摘要
目的通过对非细菌性儿童社区获得性肺炎(CAP)进行专家问卷调查,了解病原体与证候相关性。方法基于德尔菲法研究,针对腺病毒肺炎、呼吸道合胞病毒肺炎、甲型流感病毒肺炎、乙型流感病毒肺炎、肺炎支原体肺炎制定并发放“儿童CAP中西医结合诊疗方案”,对来自20个省、自治区及直辖市的35所省市级医院的50名专家进行调查,并对结果进行统计分析。计算等级和(S)、均数(x^(-))、不重要百分比(R)体现专家意见集中程度,计算变异系数(CV)体现协调程度,计算秩均值。结果非细菌性CAP六淫致病以风、热为主;初期表现为风热闭肺,急性期为痰热闭肺,重症为毒热闭肺;主要症状为发热、咳嗽,不同病原体CAP症状有所区别,且发热、咳嗽、喘息、咳痰也具有不同特点,主要治法也存在一定差异;选用中成药注射剂治疗非细菌性CAP主要原因为认可临床疗效,不选用主要考虑药物过敏风险。结论不同病原体相关的肺炎有证候特异性,证候表现结合病原学检查可进行病情预估和防治。
Objective To investigate the correlation between pathogen and syndrome of non-bacterial community-acquired pneumonia(CAP)in children by expert questionnaire survey.Methods Based on Delphi method,the questionnaire of“Diagnosis and Treatment Protocol of Integrated Traditional and Western Medicine for CAP in Children”for adenovirus pneumonia(ADVP),respiratory syncytial virus pneumonia(RSVP),influenza A virus pneumonia(INFAP),influenza B virus pneumonia(INFBP)and mycoplasmal pneumonia(MPP)was sent to 50 experts from 35 provincial and municipal hospitals in 20 provinces,autonomous regions and municipalities,and then the results were statistically analyzed.The rank sum(S),mean(x^(-))and unimportant percentage(R)were calculated to reflect the concentration degree of expert opinions,the coefficient of variation(CV)was calculated to reflect the degree of coordination,and the rank mean was calculated.Results The pathogenic causes of non-bacterial CAP,known as the six evil qi,were mainly wind evil and heat evil.The initial symptoms were wind-heat closed Fei type,phlegm-heat closed Fei type in the acute stage,and toxic-heat closed Fei in the severe stage.The main symptoms were fever and cough.The symptoms of non-bacterial CAP related to different pathogens,and the symptoms of fever,cough,wheezing and expectoration also showed different characteristics,and the main treatment methods were also different.The main reason for choosing Chinese patent medicine injection in the treatment of non-bacterial CAP was the approved clinical efficacy,and the reason for not choosing it was the risk of drug allergy.Conclusions Pneumonia associated with different pathogens has syndrome specificity.Syndrome manifestations combined with etiological examination could be used for disease prediction and prevention.
作者
王晓
张恒
贺红安
张葆青
WANG Xiao;ZHANG Heng;HE Hong-an;ZHANG Bao-qing(First College of Clinical Medicine,Shandong University of Traditional Chinese Medicine,Jinan 250355;Department of Pediatrics,Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250011)
出处
《中国中西医结合杂志》
CAS
CSCD
北大核心
2022年第11期1323-1328,共6页
Chinese Journal of Integrated Traditional and Western Medicine
基金
国家中医药管理局专科专病循证能力提升项目(No.2019XZZX-EK004)
山东省中西医结合专病防治项目(No.YXH2019ZXY010)。
关键词
儿童社区获得性肺炎
病原体
证候
专家问卷调查
community-acquired pneumonia in children
pathogen
syndrome
expert questionnaire
