中药使用时机对重症新型冠状病毒肺炎的治疗效果及预后的影响  

Impact of the Timing of Traditional Chinese Medicine Therapy on the Therapeutic Effect and Prognosis of Severe Coronavirus Disease 2019

作　　者：张安[1] 李延萍[2] 邱敏[3] 刘华宝[4] 陈中沛[5] 万鹏[6] 陶杨[6] 王辉[7] 魏大荣 李群堂[9] 秦娅蓝 ZHANG An;LI Yanping;QIU Min;LIU Huabao;CHEN Zhongpei;WAN Peng;TAO Yang;WANG Hui;WEI Darong;LI Quntang;QIN Yalan(Department of Critical Care Medicine,the Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China;Department of Rheumatology,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China;Department of Oncology,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China;Department of Liver Disease,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China;Department of Endocrinology,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China;Department of Gastroenterology,Chongqing Beibei District Hospital of Traditional Chinese Medicine,Chongqing 400700,China;Department of Respiratory Medicine,Chongqing Beibei District Hospital of Traditional Chinese Medicine,Chongqing 400700,China;Department of Traditional Chinese Medicine,the Three Gorges Central Hospital of Chongqing,Chongqing 404100,China;Treating Potential Diseases Center,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China)

机构地区：[1]重庆医科大学附属第二医院重症医学科,重庆400010 [2]重庆市中医院风湿科,重庆400021 [3]重庆市中医院肿瘤科,重庆400021 [4]重庆市中医院肝病科,重庆400021 [5]重庆市中医院内分泌科,重庆400021 [6]重庆市北碚区中医院脾胃病科,重庆400700 [7]重庆市北碚区中医院肺病科,重庆400700 [8]重庆市三峡中心医院中医科,重庆404100 [9]重庆市中医院治未病中心,重庆400021

出　　处：《中国医学科学院学报》2020年第4期521-530,共10页Acta Academiae Medicinae Sinicae

基　　金：国家中医药管理局“新型冠状病毒感染肺炎中医药应急专项”(2020ZYLCYJ02-2);重庆市科学技术局“新型冠状病毒感染肺炎疫情应急科技攻关专项”(cstc2020jscx-fyzxX0012)。

摘　　要：目的探索中药治疗重症新型冠状病毒肺炎[又称2019冠状病毒病(COVID-19)]的最佳切入时机及其对治疗效果和预后的影响。方法收集2020年1月20日至3月11日重庆市64例联合中药治疗的COVID-19重症患者临床资料,在首次诊断为重型/危重型COVID-19后,3 d以内(包括第3天)开始服用中药患者为早期干预组,在首次诊断为重型/危重型COVID-19后,7 d以后(包括第7天)开始服用中药患者为晚期干预组,比较两组患者的临床疗效及预后。结果入组第14天,早期干预组氧合指数为292.5(252.0,351.0)mmHg(1 mmHg=0.133 kPa),明显高于晚期干预组的246.0(170.0,292.5)mmHg(P=0.005)。早期干预组住院时间[(18.56±1.11)d比(24.87±1.64)d,P=0.001]、住ICU时间[(14.12±0.91)d比(20.00±1.53)d,P=0.000]及病毒核酸转阴时间[(16.77±1.04)d比(22.48±1.66)d,P=0.001]均明显短于晚期干预组。早期干预组气管插管率(7.3%)较晚期干预组(30.4%)更低(P=0.028)。结论初次诊断为重症COVID-19后3 d以内(早期)予以中药治疗可缩短患者的住院时间、住ICU时间、核酸转阴时间并降低插管率。Objective To explore the optimal therapy time for the treatment of severe coronavirus disease 2019(COVID-19)by traditional Chinese medicine(TCM)and its influence on the therapeutic effect and prognosis.Methods The clinical data,laboratory findings,and outcomes of 64 patients with severe COVID-19 treated with TCM and western medicine in Chongqing from January 20,2020,to March 11,2020 were retrospectively analyzed.Patients were divided into early intervention group[TCM was initiated within 3 days(including day 3)after the first diagnosis of severe type/critical type COVID-19]and late intervention group[TCM was initiated after 7 days(including day 7)after the first diagnosis of severe type/critical type COVID-19].The changes in clinical parameters during the course of disease were compared between the two groups.Results On day 14,the oxygenation index was 292.5(252.0,351.0)mmHg in the early intervention group,which was significantly higher than that in the late intervention group[246.0(170.0,292.5)mmHg](P=0.005).The length of hospital stay[(18.56±1.11)d vs.(24.87±1.64)d,P=0.001],duration of ICU stay[(14.12±0.91)d vs.(20.00±1.53)d,P=0.000]and time to negativity[(16.77±1.04)d vs.(22.48±1.66)d,P=0.001]in the early intervention group were significantly shorter than those in the late intervention group.The intubation rate(7.3%)in the early intervention group was significantly lower than that in the late intervention group(30.4%)(P=0.028).Conclusion Early TCM therapy within three days after a diagnosis of severe COVID-19 can shorten the length of hospital stay,duration of ICU stay,and time to negativity and decrease intubation rate.

关 键 词：新型冠状病毒肺炎 中西医结合治疗 中药治疗时机 治疗效果 预后 

分 类 号：R459.9[医药卫生—治疗学] R243[医药卫生—临床医学]