重癥社區(qū)獲得性肺炎患者病原體與證候關(guān)系研究
發(fā)布時(shí)間：2018-11-25 19:45
【摘要】：目的:1.分析重癥社區(qū)獲得性肺炎患者臨床癥狀的證候分布特點(diǎn)及證候、病機(jī)演變特點(diǎn)。2.研究重癥社區(qū)獲得性肺炎病原體種類分布情況,探討不同病原體與證候、病機(jī)演變之間的關(guān)系。方法:采用前瞻性研究方法,根據(jù)納入與排除標(biāo)準(zhǔn)收錄2016年12月1日至2017年2月28日入住北京中醫(yī)藥大學(xué)附屬第一臨床醫(yī)學(xué)院ICU、中日友好醫(yī)院呼吸與重癥醫(yī)學(xué)科ICU、首都醫(yī)科大學(xué)附屬朝陽醫(yī)院呼吸與重癥醫(yī)學(xué)科ICU符合重癥社區(qū)獲得性肺炎中西醫(yī)診斷標(biāo)準(zhǔn)的患者。記錄入院一般情況、實(shí)驗(yàn)室檢查、主要臨床表現(xiàn)等內(nèi)容;將內(nèi)容填入調(diào)查表,建立原始數(shù)據(jù)庫,運(yùn)用SAS軟件進(jìn)行分析,歸納重癥社區(qū)獲得性肺炎患者的中醫(yī)證候;觀察不同種類病原體與證候的關(guān)系。結(jié)果:1.重癥社區(qū)獲得性肺炎證候演變規(guī)律:重癥社區(qū)獲得性肺炎入院證候以痰熱壅肺證、痰濕阻肺證、熱陷心包證為主。第7、14天證候以氣陰兩虛證、肺脾氣虛證為主。痰熱壅肺證主要轉(zhuǎn)變?yōu)闅怅巸商撟C,熱陷心包證易轉(zhuǎn)變?yōu)闊岫救霠I證而成危候,或轉(zhuǎn)變成痰熱壅肺證轉(zhuǎn)出氣分向愈。痰濕阻肺證易轉(zhuǎn)變成痰熱壅肺證和肺脾氣虛證。氣陰兩虛證可轉(zhuǎn)變成為肺脾氣虛證。2.重癥社區(qū)獲得性肺炎證候與病原體之間的關(guān)系:重癥社區(qū)獲得性肺炎以革蘭陰性菌為主。常見致病菌為銅綠假單胞菌、鮑曼不動(dòng)桿菌、肺炎克雷伯菌等。革蘭陽性菌以肺炎鏈球菌、金黃色葡萄球菌為主;病毒、真菌和非典型致病菌也可感染發(fā)病。細(xì)菌、真菌、病毒、支原體與各觀察點(diǎn)(入院第1天、第7天、第14天)SCAP證候分布之間存在相關(guān)性,革蘭陽性菌和革蘭陰性菌在各證候分布上未見明顯差異。結(jié)論:1.重癥社區(qū)獲得性肺炎入ICU以里熱證為主要表現(xiàn),以邪熱流連氣分為主,可出現(xiàn)熱毒入營血的危重證候。熱邪留戀氣分耗氣傷津而見氣陰兩虛的表現(xiàn)�？梢娭匕Y社區(qū)獲得性肺炎核心病機(jī)符合風(fēng)熱毒邪乘體虛侵襲,肺衛(wèi)受襲,宣降失常,肺衛(wèi)熱邪不解,則痰熱瘀毒阻肺,傷氣傷陰,甚至內(nèi)陷營血,熱陷心包,進(jìn)一步陰竭陽脫而成死證。及早應(yīng)用中藥可防止病證進(jìn)一步進(jìn)展。2.細(xì)菌感染更易出現(xiàn)痰熱壅肺氣分證,真菌感染易出現(xiàn)痰熱壅肺證和痰濕阻肺證,而病毒感染傳變較快,易引起熱陷心包、熱毒入營血分的更危重證候。把握好氣分關(guān)是預(yù)防危重癥發(fā)生和降低死亡率的關(guān)鍵。
[Abstract]:Objective: 1. To analyze the characteristics of syndromes distribution and pathogenesis of severe community-acquired pneumonia. 2. To study the distribution of pathogens in severe community acquired pneumonia, and to explore the relationship between different pathogens, syndromes and pathogenesis. Methods: according to the criteria of inclusion and exclusion, ICU, was admitted to ICU, the first Clinical College affiliated to Beijing University of traditional Chinese Medicine, from December 1, 2016 to February 28, 2017, according to the criteria of inclusion and exclusion. ICU of Department of Respiratory and intensive Medicine of Chaoyang Hospital affiliated to Capital Medical University meets the diagnostic criteria of TCM and Western medicine for severe community-acquired pneumonia. The general condition of admission, laboratory examination and main clinical manifestations were recorded, the contents were filled in the questionnaire, the original database was established, and the SAS software was used to analyze the TCM syndromes of the patients with severe community-acquired pneumonia. To observe the relationship between different pathogens and syndromes. Results: 1. The syndromes of severe community-acquired pneumonia were characterized by phlegm-heat blockage, phlegm-dampness obstruction and pericardial heat. The 7 th day 14 th syndrome to qi-yin two-deficiency syndrome, lung-qi-deficiency syndrome. The syndrome of phlegm and heat obstructing the lung mainly changed into deficiency of qi and yin, and the syndrome of pericardium of heat trapping easily changed into heat toxin into camp syndrome and became dangerous, or turned into phlegm and heat stagnation of lung syndrome to turn out qi to recover. Phlegm dampness blocking lung syndrome is easy to change into phlegm heat obstruction lung syndrome and lung spleen qi deficiency syndrome. Qi and Yin deficiency syndrome can be transformed into lung and spleen qi deficiency syndrome. 2. The relationship between the syndromes and pathogens of severe community acquired pneumonia: Gram-negative bacteria were the main cause of severe community acquired pneumonia. Common pathogens are Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae and so on. Gram-positive bacteria are mainly Streptococcus pneumoniae and Staphylococcus aureus. Viruses, fungi and atypical pathogens can also be infected. There was a correlation between bacteria, fungi, virus, mycoplasma and the distribution of SCAP syndromes at the observation sites (1st, 7th, 14th day). There was no significant difference between Gram-positive bacteria and Gram-negative bacteria in the distribution of the syndromes. Conclusion: 1. The main manifestations of severe community-acquired pneumonia in ICU were heat syndrome, heat flow combined with qi, and serious syndrome of heat toxin entering camp blood. Heat evil nostalgia Qi points out qi injury and see Qi Yin deficiency performance. It can be seen that the core pathogenesis of severe community-acquired pneumonia is in accordance with the invasion of wind-heat toxin evil and deficiency of body, the attack on lung and Wei, the disorder of propaganda and lowering, the confusion of lung and heat evil, the phlegm and heat stasis toxin obstructing the lung, the injury of qi and the injury of yin, and even the depression of blood and heat in the pericardium. Further Yin exhausted Yang to become a death syndrome. Early application of traditional Chinese medicine can prevent further progress of disease and syndrome. 2. Bacterial infection is more likely to appear phlegm and heat obstruction of lung qi syndrome, fungal infection is prone to phlegm heat blockage lung syndrome and phlegm dampness block lung syndrome, while virus infection becomes faster, easily cause heat into the pericardium, heat into the blood of the more serious syndrome. It is the key to prevent the occurrence of critical illness and reduce the mortality.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R259
