小儿社区获得性肺炎中医证型分布和临床研究

发布时间：2018-05-24 08:21

本文选题：肺炎 + 中医证型　；参考：《大连医科大学》2016年硕士论文

【摘要】：目的:从中西医结合角度探讨小儿社区获得性肺炎中医证分布特点、临床表现,及不同中医证型的病原学、肺功能特点及其相关性;比较不同载体下中药帖敷外治的临床疗效。方法:采用随机抽样的方法,选择2014年04月至2014年9月期间于大连市儿童医院住院,符合社区获得性肺炎纳入标准的120例患儿,通过定时采集患儿的舌象、咳嗽、咯痰、肺部Up音等临床指标观察并分析其中医症候,进行病原学检查和肺功能监测。并从120例患儿中随机抽取80例分为两组,每组40例,在西医常规治疗基础上分别给背部帖敷治疗,观察临床症状并记录肺部体征。结果:1.在符合纳入标准的120例患儿中,风热闭肺证者35例,占29.2%,痰热闭肺证者80例,占66.7%,毒热闭肺证者5例,占4.1%。病原阳性者46例(53例次),占38.3%。在53例次病原阳性者中,肺炎支原体感染者29例次,占54.7%;病毒感染者13例次,占24.5%;细菌感染者11例次,占21.3%。69例患儿完成肺功能检查,阻塞性肺通气功能障碍者30例,占43.5%;限制性肺通气功能障碍者4例,占5.8%;混合性肺通气功能障碍者26例,占37.7%;肺功能正常者9例,占13.0%。2.在35例风热闭肺证患儿中,支原体感染者6例次,占16.7%;病毒感染者3例次,占2.8%;细菌性肺炎者3例,占2.8%,病原阴性者24例次,占66.7%;在80例痰热闭肺证患儿中,支原体肺炎感染者22例次,占26.2%;病毒性感染者10例,占12.2%;细菌性感染者8例,9.6%,病原阴性者44例,占52.5%。在5例毒热闭肺证患儿中,肺炎支原体感染者1例次,占20.0%;病原阴性者4例次,占80.0%。3.在35例风热闭肺证患儿中,完成肺功能检测者共19例,占54.3%;其中阻塞性通气障碍者7例,占36.8%;限制性肺通气功能障碍者2例,占10.5%;混合性肺通气功能障碍者8例,占42.2%;肺功能正常者2例,占10.5%。在80例痰热闭肺证患儿中,完成肺功能检测者共48例,占60.0%;其中阻塞性通气障碍者22例,占45.8%;限制性肺通气功能障碍者2例,占4.2%;混合性肺通气功能障碍者17例,占35.4%;肺功能正常者7例,占14.6%。在5例毒热闭肺证患儿中,完成肺功能检测者共2例,占40.0%;其中阻塞性肺通气功能障碍者1例,占50.0%;混合性肺通气功能障碍者1例,占50.0%。4.在29例次支原体感染患儿中,风热闭肺证者6例,占20.7%;痰热闭肺证者22例,占75.7%;毒热闭肺证者1例,占3.6%。在13例次病毒感染者中,风热闭肺证者3例,占23.1%;痰热闭肺证者10例,占76.9%。在11例次细菌性感染者中,风热闭肺证者3例,占27.3%;痰热闭肺证者8例,占72.7%。5.在29例次支原体感染患儿中,完成肺功能检测者共23例,其中阻塞性通气障碍者8例,占34.8%;限制性肺通气功能障碍者3例,占13.0%;混合性肺通气功能障碍者7例,占30.4%;肺功能正常者5例,占21.8%。在13例次病毒感染者中,完成肺功能者7例,占50%;其中阻塞性通气障碍者2例,占28.6%;混合性肺通气功能障碍者2例,占28.6%;肺功能正常者3例,占42.8%。在11例次细菌性感染者中,完成肺功能检测者共10例;其中阻塞性肺通气功能障碍者3例,占30%;混合性肺通气功能障碍者5例,占50%;肺功能正常者2例,占20%。6.在符合纳入标准的80例社区获得性肺炎患儿中,敷胸巴布贴组和敷胸散组患儿的临床症状、肺部体征的消失时间及中医疗效相比,p0.005,差异不显著,无统计学差异。结论:1.儿童社区获得性肺炎的中医证型分布以痰热闭肺证为主,病原学分布以支原体感染为主,肺功能分布以阻塞性通气功能障碍为主。2.风热闭肺证、痰热闭肺证、毒热闭肺证患儿的病原学均以支原体感染为主。3.风热闭肺证、痰热闭肺证患儿的肺功能均以阻塞性通气功能障碍为主。4.支原体感染、病毒感染、细菌感染患儿均以痰热闭肺证为主。5.支原体感染患儿的肺功能以阻塞性通气功能障碍为主;病毒感染患儿的肺功能以正常肺功能为主;细菌感染的肺功能以混合型通气功能障碍为主。6.敷胸巴布贴可以有效治疗小儿肺炎,促进肺部Up音吸收,与敷胸散疗效相同。
[Abstract]:Objective: To explore the characteristics of TCM syndrome distribution, clinical manifestation, pathogeny of different TCM syndromes, characteristics of lung function and its correlation, and compare the clinical efficacy of traditional Chinese medicine under different carriers. Methods: a random sampling method was used to choose the period from 04 months to September 2014 2014. 120 children who were hospitalized in city children's Hospital conformed to the standard of community-acquired pneumonia in 120 children, observe and analyze the symptoms of the tongue, cough, phlegm, lung Up sound and other clinical indexes, analyze the TCM syndrome, carry out the etiology examination and lung function monitoring, and divide the 80 cases into two groups randomly, 40 cases in each group, in the western medicine. On the basis of conventional therapy, the clinical symptoms were observed and the pulmonary signs were recorded. Results: 1. of the 120 cases with the inclusion criteria, 35 cases of wind heat closed lung syndrome, 80 cases of phlegm heat closed lung syndrome, 66.7% and 5 cases of toxic heat closed lung syndrome, 46 cases (53 cases) of 4.1%. disease, and 53 cases of 38.3%. positive. Among them, 29 cases of Mycoplasma pneumoniae infection accounted for 54.7%, 13 cases of virus infection, accounting for 24.5%, 11 cases of bacterial infection, 30 cases of obstructive pulmonary ventilation dysfunction in 21.3%.69 cases, 43.5% of obstructive pulmonary ventilation dysfunction, 4 cases with restrictive pulmonary ventilation dysfunction, 26 cases of mixed pulmonary ventilation dysfunction, 37.7%, pulmonary function. Among the 9 cases of normal patients, 6 cases of mycoplasma infection, accounting for 16.7%, 3 cases of virus infection, 2.8%, 3 cases of bacterial pneumonia, 2.8%, 24 cases of pathogenic bacteria, accounting for 66.7%, 6 cases of Mycoplasma pneumonitis and 66.7% cases of Mycoplasma pneumonitis, accounted for 26.2% in 80 cases of Mycoplasma pneumoniae infection. 