急诊社区获得性肺炎病原学及中医证候研究  

Study on Etiological Characteristics and TCM Syndrome Correlation of Community Acquired Pneumonia in Emergency Department

作　　者：李雅莉 郝丹丹 徐红日 马冬梅 马洪皓 Li Yali;Hao Dandan;Xu Hongri;Ma Dongmei;Ma Honghao(The Third Affiliated Hospital of Beijing University of Chinese Medicine,Bejing 100029,China)

机构地区：[1]北京中医药大学第三附属医院,北京100029 [2]北京市怀柔区中医医院,北京101400

出　　处：《中国中医急症》2025年第1期51-54,76,共5页Journal of Emergency in Traditional Chinese 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);北京市自然科学基金面上项目(7232285)。

摘　　要：目的研究急诊留观社区获得性肺炎的病原学特点、病原学与中医证候相关性,为中西医结合治疗肺炎提供一定的客观依据。方法采用横断面调查研究方法,收集由北京中医药大学第三附属医院急诊科留观收入院的社区获得性肺炎患者278例,详细采集患者诊疗信息,通过SPSS26.0软件进行统计分析,总结急诊留观社区获得性肺炎患者的病原学分布特点、病原学与中医证候的相关性。结果急诊科留观社区获得性肺炎患者检出病原体以革兰氏阴性杆菌为主,占比94.12%。其中耐药菌占89.06%,多重耐药菌占耐药菌株的78.95%。鲍曼不动杆菌的耐药范围最广,对9种抗菌药物的耐药率均达50.00%以上,铜绿假单胞菌对头孢他啶、哌拉西林、庆大霉素、氯霉素、头孢唑林的耐药率也在50.00%以上,肺炎克雷伯杆菌仅对哌拉西林、氯霉素、氨苄西林、头孢唑林的耐药率较高。中医证候方面,与非多重耐药菌感染社区获得性肺炎患者相比,多重耐药菌感染社区获得性肺炎患者可能不以咳嗽为临床首发症状,咯痰、便秘、神昏等证候表现更常见;中医证型分布方面,多重耐药菌感染组患者以痰热壅肺证为主,非多重耐药菌感染组患者中痰浊阻肺证占比更高。结论急诊留观社区获得性肺炎患者病原学以革兰氏阴性杆菌为主,多重耐药菌在革兰氏阴性杆菌中占比达70%以上。多重耐药菌感染所致社区获得性肺炎患者证候特点以热证、虚证为主,“痰、热”是其主要的病理因素。Objective:To study the etiological characteristics of community acquired pneumonia(CAP)in Emergency Department,and to explore the correlation between etiology and TCM syndromes,so as to provide objective basis for the treatment of pneumonia with integrated Chinese and Western medicine.Methods:A cross-sectional study was carried out to collect 278 patients with CAP admitted to the Third Affiliated Hospital of Beijing University of Chinese Medicine in the Emergency Department.The diagnosis and treatment information of the patients was collected,and statistical analysis was carried out by SPSS26.0 software to summarize the etiological distribution characteristics of the patients with CAP in the Emergency Department,and the correlation between etiology and TCM syndromes.Results:The pathogens were mainly Gram-negative bacilli,accounting for 94.12%.Drug resistant bacteria accounted for 89.06%,and multi-drug resistant bacteria accounted for 78.95%of drug-resistant strains.Acinetobacter baumannii had the widest range of drug resistance,with resistance rates of over 50.00%to 9antimicrobials;the resistance rates of Pseudomonas aeraerosa to ceftazidme,piperacillin,gentamicin,chloramphenicol and cefazolin were also over 50.00%;the resistance rates of Klebsiella pneumoniae to piperacillin,chloramphenicol,ampicillin and cefazolin were relatively high.In terms of TCM syndromes,compared with non-multidrug-resistant bacteria infected with CAP patients,multi-drug-resistant bacteria infected with CAP patients may not have cough as the first clinical symptom,and the syndromes such as expectoration,constipation and coma are more common.In the comparison of TCM syndrome distribution,the proportion of phlegm-heat obstructing lung syndrome in patients with multi-drug resistant bacteria infection was higher than that in patients with non-multi-drug resistant bacteria infection,while the proportion of phlegm-turbidity obstructing lung syndrome in patients with non-multi-drug resistant bacteria infection was higher than that in patients wi

关 键 词：社区获得性肺炎 急诊 病原学 中医证候 相关性 

分 类 号：R563.1[医药卫生—呼吸系统]