胸外科手术后肺部感染中医辨证分型及演变规律的临床观察
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摘要
目的:观察并总结胸外科手术后肺部感染中医辨证分型的临床特点及演变规律。方法:连续性纳入四川大学华西医院胸外科2017年11月~2017年12月胸外科手术患者共217例,其中男性109例,女性108例,平均年龄(55.3±11.5)岁。对所有术后患者的术后第1天、第3天、第5天依据手术后肺部感染的诊断标准进行手术后肺部感染的判定,同时制定中医四诊调查表采用中医四诊诊断方法进行资料的搜集,提取关键性中医症状及体征并进行辨证分型。结果:217例手术患者中术后肺部感染患者共39例,占所有胸外科手术患者17.9%,术后肺部感染发生于术后第1天者10例,占所有患者的4.60%,发生于术后第3天者20例,占所有患者的9.21%,发生于术后5天及以后者6例,占所有患者的2.76%。术后早期主要表现为风热犯肺、风寒袭肺、燥邪伤肺的表实证或者肺气亏虚的表虚证,术后中期(第3天)表现为表证、虚证的患者逐渐减少,而表现为痰湿阻肺、痰热壅肺的实证、里证者逐渐增加并成为肺部感染的主要构成部分,后期(第5天以后)除了实证、里证之外,还出现气虚夹湿,气阴两虚的虚症或虚实夹杂的症候。结论:由表及里、由实转虚、虚实夹杂是胸外科手术后肺部感染中医辨证分型分布及演变的主要特点,基于中医诊断方法的中医辨证分型及其演化能够充分反映胸外科手术后肺部感染发生机理和演变规律,是诊断胸外科手术后肺部感染、评估其严重程度的有益补充,可以为中医药技术参与到胸外科围手术期管理中提供新的依据和治疗方法。
Objective: To observe and summarize the clinical characteristic and evolution rule of Traditional Chinese Medicine( TCM) syndrome on post thoracotomy pulmonary infection( PTPI). Methods: 217 cases of thoracotomy in our department from November 2017 to December 2017 were enrolled,consisted of 109 males and 108 females. According to the diagnostic criteria of PTPI,the diagnosis of PTPI was made on the first day,the third day,and the fifth days after the operation. At the same time,the TCM survey were enacted. After the TCM diagnosis method was used to collect diagnostic data and the key symptoms and signs of the TCM were extracted,the TCM syndrome were confirmed. Results: 39 cases of pulmonary infection after operation were confirmed,the incidence of pulmonary infection was 17. 9%,required respiratory support in 2 cases,with an incidence of 0. 92%.Pulmonary infection occurred on the first day after operation in 10 cases( 25. 6%),on the third day after operation in 20 cases( 51. 2%),and on fifth days in 6 cases( 15. 3% cases),two cases occurred on seventh days,with an incidence of 5. 1%. Early postoperative patients appeared deficiency( deficiency of lung Qi) or exterior syndrome( wind-heat invading lung,wind-cold attacking lung,dryness evil damaging the lung),mid postoperative patients appeared excess or interior syndrome( pulmonary stagnation of phlegm,phlegm-heat obstructing in the lung),and late postoperative patients appeared deficiency syndrome( deficiency of both Qi and Yin) or intermingled deficiency and excess symptoms( Qi deficiency and dampness). Conclusion: The main TCM characteristics of the distribution and evolvement about pulmonary infection after thoracic surgery are from the exterior or exterior deficiency syndrome to the excess or interior syndrome and from the excess or interior syndrome to the deficiency syndrome or intermingled deficiency syndrome. The TCM syndrome differentiation of the pulmonary infection after the thoracic surgery operation can fully reflect the occurrence and evolution,and the TCM diagnostic methods can provide new basses and treatment principles for the diagnosis and treatment of the perioperative period of thoracic surgery.
