases in spring group, 89 in summer group, 86 in autumn group and 76 in winter group.3, the main symptoms are: cough 87.35%, expectoration 73.82%, dyspnea 53.82%, hemoptysis 23.53%, fever 9.41%, chest pain 2.35%.4, history and complication: chronic obstructive pulmonary disease (COPD) 31.76%, past old pulmonary tuberculosis 13.24%, rheumatoid arthritis 1.18%, numb, anesthesia Rash 0.88%, reflux esophagitis 0.59%, sinusitis 0.29%.4, sputum culture and antibiotic use: 153 cases of sputum culture examination, 39 cases of sputum culture positive, of which 71.79% were Gram-negative bacteria and 20.52% were fungi. The positive rate of Pseudomonas aeruginosa was 59.62%. antibiotic piperasine sulbactam use rate was 58.86%.5, Chinese medicine name: pre row ten position Nomenclature of lung collaterals (32.75%), hemoptysis (9.71%), lung cough (8.63%), asthma (6.48%), pulmonary fever (4.73%), pulmonary accumulation (2.12%), lung carbuncle (1.53%), suspension (1.19%), tuberculosis (0.88%).6, TCM syndrome type and disease analysis: phlegm heat accumulation (56.48%), phlegm obstructing lung (7.66%), thermal asthma (4.42%), phlegm heat accumulation, Qi deficiency and blood stasis (4.13%), lung kidney deficiency deficiency (4.13%) lung spleen two deficiency (2.07%), phlegm heat accumulation (2.07%), hot wound blood collaterals (2.07%), phlegm and blood stasis (1.47%), lung and spleen qi deficiency (1.18%), wind and spleen qi deficiency (1.18%), lung and spleen qi (1.18%). 272 cases, 36 cases of deficiency syndrome, 32.8 of false and solid inclusions, Chinese medicine prescription: 340 cases of patients taking Chinese medicine prescription, use frequency as mulberry white soup (37.39%), Qin Lian Wendan soup (7.42%), 5.93%, two Chen Tang (5.04%), fixed Asthma Decoction (4.75%), Wendan Decoction (4.75%), Jinshui six Jun Decoction (4.15%), Qianjin reed stem soup (2.37%), two Chen Decoction (2.37%), three Zi Yang Shu Tang (2.37%), Shen Ling Baizhu powder (2.08%). Conclusion: 1, in this study, more men were enlarged than women, and the elderly patients were mainly.2, and the bronchitis was extended in spring summer and autumn. The incidence of the three season is.3. With the extensive use of antibiotics, the symptoms of the patients with bronchiectasis are atypical.4, c0pd is the most common complication of the bronchiectasis, the two affects each other and aggravates the disease damage. The patients with previous tuberculosis, malignant tumor, rheumatoid arthritis, measles, reflux esophagitis, sinusitis and other related factors of susceptibility to the enlarging of the disease The positive rate of the sputum culture is low, the positive rate of the sputum culture is low, and the positive rate of the specimen culture is mainly Gram-negative bacteria. Among them, the positive rate of Pseudomonas aeruginosa is the highest. Before the drug sensitivity results, the effective broad-spectrum antibiotics for Gram-negative bacteria (especially Pseudomonas aeruginosa) can be empirically selected. Fungal infection has increased year by year to become an acute phase of bronchiectasis. The disease name and syndrome type diagnosis of Chinese medicine,.6, lacks unified standard. In this study, the most common patients in Luzhou area were sputum heat accumulation, and most of them were positive, stagnant and deficiency syndrome in the elderly patients. The frequency of clearing heat and phlegm was the most frequently used in Chinese Medicine prescription, and mulberry white peel soup could be used as the phlegm heat accumulation of lung type bronchiectasis. The test is used.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R259
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 石明;唐友勇;楊中衛(wèi);李威;王正艷;袁美春;;布地奈德福莫特羅對支氣管擴(kuò)張癥合并支氣管哮喘患者肺功能及生活質(zhì)量的影響[J];中國醫(yī)藥;2015年11期
2 龔敏燕;;桑白皮湯加減結(jié)合西藥治療熱痰蘊(yùn)肺型慢性肺源性心臟病臨床觀察[J];四川中醫(yī);2015年07期
3 亓倩;汪雯;李陶;李玉;;成人支氣管擴(kuò)張癥的臨床特點(diǎn)[J];山東大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2015年07期
4 李虹英;;桑白皮湯治療痰熱郁肺型慢性阻塞性肺疾病急性加重期臨床研究[J];亞太傳統(tǒng)醫(yī)藥;2015年12期
5 林俊雄;;垂體后葉素山莨菪堿聯(lián)合治療咯血的療效觀察[J];河北醫(yī)學(xué);2014年04期
6 桂吟哲;林琳;;從“動血之由,惟火惟氣”探討林琳教授治療支氣管擴(kuò)張經(jīng)驗(yàn)[J];時珍國醫(yī)國藥;2014年04期
7 羅慧;張立山;武維屏;;武維屏教授治療支氣管擴(kuò)張經(jīng)驗(yàn)[J];中華中醫(yī)藥雜志;2014年03期
8 呂華亮;譚世繁;;霧化吸入蛇毒血凝酶治療支氣管擴(kuò)張并咯血效果觀察[J];當(dāng)代醫(yī)學(xué);2014年04期
9 陳偉鵬;;噻托溴銨粉吸入劑治療支氣管擴(kuò)張癥的療效觀察[J];中國醫(yī)藥指南;2013年34期
10 邵娜;蔡琦玲;;咯血的非止血藥物治療進(jìn)展[J];內(nèi)蒙古中醫(yī)藥;2013年32期
相關(guān)碩士學(xué)位論文 前2條
1 黃國富;桑白皮湯加減治療成人社區(qū)獲得性肺炎痰熱壅肺證患者的臨床觀察[D];福建中醫(yī)藥大學(xué);2015年
2 藺雪;支氣管擴(kuò)張癥穩(wěn)定期下呼吸道細(xì)菌定植的研究[D];石河子大學(xué);2014年
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