海南省1155例新型冠状病毒Omicron(BA.5.1.3)变异株感染的中医证候特征及诊疗策略  

Traditional Chinese Medicine syndromes and treatment strategies in 1155 patients infected with the Omicron(BA.5.1.3)variant in Hainan Province

作　　者：华俏丽 郑丹文 刘云涛 水敬伟 蔡怡航 李泉[3] 张达坤[4] 李深明 杜永明[3] 丁邦晗 郭建文 张汉洪[3] 张忠德 HUA Qiao-li;ZHENG Dan-wen;LIU Yun-tao;SHUI Jing-wei;CAI Yi-hang;LI Quan;ZHANG Da-kun;LI Shen-ming;DU Yong-ming;DING Bang-hang;GUO Jian-uen;ZHANG Han-hong;ZHANG Zhong-de(The Second Clinical College,Guangzhou University of Chinese Medicine,Guangzhou,510006,China)

机构地区：[1]广州中医药大学第二临床医学院,广东广州510006 [2]广州中医药大学第二附属医院急诊科、广东省中医急症研究重点实验室,广东广州510120 [3]海南省中医院急诊科,海南海口570203 [4]海南省中医院脾胃肝病科,海南海口570203 [5]海南省中医院老年病科,海南海口570203

出　　处：《广东医学》2023年第5期558-564,共7页Guangdong Medical Journal

基　　金：国家重点研发计划“公共安全风险防控与应急技术装备”重点专项新冠肺炎应急项目(2022YFC0867400);国家中医药管理局中医药防治新型冠状病毒感染的肺炎应急研究专项(2020ZYLCYJ05-11);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”(2021ZYLCYJ01);广东省防治新型冠状病毒科技攻关专项(2021A1111110004);广东省中医药局科研课题(20223011)。

摘　　要：目的 分析海南省新型冠状病毒奥密克戎变异株(BA.5.1.3)感染者中医证候特征及中医治法治则。方法 纳入海南省三亚市2022年8月4至19日方舱医院、定点医院收治的感染奥密克戎变异株(BA.5.1.3)的成人病例,收集病例中医证候信息,通过潜在类别分析探讨此次疫情的核心病机。结果 共纳入1 155例病例,其平均年龄(46.1±15.5)岁,临床分型以轻型(77.1%)和无症状感染者(21.7%)为主。症状以咳嗽(57.6%)、咳痰(42.3%)、咽痛(21.7%)、鼻塞流涕(17.6%)为主。舌质为舌淡红(59.8%)、舌红(33.4%)、舌紫暗(2.3%),舌苔多为苔薄白(43.7%)、苔薄黄(25.8%)、苔白腻(11.4%)。脉以滑脉(36.8%)、浮脉(29.4%)、弱脉(11.9%)为主。在证候演变上,发热多出现病程早期,随后咳嗽、鼻塞流涕、咽干、纳差占比上升,而至发病7 d以后,各症状占比均呈下降趋势。胸闷、气短、纳差、便秘、滑脉、舌紫暗、苔白腻多见于重症高危病例。结论 新型冠状病毒奥密克戎变异株(BA.5.1.3)感染的核心病机为暑热夹湿,以上焦病变为核心,早期疫疠邪气挟风热袭表,随后病邪逐渐由表入里侵犯肺及脾胃,暑湿表现较为明显,采取清热透邪、化湿解毒之法。而重症高危人群多表现阳气受损,湿毒未清的特点,予以益气温阳,化湿解毒。Objective To analyze the Traditional Chinese Medicine(TCM)Syndromes in patients infected with the Omicron(BA.5.1.3)variant in Hainan province.Methods From August 4 to 19,2022,1155 adults infected with the Omicron variant(BA.5.1.3)in Sanya were included.The latent class analysis was used to investigate the core pathogenesis of the epidemic.Results Mean age of the 1155 patients was(46.1±15.5)years.Most of them were mild(77.1%)and asymptomatic(21.7%).Cough(57.6%),expectoration(42.3%),sore throat(21.7%)and stuffy and runny nose(17.6%)were the main symptoms with light red(59.8%),red(33.4%)and purple(2.3%)tongue body.The tough coatings were thin white(43.7%),thin yellow(25.8%)and white-greasy(11.4%).The pulses were slippery(36.8%),floating(29.4%),followed by a weak pulse(11.9%).In terms of the evolution of the symptoms,fever tended to appear in the early phase,followed by an increase in the proportion of cough,stuffy and runny nose,dry throat and poor appetite,and a decrease in the proportion of symptoms after 7 days.The proportion of chest tightness,shortness of breath,poor appetite,constipation,slippery pulse,purple tongue and white-greasy coating were higher in high-risk patients.Conclusion The core pathogenesis of the Omicron(BA.5.1.3)variant infection was summer-heat and dampness.The treatment principle was clearing heat,removing toxin and dampness for non-high-risk cases.High-risk cases presented with impaired yang energy with dampness and toxins,and these cases were treated with supplementing Qi and Warm Yang in the basis of removing toxin and dampness.

关 键 词：奥秘克戎变异株 BA.5.1.3 中医证候 海南省 

分 类 号：R511[医药卫生—内科学] R259.631[医药卫生—临床医学]