宣肺败毒汤治疗重症新型冠状病毒肺炎的临床病例观察  

Clinical observation of Xuanfei Baidu Decoction in treatment of severe coronavirus disease 2019(COVID-19)

作　　者：李旭成[1] 张军[1] 夏文广 刘清泉[3] 王辉 黄明 杨丰文 庞博 LI Xu-cheng;ZHANG Jun;XIA Wen-guang;LIU Qing-quan;WANG Hui;HUANG Ming;YANG Feng-wen;PANG Bo(Wuhan Hospital of Traditional Chinese Medicine,Wuhan 430000,China;Hubei Provincial Hospital of Integrated Chinese and Western Medicine,Wuhan 430065,China;Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China;Center for Evidence-based Medicine,Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China)

机构地区：[1]武汉市中医医院,湖北武汉430000 [2]湖北省中西医结合医院,湖北武汉430065 [3]首都医科大学附属北京中医医院,北京100010 [4]天津中医药大学循证医学中心,天津301617

出　　处：《中国中药杂志》2022年第13期3667-3674,共8页China Journal of Chinese Materia Medica

基　　金：国家重点研发计划项目(2020YFC0841600);国家自然科学基金项目(82004505)。

摘　　要：为评价宣肺败毒汤治疗重症新型冠状病毒肺炎的临床疗效和安全性,纳入2020年2月1日至3月1日在湖北省中西医结合医院和武汉市中医医院收治住院的重症(重型、危重型)新型冠状病毒肺炎患者41例,在常规治疗基础上给予宣肺败毒汤。观察患者临床结局、住院时间、肺部CT转归,比较患者入院时与治疗第14天实验室指标及治疗第7、14天中医症状体征转归。以同期重症新型冠状病毒肺炎临床研究报告作为外部对照,描述性分析宣肺败毒汤与西医及常规治疗患者临床特征及临床结局的差异。结果显示,41例患者中,治愈出院40例,死亡1例;住院时间中位数为22 d,肺部CT好转率为87.2%(34/39)。治疗14 d后,患者白细胞(WBC)计数、C反应蛋白(CRP)、纤维蛋白原(FIB)、乳酸脱氢酶(LDH)水平较治疗前显著降低(P<0.05,P<0.01),降钙素原(PCT)、凝血酶原时间(PT)、肌酸激酶(CK)、门冬氨酸氨基转移酶(AST)、总胆红素(TBiL)等指标有下降趋势。与入院时相比,治疗第7、14天患者发热、咳嗽、胸闷/气短、喘促、头身疼痛、纳呆/纳差、腻苔均有显著改善(P<0.05,P<0.01),治疗第14天乏力有显著改善(P<0.01)。与外部对照相比,宣肺败毒汤治疗患者病死率、不良反应及重大事件发生率均低于同期西药及常规治疗,且治疗期间抗生素、激素、血管加压素及有创机械通气治疗的使用率更低。结果表明,宣肺败毒汤治疗重症新型冠状病毒肺炎具有较好临床疗效及安全性,可改善炎症反应及临床症状,促进肺部炎症吸收,降低病死率。The present study evaluated the effectiveness and safety of Xuanfei Baidu Decoction(XFBD)for severe cases with coronavirus disease 2019(COVID-19).Forty-one patients(diagnosed as severe or critical type)admitted to Hubei Provincial Hospital of Integrated Chinese and Western Medicine and Wuhan Hospital of Traditional Chinese Medicine from February 1 to March 1,2020,were included.All patients were treated with XFBD based on conventional therapies.Clinical outcomes,length of hospital stay,and lung CT images of patients were observed.Laboratory indicators were compared between admission and the 14 th day of treatment.Traditional Chinese medicine(TCM)symptoms and signs on the 7 th and 14 th days of treatment were also compared with baseline.The differences in clinical characteristics and clinical outcomes between XFBD and western medicine or conventional therapies were analyzed with the published trials on severe COVID-19 cases during the same period as external controls.According to the results,among the 41 cases,40 were cured and discharged,and 1 died;the median length of hospital stay was 22 days,and the improvement rate of lung CT was 87.2%(34/39).Compared with the conditions on admission,the levels of white blood cells(WBC),C-reactive protein(CRP),fibrinogen(FIB),and lactate dehydrogenase(LDH)were reduced(P<0.05,P<0.01),and levels of procalcitonin(PCT),prothrombin time(PT),creatine kinase(CK),alanine aminotransferase(AST),total bilirubin(TBiL),and other indicators showed a downward trend.Moreover,symptoms like fever,cough,chest tightness/shortness of breath,dyspnea,head and body pain,anorexia,and greasy tongue coating were significantly improved on the 7 th and 14 th days of treatment(P<0.05,P<0.01),and fatigue was improved on the 14 th day of treatment(P<0.01).The mortality,adverse reactions,and major events of the XFBD group were significantly lower than those of the western medicine and conventional treatment groups in the same period,and the usage of antibiotics,hormones,vasopressin,and invasive mechanical ven

关 键 词：宣肺败毒汤 新型冠状病毒肺炎(COVID-19) 重型 危重型 

分 类 号：R259[医药卫生—中西医结合]