8 cases of bacterial infection, 9.6% and 44 cases of pathogenic negative, accounted for 1 cases of Mycoplasma pneumoniae infection in 5 cases of 52.5%., 20% of Mycoplasma pneumoniae infection, 4 cases of pathogenic negative, accounting for 35 cases of wind and heat closed lung syndrome, including 19 cases of pulmonary function testing, accounting for 54.3%, 7 cases of obstructive ventilatory disorder, accounting for 36.8%; restrictive pulmonary ventilation. There were 2 cases of dysfunction, accounting for 10.5%, 8 cases of mixed pulmonary ventilation dysfunction accounted for 42.2%, 2 cases of normal lung function, 2 cases of 10.5%. in 80 cases of phlegm closed lung syndrome, 48 cases completed lung function test, accounting for 60%, 22 cases of obstructive ventilatory disorder, 45.8%, 2, 4.2%, mixed pulmonary ventilation function, mixed pulmonary ventilation function. There were 17 cases of obstruction, accounting for 35.4%, 7 cases of normal lung function, accounting for 2 cases of 14.6%. in 5 cases of toxic heat closed lung syndrome, 1 cases of obstructive pulmonary ventilation dysfunction accounted for 50%, 1 cases of mixed pulmonary ventilation dysfunction, 29 cases of 50.0%.4. in children with mycoplasma infection, 6 cases of wind heat closed lung syndrome, accounting for 20.7%; There were 22 cases of phlegm heat closed lung syndrome, 1 cases of toxic heat closed lung syndrome, 3 cases of 3.6%. in 13 cases of sub virus infection, 3 cases of wind heat closed lung syndrome, 10 cases of phlegm heat closed lung syndrome, accounting for 11 cases of bacterial infection in 11 cases, 3 cases of wind heat closed lung syndrome, 27.3% and 8 cases of phlegm heat closed lung syndrome, which accounted for 72.7%.5. in 29 cases of mycoplasma infection in children. There were 23 cases of pulmonary function test, of which 8 cases were obstructive ventilatory disorder, accounting for 34.8%, 3 cases of restrictive pulmonary ventilation dysfunction, 7 cases of mixed pulmonary ventilation dysfunction, 30.4%, 5 cases with normal lung function, 7 cases of pulmonary function, 50% of 21.8%. in 13 cases of Hypovirus infection, 2 cases of obstructive ventilatory disorder, 2, 2. 8.6%, 2 cases of mixed pulmonary ventilation dysfunction accounted for 28.6%, 3 cases of normal lung function, accounting for 10 cases of 42.8%. in 11 cases of bacterial infection, 3 cases of obstructive pulmonary ventilation dysfunction accounted for 30%, 5 cases of mixed pulmonary ventilation dysfunction accounted for 50%, 2 cases of normal lung function, accounting for inclusion criteria. Of the 80 children with community acquired pneumonia, the clinical symptoms of the children with chest Babu patch group and the group of the compress group were compared with the traditional Chinese medicine, P0.005, the difference was not significant, there was no significant difference. Conclusion: the distribution of TCM syndrome type in 1. children's community acquired pneumonia is mainly phlegm heat closed lung syndrome, and the pathogenic distribution is Mycoplasma sensation. The main pulmonary function distribution is obstructive ventilation dysfunction mainly.2. wind heat closed lung syndrome, phlegm heat closed lung syndrome, toxic heat closed lung syndrome in children with mycoplasma infection mainly.3. wind heat closed lung syndrome, pulmonary function of phlegm heat closed lung syndrome children with obstructive ventilatory dysfunction mainly.4. mycoplasma infection, virus infection, and bacterial Infection Children The pulmonary function of children with Mycoplasma.5. infection mainly with phlegm heat closure is obstructive ventilation dysfunction, and the lung function of the virus infected children is mainly with normal lung function, and the pulmonary function of bacterial infection with mixed ventilation dysfunction based on.6. plaster Babu plaster can effectively treat children pneumonia, promote lung Up sound absorption, and apply chest compress. The curative effect was the same.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R272

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