泸州地区支气管扩张症住院患者临床特征分析
发布时间：2018-07-29 15:56
【摘要】：目的:本研究通过回顾性总结泸州地区支气管扩张症(以下简称支扩)住院患者的临床特征,为支扩的防治提供循证学依据,同时为制定及优化临床路径提供思路。方法:用EXCEL制定信息采集表,采用回顾性研究法,利用西南医科大学附属中医医院电子病历系统查询,检索出2014年10月至2016年10月期间在本院呼吸内科住院,出院诊断为支扩的泸州本地患者,回顾性分析入选患者的年龄、性别、发病节气、病程、既往史及合并疾病、临床症状、肺功能、痰培养、抗生素使用、中医病名、证型和病性分布规律及首剂中药方剂使用等临床资料。数据处理采用SPSS17.0统计学软件进行分析,其中定性资料用构成比(%)进行描述,用卡方检验、Fisher确切概率法进行检验;定量资料采用SX?进行统计描述,用方差分析进行检验,多组间的两两比较采用SNK法。以P0.05为差异有统计学意义。结果:1、一般情况:340例支扩患者中男性176例,女性164例,男女比例:1.07:1,≥60岁(老年)患者74.12%,平均年龄:65.45±12.98(岁),平均病程18.75±13.16(年),平均住院天数:10.34±5.53(天)。2、四季发病分布规律:春季组89例,夏季组89例,秋季组86例,冬季组76例。3、主要症状:咳嗽87.35%,咳痰73.82%,呼吸困难53.82%,咯血23.53%,发热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%,既往有陈旧性肺结核13.24%、类风湿性关节炎1.18%、麻疹0.88%、反流性食管炎0.59%、鼻窦炎0.29%。4、痰培养及抗生素使用:153例患者行痰培养检查,39例痰培养阳性,其中71.79%为革兰阴性菌,20.52%为真菌。细菌中铜绿假单胞菌阳性率为59.62%。抗生素哌拉西林舒巴坦使用率为58.86%。5、中医病名:排前十位的命名为:肺络张(32.75%),肺胀(30.51%),咯血(9.71%),肺咳(8.63%),哮病(6.48%),(风温)肺热病(4.73%),肺积(2.12%),肺痈(1.53%),悬饮(1.19%),肺痨(0.88%)。6、中医证型及病性分析:痰热蕴肺(56.48%),痰浊阻肺(7.66%),热哮(4.42%),痰热蕴肺、气虚血瘀(4.13%),肺肾亏虚(4.13%),肺脾两虚(2.07%),痰热蕴肺、热伤血络(2.07%),热伤血络(2.07%),痰瘀阻肺(1.47%),肺脾气虚(1.18%),风热犯肺(1.18%)。实证者272例,虚证者36例,虚实夹杂者32例。8、中药方剂:340例患者中共有337例患者服用中药方剂,使用频次为:桑白皮汤(37.39%),芩连温胆汤(7.42%),清金化痰汤(5.93%),二陈汤(5.04%),定喘汤(4.75%),温胆汤(4.75%),金水六君煎(4.15%),千金苇茎汤(2.37%),二陈汤合三子养亲汤(2.37%),参苓白术散(2.08%)。结论:1、本研究中支扩患者男性多于女性,且以老年患者为主。2、支扩以春夏秋三季发病居多。3、随着抗菌药物的广泛使用,支扩患者的症状表现不典型。4、c0pd是支扩最常见合并疾病,二者相互影响,加重疾病损害。既往患有肺结核、恶性肿瘤、类风湿性关节炎、麻疹、反流性食管炎、鼻窦炎等相关易感因素的支扩患者,要注重病因排查。5、痰培养阳性率低,标本培养阳性者以革兰阴性菌为主,其中又以铜绿假单胞菌阳性率最高,在没有药敏结果前,可经验性选择对革兰阴性菌(特别是铜绿假单胞菌)有效的广谱抗生素。真菌感染逐年上升,成为支扩急性期致病菌之一。6、中医病名及证型诊断缺乏统一标准,本研究中泸州地区支扩住院患者以痰热蕴肺最多见,并以实证居多,瘀证、虚症多见于老年患者。在中药方剂上以清热化痰类方药使用频次最多,其中桑白皮汤可作为痰热蕴肺型支扩的经验方运用。
[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.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259
本文编号：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.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259
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