摘要
目的总结自拟协定方治疗新型冠状病毒肺炎(COVID-19)的效果,分析从“湿热疫毒”诊治及防治病情进展的思路与方法。方法选取2020年2月3日至18日在北京市回民医院连续住院的24例新型冠状病毒肺炎24例患者作为研究对象。所有患者在常规抗病毒及对症治疗的基础上,全程服用自拟协定方治疗。疗程6~14 d。通过体温、症状、白细胞(white blood cell,WBC)、中性粒细胞(neutrophil,NE)和淋巴细胞计数(lymphocyte,LY)及中性粒细胞淋巴细胞比值(neutrophil lymphocyte ratio,NLR)、胸部电子计算机断层扫描(computed tomography,CT)的改变评价疗效。结果研究显示该病传染性强、以发热、咽干、咽痛、咳嗽、乏力及肌肉酸痛、纳差、腹泻、舌红、黄腻苔为主要临床表现,属湿热疫毒、侵袭肺胃。24例患者中,15例发热患者平均热程(从开始发热到体温正常的时间)(6.23±3.67)d。呼吸消化道及神经系统等临床症状均得到改善。23例患者治疗前后复测血常规,入院时降低的WBC、NE及LY有显著提升,差异有统计学意义(P<0.01)。值得注意的是本研究中50岁以上患者入院时NLR>3.13的5例患者CT显示炎性反应明显吸收,3例经过治疗后,NLR降至2.90以下。22例入院胸部CT检查符合肺炎改变者,治疗后21例复测胸部CT。结果显示,6例患者CT显示炎性反应明显吸收,11例患者CT显示炎性反应部分吸收,3例患者CT无明显变化,CT好转率80.95%。2例CT有加重者均为60岁以上,NLR>3.13,出现血氧饱和度(oxygen saturation,SpO2)下降,1例转院,1例及时应用祛湿排痈化瘀药物显著好转,NLR下降至2.90,SpO2上升至95%以上,胸部CT显示大部分病灶范围缩小。由普通转重型1例占4.2%。结论依据“湿热疫毒”拟中药协定方治疗新型冠状病毒肺炎效果显著。对素有络脉瘀阻或存在基础疾病的中老年人群,建议重视早期化瘀通络,有湿热蕴毒、闭肺趋势者,建议清利排痰消壅、解毒逐瘀通络防治病情进展。
Objective To summarize the clinical efficacy of the self-designed traditional Chinese medicine(TCM)protocol on COVID-19,and analyze the thoughts and methods about diagnosis,treatment and preventing disease from progressing based on“damp-heat epidemic virus”.Methods A total of 24 patients with COVID-19 continuously hospitalized in Beijing Huimin Hospital from February 3,2020 to February 18,2020 were enrolled.On the basis of routine antiviral and symptomatic treatment,all patients were treated with the self-designed TCM protocol.The treatment lasted 6 to 14 days.The efficacy was evaluated by temperature,symptoms,white blood cell(WBC),neutrophil count(NE),lymphocyte count(LY)and neutrophil lymphocyte ratio(NLR),and the changes of chest computed tomography(CT)manifestations.Results Clinical observation found that the disease is highly contagious,belongs to the damp-heat epidemic virus,invades lung and stomach.The main clinical manifestations are fever,pharyngoxerosis,pharyngalgia,cough,fatigue and muscle pain,anorexia,diarrhea,red tongue and yellow greasy coating.In the 24 patients,there were 15 patients with fever,whose average duration of fever(since the day of having a fever to the last fever day)was(6.23±3.67)days.Symptoms of the respiratory,digestive and nervous system were relieved.Decreased WBC,NE,and LY levels of 23 patients were significantly increased after the treatment(P<0.01).It is worth noting that,NLR of 3 patient among 5 patients older than 50 years with NLR over 3.13 decreased less than 2.90.Among 22 patients admitted to hospital with chest CT diagnosis,6 patients had significant absorption,11 had partial absorption,and 3 had no significant change.The improvement rate of the chest CT manifestations was 80.95%.Two patients with chest CT worsen were both over 60 years old,with NLR>3.13,and oxygen saturation(SpO2)decreased.One of them was transferred.The other was treated with dispelling-dampness,draining-abscess and dissolving-blood-stasis herbal medicines.After treatment,the NLR decreased to 2.90,SpO2 increased to more than 95%,and most of focus in chest CT were reduced.In this study,one moderate type case developed to severe type accounting for 4.2%.Conclusion It is significantly effective to treat COVID-19 with the self-designed TCM protocol based on“damp-heat epidemic virus”.For the middle-aged and elderly population with collateral stasis or underlying diseases,it is suggested to pay attention to the early application of dissolving-blood-stasis and dredging-collateral herbal medicines.For those who had the tendency of damp-heat accumulating virulence and obstructing lung,it is suggested to clear and eliminate phlegm and obstruction,detoxify,dissolving-blood-stasis and dredging-collateral to prevent the disease progression.
作者
张勇
谢颖桢
王芳
金佳欣
韩璐瑶
Zhang Yong;Xie Yingzhen;Wang Fang;Jin Jiaxin;Han Luyao(Department of Neurology,Beijing Huimin Hospital,Beijing 100054,China;Department of Neurology, Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijng 100700,China;Daxing Branch of Guang'anmen Hospital,Beijing 102618,China;Beijing University of Chinese Medicine,Beijing 100029,China)
出处
《首都医科大学学报》
CAS
北大核心
2020年第2期277-282,共6页
Journal of Capital Medical University
关键词
COVID-19
湿热疫毒
化瘀通络
排痰解毒
SPO2下降
COVID-19
damp-heat epidemic virus
dissolving-blood-stasis and dredging-collateral
eliminate phlegm and detoxify
decrease of SpO2