Objective: To observe and summarize the clinical characteristic and evolution rule of Traditional Chinese Medicine( TCM) syndrome on post thoracotomy pulmonary infection( PTPI). Methods: 217 cases of thoracotomy in our department from November 2017 to December 2017 were enrolled,consisted of 109 males and 108 females. According to the diagnostic criteria of PTPI,the diagnosis of PTPI was made on the first day,the third day,and the fifth days after the operation. At the same time,the TCM survey were enacted. After the TCM diagnosis method was used to collect diagnostic data and the key symptoms and signs of the TCM were extracted,the TCM syndrome were confirmed. Results: 39 cases of pulmonary infection after operation were confirmed,the incidence of pulmonary infection was 17. 9%,required respiratory support in 2 cases,with an incidence of 0. 92%.Pulmonary infection occurred on the first day after operation in 10 cases( 25. 6%),on the third day after operation in 20 cases( 51. 2%),and on fifth days in 6 cases( 15. 3% cases),two cases occurred on seventh days,with an incidence of 5. 1%. Early postoperative patients appeared deficiency( deficiency of lung Qi) or exterior syndrome( wind-heat invading lung,wind-cold attacking lung,dryness evil damaging the lung),mid postoperative patients appeared excess or interior syndrome( pulmonary stagnation of phlegm,phlegm-heat obstructing in the lung),and late postoperative patients appeared deficiency syndrome( deficiency of both Qi and Yin) or intermingled deficiency and excess symptoms( Qi deficiency and dampness). Conclusion: The main TCM characteristics of the distribution and evolvement about pulmonary infection after thoracic surgery are from the exterior or exterior deficiency syndrome to the excess or interior syndrome and from the excess or interior syndrome to the deficiency syndrome or intermingled deficiency syndrome. The TCM syndrome differentiation of the pulmonary infection after the thoracic surgery operation can fully reflect the occurrence and evolution,and the TCM diagnostic methods can provide new basses and treatment principles for the diagnosis and treatment of the perioperative period of thoracic surgery.
引文
[1]Alifano m RJ.Postoperative pneumonia in lung Cancer patients chronic obstructive.Eur J Cardiothorac Surg,2010,37(4):750~751
[2]Bouza E,Hortal J,Mu?oz P,et al.Postoperative infections after major heart surgery and prevention of ventilator-associated pneumonia:a one-day European prevalence study(ESGNI-008).J Hosp Infect,2006,64(3):224~230
[3]W c W,M e C,F N,et al.New epidemiology for postoperative nosocomial infections.Am Surg,2000,66(9):847~848
[4]车国卫,李为民,刘伦旭.快速肺康复需要围手术期流程优化.中国胸心血管外科临床杂志,2016(03):216~220
[5]《应用抗菌药物防治外科感染的指导意见》撰写协作组.应用抗菌药物防治外科感染的指导意见ⅩⅪ——手术后肺炎.中华外科杂志,2005(17):58~60
[6]朱文峰.中医诊断学.北京:中国中医药出版社,2007,9~125
[7]黎敬波,马力.中医临床常见症状术语规范.北京:中国医药科技出版社,2005,1~86
[8]中华中医药学会内科分会肺系病专业委员会.咳嗽中医诊疗专家共识意见(2011版).中医杂志,2011,52(10):896~899
[9]中华中医药学会内科分会肺系病专业委员会.社区获得性肺炎中医诊疗指南(2011版).中医杂志,2011,52(21):1883~1888
[10]田德禄,蔡淦.中医内科学.上海:上海科学技术出版社,2006,64~71
[11]朱文峰.中医诊断学.北京:中国中医药出版社,2007,177~181
[12]Martin LF,Asher EF,Casy JM.Postoperative pneumonia:determinants of mortality,1984:379~383
