急诊重症社区获得性肺炎中医证候学特点与预后临床研究  

TCM Syndrome Characteristics and Prognosis of Severe Community-Acquired Pneumonia in the Emergency Department

作　　者：王鑫菊 徐红日 郝丹丹 张路遥 李雅莉 杨丽娟 WANG Xin-ju;XU Hong-ri;HAO Dan-dan;ZHANG Lu-yao;LI Ya-li;YANG Li-juan(Graduate School of Beijing University of Chinese Medicine,Beijing 100029;Department of Emergency,The Third Af-filiated Hospital of Beijing University of Chinese Medicine,Beijing 100029;Emergency Department,Huairou District Hospital of Traditional Chinese Medicine,Beijing 101400)

机构地区：[1]北京中医药大学研究生院,北京100029 [2]北京中医药大学第三附属医院急诊科,北京100029 [3]北京市怀柔区中医医院急诊科,北京101400

出　　处：《世界中西医结合杂志》2024年第11期2222-2227,共6页World Journal of Integrated Traditional and Western Medicine

基　　金：国家中医药管理局中医药创新团队及人才支持计划项目(ZYYCXTD-D-202208)。

摘　　要：目的探讨急诊科留观重症社区获得性肺炎(Severe community-acquired pneumonia,SCAP)中医证候学特点与预后。方法采用回顾性研究的方法,选取2018年8月1日—2022年12月31日期间北京中医药大学第三附属医院急诊科留观收治入院的社区获得性肺炎(Community-acquired pneumonia,CAP)患者278例,分析探讨其中医证候和证型特点与预后。结果共纳入278例,其中男146例,女132例,平均年龄(83.18±8.86)岁。97.48%的患者合并基础疾病,高血压病是最常见的基础疾病。SCAP患者较非重症社区获得性肺炎(Non-severe community-acquired pneumonia,NSCAP)患者更易出现发热、意识障碍、心率及呼吸频率加快、肺部闻及湿啰音和痰鸣音、多肺叶受累、合并胸腔积液,白细胞计数(White blood cell count,WBC)、中性粒细胞比例(Neutrophil,NEUT%)、C-反应蛋白(C-reactive protein,CRP)和尿素氮(Blood urea nitrogen,BUN)更高,白蛋白(Albumin,ALB)水平更低。中医方面,SCAP患者气促、形体消瘦、痰多、咯黄痰、神昏、细脉、数脉的出现比例高于NSCAP患者,大便干结的出现比例则低于NSCAP患者。SCAP患者常见的中医证型为痰热壅肺证和痰浊阻肺证,比NSCAP患者更易出现热陷心包证,预后更差。结论急诊留观SCAP患者以合并基础疾病的老年人多见,证候以咳嗽、咳痰、痰多为主,常见的中医证型为痰热壅肺证和痰浊阻肺证,SCAP患者更易出现神昏、气促等热闭心包证的表现,病死率更高。Objective To investigate the traditional Chinese medicine(TCM)syndromic characteristics and prognosis of patients with severe community-acquired pneumonia(SCAP)under observation in the emergency department.Methods A retrospective study was conducted on 278 patients with community-acquired pneumonia(CAP)admitted to the emergency department of the Third Affiliated Hospital of Beijing University of Chinese Medicine between August 1,2018,and December 31,2022.The TCM syndrome and pattern characteristics and prognosis of these patients were analyzed.Results A total of 278 cases were included,comprising 146 males and 132 females,with an average age of 83.18±8.86 years.Among them,97.48%had underlying diseases,with hypertension being the most common.SCAP patients,compared to those with non-severe community-acquired pneumonia(NSCAP),exhibited a higher frequency of fever,altered consciousness,increased heart rate and respiratory rate,pulmonary moist rales and rhonchi,multi-lobar involvement,pleural effusion,elevated white blood cell count(WBC),neutrophil percentage(NEUT%),C-reactive protein(CRP),and blood urea nitrogen(BUN),along with lower albumin(ALB)levels.In terms of TCM,SCAP patients were more likely to present with symptoms such as shortness of breath,emaciation,excessive sputum,yellow sputum,clouded consciousness,thready and rapid pulses,while the frequency of dry stools was lower than NSCAP patients.The most common TCM syndromes in SCAP patients were phlegm-heat obstructing the lungs and phlegm-turbidity obstructing the lungs.SCAP patients were also more prone to heat entering the pericardium syndrome,associated with poorer prognosis.Conclusion SCAP patients under emergency observation are predominantly elderly individuals with underlying diseases.Their syndromic manifestations are characterized by coughing,expectoration,and excessive phlegm,with common TCM syndromes being phlegm-heat obstructing the lungs and phlegm-turbidity obstructing the lungs.SCAP patients are more likely to develop symptoms indicative of hea

关 键 词：急诊科 重症社区获得性肺炎 证候 中医证型 预后 炎症因子 

分 类 号：R563.1[医药卫生—呼吸系统]