472例新型甲型H1N1流感的分期辨证与病因病机规律探讨  

Investigation on Laws of Dialectical Staging and Etiology and Pathogenesis of 472 Cases Neotype H1N1 Influenza A

作　　者：黄练秋[1] 刘映霞[2] 李慧涓[2] 白冰[2] 聂广[2] 柯新桥[3] 

机构地区：[1]湖北中医药大学 [2]广东省深圳市第三人民医院,广东深圳518020 [3]广东省深圳市第五人民医院,广东深圳518001

出　　处：《深圳中西医结合杂志》2011年第2期72-76,共5页Shenzhen Journal of Integrated Traditional Chinese and Western Medicine

基　　金：国家中医药管理局行业建设项目(200907001-1);广东省中医药管理局资助项目(2010304)

摘　　要：目的:通过对472例新型甲型H1N1流感患者的证候学分期调查,总结新型甲型H1N1流感的分期辨证模式,使其辨证论治根据符合临床实际。方法:参考卫生部甲型HINI流感诊疗方案为诊断标准,选择深圳市第三人民医院2009年5月-2010年3月期间住院隔离并确诊的患者472例。采用横断面调查方法回顾性分析甲型H1N1流感确诊病例472例,分别按照表证期、里证期和恢复期三个阶段的各自临床症状、体征,以及各期相关证素等对346例轻症以及126例重症患者的发病年龄,体重,住院天数,发热情况(包括发病中最高体温,发热持续时间以及治疗-体温正常时间),进行统计学分析。结果:根据472例甲型H1N1流感患者的临床特征,表证期表达频数超过50%的症状、体征有:发热90.46%,疲乏68.21%,咳嗽50.29%,咽充血72.83%,扁桃体肿大83.53%等;里证期表达频数超过50%的症状、体征有:发热100%、咳嗽100%、小便黄100%、口渴100%、胸痛76.98%、咽痛81.75%等;恢复期相对高频的有:疲乏30.29%、纳差17.58%、脘痞17.58%、小便黄17.16%、咳嗽11.23%等。结论:新型甲型H1N1流感患者表证期以风热袭表、正气受损为特点,里证期类似于"风温病"的"热郁胸膈证"和"邪热壅肺证"的组合,恢复期以正气受损(气虚、阴虚、阳虚)、余邪未净为病机特点。Objective To observe the syndrome characteristics of neotype HINI influenza A patients and explain its etiology and pathogenesis,so as to summarize the staging dialectical model according with clinicalpractice..Methods 472 cases of influenza H1N1 were confirmed in line with the diagnostic criteria of Ministry of Public Health,who were isolated and hospitalized in Shenzhen Third People＇s Hospital during March 2009 to March 2010.They were retrospectively analyzed using cross-sectional survey methods and statistical analysis respectively according to respective clinical symptoms,signs,and each stage related syndrome factor of three stages such as superficial syndrome,interior syndrome and recovery stage.The corresponding basic syndrome,clips syndrome and main pathogenesis,secondary pathogenesis were identified on the basis of its expression frequency.Results The express frequencies more than 50% of the symptoms and signs in superficial syndrome stage were respectively such as fever 90.46%,fatigue 68.21%,cough 50.29%,pharynx hyperemia 72.83% and tonsil enlargement congestion 83.53%,etc.The express frequencies more than 50% of the symptoms and signs in interior syndrome stage were respectively such as fever,cough,yellow urinate,being thirsty all for 100%,thoracalgia 76.98%,pharyngodynia 81.75%,etc.The relative frequencies of the symptoms and signs in recovery stage were respectively fatigue 30.29%,poor diet 17.58%,yellow urinate 17.16%,cough 11.23%,etc.Conclusion Neotype HINI influenza A patient in superficial syndrome stage was characterized as Wind Hot invading and Healthy Qi damaged.The patient in interior syndrome stage was characterized as the combination of Pyretic Stagnation in Chest-Diaphragm and Accumulation of Pathogenic Heat in Lung.Patients in recovery stage was characterized as Healthy Qi damaged including Qi asthenia,Yin deficiency,Yang deficiency,and showed the pathogenesis characteristics not net subsidized.

关 键 词：新型甲型流感 H1N1 分期辨证 

分 类 号：R511.7[医药卫生—内科学]