[13]Bouza E,Hortal J,Mu?oz P,et al.Postoperative infections after major heart surgery and prevention of ventilator-associated pneumonia:a one-day European prevalence study(ESGNI-008).J.Hosp.Infect.,2006,64(3):224~230
[14]Muscedere JG,Day A,Heyland DK.Mortality,attributable mortality,and clinical events as end points for clinical trials of ventilatorassociated pneumonia and hospital-acquired pneumonia.Clinical infectious diseases:an official publica,2010,51(Suppl 1):S120-S125
[15]刘又宁,曹彬,王辉,等.中国九城市成人医院获得性肺炎微生物学与临床特点调查.中华结核和呼吸杂志,2012,35(10):739~746
[16]邹青,谢超,李伟,等.肺部感染评分标准在重型颅脑损伤感染中的临床应用研究.中华医院感染学杂志,2016,26(16):3746~3748
[17]李朝红.肺部感染评分对卒中相关性肺炎患者预后的评估作用.临床肺科杂志,2015(04):738~740
[18]管向东,唐朝霞.腹部手术后肺部感染的处理.中国实用外科杂志,2011(09):874~876
[19]梁劲军.浅谈围手术期从气血论治.广州医药,2012(02):48~49
[20]杨永珠,苏云峰.中西医结合治疗在食管癌贲门癌围手术期的应用.中国中西医结合杂志,2002(08):580
[21]杨振江,张英,郭振球.食管癌舌脱落细胞变化及其与中医辨证分型关系的初步研究.中国中西医结合杂志,1995(05):277~280
[22]吕立江,盛燮荪.手术前后的舌象变化观察——附50例临床资料分析.浙江中医学院学报,1990(04):13~14
[23]魏惠芳,张露芬.从整体观念谈中医“正气”的特点.北京中医药大学学报,2009,32(7):440~442
[24]高新平,赵卫星,张志亮,等.黄芪增免散对围手术期食管癌间质反应的影响.中国中西医结合杂志,2001(03):171~173
[25]赵群,李勇,王力利,等.参芪扶正注射液对胃癌患者手术及化疗时免疫功能的影响.中国中西医结合杂志,2001(06):424~426
[2]Bouza E,Hortal J,Mu?oz P,et al.Postoperative infections after major heart surgery and prevention of ventilator-associated pneumonia:a one-day European prevalence study(ESGNI-008).J Hosp Infect,2006,64(3):224~230
[3]W c W,M e C,F N,et al.New epidemiology for postoperative nosocomial infections.Am Surg,2000,66(9):847~848
[4]车国卫,李为民,刘伦旭.快速肺康复需要围手术期流程优化.中国胸心血管外科临床杂志,2016(03):216~220
[5]《应用抗菌药物防治外科感染的指导意见》撰写协作组.应用抗菌药物防治外科感染的指导意见ⅩⅪ——手术后肺炎.中华外科杂志,2005(17):58~60
[6]朱文峰.中医诊断学.北京:中国中医药出版社,2007,9~125
[7]黎敬波,马力.中医临床常见症状术语规范.北京:中国医药科技出版社,2005,1~86
[8]中华中医药学会内科分会肺系病专业委员会.咳嗽中医诊疗专家共识意见(2011版).中医杂志,2011,52(10):896~899
[9]中华中医药学会内科分会肺系病专业委员会.社区获得性肺炎中医诊疗指南(2011版).中医杂志,2011,52(21):1883~1888
[10]田德禄,蔡淦.中医内科学.上海:上海科学技术出版社,2006,64~71
[11]朱文峰.中医诊断学.北京:中国中医药出版社,2007,177~181
[12]Martin LF,Asher EF,Casy JM.Postoperative pneumonia:determinants of mortality,1984:379~383
[13]Bouza E,Hortal J,Mu?oz P,et al.Postoperative infections after major heart surgery and prevention of ventilator-associated pneumonia:a one-day European prevalence study(ESGNI-008).J.Hosp.Infect.,2006,64(3):224~230
[14]Muscedere JG,Day A,Heyland DK.Mortality,attributable mortality,and clinical events as end points for clinical trials of ventilatorassociated pneumonia and hospital-acquired pneumonia.Clinical infectious diseases:an official publica,2010,51(Suppl 1):S120-S125
[15]刘又宁,曹彬,王辉,等.中国九城市成人医院获得性肺炎微生物学与临床特点调查.中华结核和呼吸杂志,2012,35(10):739~746
[16]邹青,谢超,李伟,等.肺部感染评分标准在重型颅脑损伤感染中的临床应用研究.中华医院感染学杂志,2016,26(16):3746~3748
[17]李朝红.肺部感染评分对卒中相关性肺炎患者预后的评估作用.临床肺科杂志,2015(04):738~740
[18]管向东,唐朝霞.腹部手术后肺部感染的处理.中国实用外科杂志,2011(09):874~876
[19]梁劲军.浅谈围手术期从气血论治.广州医药,2012(02):48~49
[20]杨永珠,苏云峰.中西医结合治疗在食管癌贲门癌围手术期的应用.中国中西医结合杂志,2002(08):580
[21]杨振江,张英,郭振球.食管癌舌脱落细胞变化及其与中医辨证分型关系的初步研究.中国中西医结合杂志,1995(05):277~280
[22]吕立江,盛燮荪.手术前后的舌象变化观察——附50例临床资料分析.浙江中医学院学报,1990(04):13~14
[23]魏惠芳,张露芬.从整体观念谈中医“正气”的特点.北京中医药大学学报,2009,32(7):440~442
[24]高新平,赵卫星,张志亮,等.黄芪增免散对围手术期食管癌间质反应的影响.中国中西医结合杂志,2001(03):171~173
[25]赵群,李勇,王力利,等.参芪扶正注射液对胃癌患者手术及化疗时免疫功能的影响.中国中西医结合杂志,2001(06):424~426