本文編號(hào)：2357194
[Abstract]:Objective: 1. To analyze the characteristics of syndromes distribution and pathogenesis of severe community-acquired pneumonia. 2. To study the distribution of pathogens in severe community acquired pneumonia, and to explore the relationship between different pathogens, syndromes and pathogenesis. Methods: according to the criteria of inclusion and exclusion, ICU, was admitted to ICU, the first Clinical College affiliated to Beijing University of traditional Chinese Medicine, from December 1, 2016 to February 28, 2017, according to the criteria of inclusion and exclusion. ICU of Department of Respiratory and intensive Medicine of Chaoyang Hospital affiliated to Capital Medical University meets the diagnostic criteria of TCM and Western medicine for severe community-acquired pneumonia. The general condition of admission, laboratory examination and main clinical manifestations were recorded, the contents were filled in the questionnaire, the original database was established, and the SAS software was used to analyze the TCM syndromes of the patients with severe community-acquired pneumonia. To observe the relationship between different pathogens and syndromes. Results: 1. The syndromes of severe community-acquired pneumonia were characterized by phlegm-heat blockage, phlegm-dampness obstruction and pericardial heat. The 7 th day 14 th syndrome to qi-yin two-deficiency syndrome, lung-qi-deficiency syndrome. The syndrome of phlegm and heat obstructing the lung mainly changed into deficiency of qi and yin, and the syndrome of pericardium of heat trapping easily changed into heat toxin into camp syndrome and became dangerous, or turned into phlegm and heat stagnation of lung syndrome to turn out qi to recover. Phlegm dampness blocking lung syndrome is easy to change into phlegm heat obstruction lung syndrome and lung spleen qi deficiency syndrome. Qi and Yin deficiency syndrome can be transformed into lung and spleen qi deficiency syndrome. 2. The relationship between the syndromes and pathogens of severe community acquired pneumonia: Gram-negative bacteria were the main cause of severe community acquired pneumonia. Common pathogens are Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae and so on. Gram-positive bacteria are mainly Streptococcus pneumoniae and Staphylococcus aureus. Viruses, fungi and atypical pathogens can also be infected. There was a correlation between bacteria, fungi, virus, mycoplasma and the distribution of SCAP syndromes at the observation sites (1st, 7th, 14th day). There was no significant difference between Gram-positive bacteria and Gram-negative bacteria in the distribution of the syndromes. Conclusion: 1. The main manifestations of severe community-acquired pneumonia in ICU were heat syndrome, heat flow combined with qi, and serious syndrome of heat toxin entering camp blood. Heat evil nostalgia Qi points out qi injury and see Qi Yin deficiency performance. It can be seen that the core pathogenesis of severe community-acquired pneumonia is in accordance with the invasion of wind-heat toxin evil and deficiency of body, the attack on lung and Wei, the disorder of propaganda and lowering, the confusion of lung and heat evil, the phlegm and heat stasis toxin obstructing the lung, the injury of qi and the injury of yin, and even the depression of blood and heat in the pericardium. Further Yin exhausted Yang to become a death syndrome. Early application of traditional Chinese medicine can prevent further progress of disease and syndrome. 2. Bacterial infection is more likely to appear phlegm and heat obstruction of lung qi syndrome, fungal infection is prone to phlegm heat blockage lung syndrome and phlegm dampness block lung syndrome, while virus infection becomes faster, easily cause heat into the pericardium, heat into the blood of the more serious syndrome. It is the key to prevent the occurrence of critical illness and reduce the mortality.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R259
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