中西医结合治疗80例新型冠状病毒肺炎重型及危重型患者疗效观察  

Curative effect of integrated Chinese and Western medicine on 80 severe and critical COVID-19 patients

作　　者：王源 黄东晖[2] 王慧贤[2] 冯淬灵[3] 钟子劭 蔡俊翔 谢东平[4] 宋林 温敏勇[6] 王同汉[7] 张忠德[4] WANG Yuan;HUANG Donghui;WANG Huixian;FENG Cuiling;ZHONG Zishao;CAI Junxiang;XIE Dongping;SONG Lin;WEN Minyong;WANG Tonghan;ZHANG Zhongde(Guangzhou University of Chinese Medicine,Guangzhou 510006,China;Guangdong Provincial Hospital of Chinese Medicine Zhuhai Branch,Zhuhai 519015,China;Peking University People's Hospital,Beijing 100044,China;Guangdong Provincial Hospital of Chinese Medicine,Guangzhou 510120,China;Hubei Provincial Hospital of Integrated Chinese&Western Medicine,Wuhan 430015,China;The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzliou 510405,China;Guangdong Second Traditional Chinese Medicine Hospital,Guangzhou 510095,China)

机构地区：[1]广州中医药大学,广州510006 [2]广东省中医院珠海医院 [3]北京大学人民医院 [4]广东省中医院 [5]湖北省中西医结合医院 [6]广州中医药大学第一附属医院 [7]广东省第二中医院

出　　处：《北京中医药大学学报》2022年第6期555-562,共8页Journal of Beijing University of Traditional Chinese Medicine

基　　金：广东省教育厅普通高校新冠疫情防控专项资助项目(No.2020KZDZX1053)。

摘　　要：目的 观察中医药辨证治疗结合西医基础治疗对新型冠状病毒肺炎(COVID-19)重型及危重型患者病情转归及各项指标的影响,综合评估其临床疗效及安全性。方法 选择2020年2—3月广东省中医医疗队收治于湖北省中西医结合医院的COVID-19重型及危重型患者,按2∶1随机分为试验组及对照组。根据《新型冠状病毒感染的肺炎诊疗方案(试行第五版)》,给予对照组西医基础治疗,试验组在西医基础治疗上全程进行中医辨证施治,针对邪郁少阳证、邪伏膜原证、湿热蕴肺证、疫毒闭肺证、气阴两伤证、气营两燔证及内闭外脱证加用中药汤剂及中成药。观察2组患者结局转归、核酸转阴时间、治疗前后中医证候总积分和实验室指标变化。结果 试验组总有效率、核酸转阴率高于对照组(P<0.05),但2组28 d病死率、核酸转阴时间差异无统计学意义(P>0.05)。治疗后,2组中医证候总积分均下降(P<0.05),且试验组较对照组降低(P<0.05);2组C反应蛋白、血清淀粉样蛋白A、白细胞介素-6均降低,且试验组血清淀粉样蛋白A、白细胞介素-6较对照组降低(P<0.05);试验组白细胞计数、淋巴细胞计数、T淋巴细胞计数、自然杀伤细胞计数及对照组白细胞计数、T淋巴细胞计数均较治疗前升高,且试验组白细胞计数、T淋巴细胞计数均较对照组升高(P<0.05);2组乳酸浓度均较治疗前降低(P<0.05),且试验组较对照组降低(P<0.05);试验组较治疗前氧合指数升高(P<0.05)。结论 中医药辨证治疗结合西医基础治疗能够调节COVID-19重型、危重型患者免疫功能,抑制机体炎症反应,改善组织缺氧及灌注不足,有效缓解患者症状,从而提高临床疗效。Objective To observe the effects of traditional Chinese medicine(TCM) dialectical treatment combined with Western medicine on the outcome and various indicators of severe and critical COVID-19 patients to comprehensively evaluate the treatment’s clinical efficacy and safety.Methods From February to March 2020, patients with severe and critical COVID-19 who were admitted to Hubei Provincial Hospital of Integrated Chinese & Western Medicine and managed by the Guangdong TCM Medical Team were selected as the study subjects. They were divided randomly into the experimental group and the control group in a ratio of 2∶1. The control group was given the basic treatment of Western medicine according to the Western medicine treatment plan issued by the National Health Commission. Along with the basic Western medicine treatment, the experimental group added TCM dialectical treatment that included Chinese herbal decoction and proprietary Chinese medicine for stagnant pathogens trapped in the Shaoyang syndrome, stagnant pathogens trapped in the Moyuan syndrome, dampness-heat obstructing lung syndrome, epidemic toxin-blocking lung, qi-yin deficiency syndrome, the dual blaze of qi and nutrient syndrome, and internal blocking and external detachment syndrome, we observed the outcome, nucleic acid negative time, the total score of the syndrome as well as the change in the laboratory index in the two groups before and after treatment.Results The total efficiency and nucleic acid negative conversion rate of the experimental group were higher than those in the control group, and the difference between the two groups was significant(P<0.05). However, there was no obvious difference in the 28-d fatality rate and nucleic acid negative time between the two groups(P>0.05). The two groups showed a downward trend in TCM scores after treatment, and the decline was more pronounced in the experimental group than in the control group(P<0.05). The two groups showed a downward trend after treatment with C-reactive protein, serum amyloid A pr

关 键 词：新型冠状病毒肺炎 重型 危重型 中西医结合 临床研究 

分 类 号：R254.3[医药卫生—中医内科学]