辨证论治在105例新型冠状病毒肺炎中西医结合诊治中的作用  

The role of syndrome differentiation in traditional Chinese-western medicine combined diagnosis and treatment of 105 cases of COVID-19

作　　者：李伟男[1,2,3] 巴元明 王林群[4] 陶然 左新河[4] 石全[1,2,3] 王小琴 吴霞[1,2,3] 陆定波[1,2,3] 张雪荣 冯毅[1,2,3] 胡刚明 姜楠[1,2,3] 余昪昪 朱晓云[4] 谢立寒 LI Weinan;BA Yuanming;WANG Linqun;TAO Ran;ZUO Xinhe;SHI Quan;WANG Xiaoqin;WU Xia;LU Dingbo;ZHANG Xuerong;FENG Yi;HU Gangming;JIANG Nan;YU Bianbian;ZHU Xiaoyun;XIE Lihan(Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan 430061, China;Hubei Provincial Traditional Chinese Medicine Research Institute, Wuhan 430061, China;Hubei University of Chinese Medicine Affiliated Hospital, Wuhan 430061, China;Hubei University of Chinese Medicine, Wuhan 430065, China;Hanchuan People's Hospital, Hanchuan, Hubei 431600, China;Central Hospital of Wuhan, Wuhan 430014, China)

机构地区：[1]湖北省中医院,湖北武汉430061 [2]湖北省中医药研究院,湖北武汉430061 [3]湖北中医药大学附属医院,湖北武汉430061 [4]湖北中医药大学,湖北武汉430065 [5]汉川市人民医院,湖北汉川431600 [6]武汉市中心医院,湖北武汉430014

出　　处：《暨南大学学报（自然科学与医学版）》2020年第5期383-390,共8页Journal of Jinan University(Natural Science & Medicine Edition)

基　　金：湖北省科技厅新型肺炎应急攻关项目(第一批)(2020FCA007);第六批全国老中医药专家学术经验继承工作指导老师项目(国中医药人教发〔2017〕29号);第三届湖北省中医大师名师项目(鄂卫生计生通报[2018]15号);第七批湖北省中医药“三堂一室”项目:湖北省巴元明知名中医工作室项目(鄂卫通[2019]18号)。

摘　　要：目的:分析新型冠状病毒肺炎(COVID-19)辨证论治的临床疗效,旨在为COVID-19的诊断和治疗提供参考.方法:以湖北省中医院和汉川市人民医院收治的105例COVID-19患者作为研究对象,采用中医辨证论治方法,观察证候分型,临床治愈率,转重率,退热时间,核酸转阴时间,症状体征、实验室检查和肺部CT影像改善情况.结果:105例患者中确诊病例88例(83.81%),临床诊断病例17例(16.19%).包括普通型82例(78.10%),重型23例(21.90%).其中湿热袭肺证13例(12.38%),邪犯少阳、湿热壅肺证72例(68.57%),痰热壅肺证20例(19.05%).全部患者采用中医辨证论治联合西医常规治疗,总体临床治愈率为95.24%;普通型向重型及危重型转化2例(2.44%).平均退热时间为2~5 d,平均3 d.乏力、发热、咳嗽、咳痰、呼吸困难主要症状发生率较治疗前明显降低(P<0.05);胸闷、纳差、肌肉酸痛或关节疼痛、咽痛、鼻塞流涕等症状发生率较治疗前均明显降低(P<0.05);舌红或绛,苔黄、厚腻的发生率较治疗前均明显降低(P<0.05);苔色白的发生率较治疗前明显升高(P<0.05).实验室检查:白细胞计数、淋巴细胞绝对值均较治疗前明显升高(P<0.05);C反应蛋白较治疗前明显降低(P<0.05).新型冠状病毒核酸转阴时间为5~12 d,平均8 d.95例(90.48%)患者的肺部CT明显好转,主要表现在影像学病灶面积减小、变薄变淡.本组中医辨证论治的中西医结合方法未见不良反应,临床应用安全.结论:COVID-19患者初期表现为湿热袭肺证,中期表现为邪犯少阳、湿热壅肺证或痰热壅肺证.中医辨证论治COVID-19临床疗效确切,能够阻断普通型向重型及危重型转化,明显改善患者临床症状,快速促进肺部炎症吸收,疗效安全可靠.Objective:The clinical efficacy of 105 cases of Corona Virus Disease 2019(COVID-19)syndrome differentiation was analyzed to provide reference and data for the diagnosis of COVID-19.Methods:COVID-19 patients admitted to Hubei Provincial Hospital of Traditional Chinese Medicine(TCM)and Hanchuan People's Hospital were recruited as participants.The treatment method of TCM was adopted to observe the improvement of syndrome classification,clinical cure rate,weight transfer rate,antipyretic time,nucleic acid negative time,symptoms and signs,laboratory examination and pulmonary CT imaging results.Results:Among 105 observations,88(83.81%)were confirmed and 17(16.19%)were clinically diagnosed.There were 82 cases of mild type(78.10%)and 23 cases of severe type(21.90%).Among them,13 cases(12.38%)were the dampness-heat obstructing lung syndrome,72 cases(68.57%)were the dampness-heat obstructing lung syndrome in Shao Yang,and 20 cases(19.05%)were the phlegm heat obstructing lung syndrome.All the patients were treated by TCM syndrome differentiation combined with western medicine,and the overall clinical cure rate was 95.24%.Two cases(2.44%)were converted from mild type to severe type and critical type.The range of antipyretic time was 2-5 d,with an average of 3 d.The incidences of main symptoms of fatigue,fever,cough,sputum and dyspnea were significantly lower after the treatment(P<0.05).The incidence of chest tightness,poor tolerance,muscle soreness or joint pain,sore throat,nasal obstruction and runny nose were significantly lower than before after the treatment(P<0.05).The incidence rates of tongue red or purple,moss yellow and thick greasy were significantly lower after the treatment(P<0.05).However,rhe incidences of moss-white was significantly higher after the treatment(P<0.05).In terms of laboratory examination,both the white blood cell count and the absolute value of lymphocytes were significantly higher after the treatment(P<0.05).C-reactive protein was significantly decreased after the treatment(P<0.05).Novel coronav

关 键 词：新型冠状病毒肺炎(COVID-19) 临床研究 中医药 瘟疫 辨证论治 

分 类 号：R254.3[医药卫生—中医内科学] R259[医药卫生—中医学]