不同中医证型重症肺炎耐药菌分布与变化情况分析  

Distribution and Change of Drug-resistant Bacteria in Severe Pneumonia with Different TCM Syn⁃dromes

作　　者：华胜毅 袁思成 周运航 芮庆林[1] Hua Shengyi;Yuan Sicheng;Zhou Yunhang;Rui Qinglin(The Affiliated Hospital of Nanjing University of TCM,Jiangsu,Nanjing 210029,China)

机构地区：[1]南京中医药大学附属医院,江苏南京210029

出　　处：《中国中医急症》2022年第8期1152-1155,共4页Journal of Emergency in Traditional Chinese Medicine

基　　金：江苏省中医药局科技项目(YB201813)。

摘　　要：目的探讨重症肺炎耐药菌与耐药程度与中医证型的相关性,同时观察辨证论治对耐药程度的影响并探讨其作用机制。方法研究采取回顾性研究的方法,收集符合标准的2016年6月至2021年12月间江苏省中医院急诊中心收治的确诊重症肺炎病例资料,分析中医证型与入院首次痰培养及药敏结果的关系。同时经过10 d辨证论治后,探究中医证型与耐药程度变化的关系。结果共纳入研究病例317例,共发现411株致病性耐药菌,革兰氏阴性菌为主,占比77.86%,其中又以鲍曼不动杆菌、铜绿假单胞菌为主。其中,中医证型以痰热壅肺与肺热腑实为主,比较发现虚证中的热陷心包、邪陷正脱革兰氏阴性菌比例更高(P<0.05),同时虚证中出现泛耐药与全耐药的比例也高于实证证型(P<0.05),治疗10 d后也发现实证证型耐药好转率高于虚证(P<0.05)。结论革兰氏阴性菌是重症肺炎的主要致病菌。虚证证型出现革兰氏阴性菌比例与耐药严重程度均高于实证证型,而实证证型耐药程度较虚证更易治疗与改善。Objective:To summarize the correlation between drug-resistant bacteria and the degree of drug re⁃sistance and TCM syndrome types in severe pneumonia,and to explore the influence of syndrome differentiation on the degree of drug resistance and its mechanism of action.Methods:A retrospective study was conducted to col⁃lect the data of confirmed severe pneumonia cases who met the inclusion criteria and were admitted to the Emer⁃gency Center of Jiangsu Hospital of Traditional Chinese Medicine from June 2016 to December 2021.The relation⁃ship between TCM syndrome types and the results of first sputum culture and drug sensitivity was analyzed.At the same time,after 10 days of syndrome differentiation and treatment,the relationship between TCM syndrome types and the change of drug resistance degree was explored.Results:A total of 317 cases were included in the study,and a total of 411 strains of pathogenic drug-resistant bacteria were found,which were mainly gram-negative bac⁃teria,accounting for 77.86%,and acinetobacter baumannii and Pseudomonas aeruginosa were the most common.Among them,the main TCM syndrome types were the syndrome of phlegm-heat obstructing lung and the syndrome of lung heat and fu-viscera excess.By comparison,it was found that the syndrome of heat invading pericardium and the syndrome of interior invasion of pathogen and vital qi collapse had higher proportion of positive gram-neg⁃ative bacteria(P<0.05).At the same time,the deficiency syndromes had higher proportion of extensive-drug resis⁃tance and pan-drug resistance than the excess syndromes(P<0.05).After 10 d of treatment,it was also found that the improvement rate of drug resistance in excess syndromes was higher than that in the deficiency syndromes(P<0.05).Conclusion:Gram-negative bacteria are the main pathogenic bacteria of severe pneumonia.The pro⁃portion of gram-negative bacteria and the severity of drug resistance in deficiency syndromes are higher than those in excess syndromes,and the drug resistance in excess syndrome i

关 键 词：重症肺炎 耐药菌 中医证型 痰热壅肺证 热闭心包证 革兰阴性菌 

分 类 号：R563.1[医药卫生—呼吸系统]