中西医结合防治新型冠状病毒肺炎的应用探讨

新型冠状病毒肺炎(COVID-19)现已在全球多个国家和地区蔓延,影响广泛,危害性大,截至目前尚无针对该病的特效药.根据党中央、国务院"坚持中西医结合,统筹中西医资源,协同攻关、优势互补"的决策部署,各地积极制定符合当地实际的中西医结合诊疗方案,力求实现轻症尽早治愈、减少危重症发生、提高治愈率和降低病死率的目标.通过研...     

从中西医结合诊疗思路谈对新型冠状病毒肺炎诊治的认识

新型冠状病毒肺炎(COVID-19)属中医"湿毒疫"范畴,根据目前该病的发病特点及临床表现,结合中医瘟疫相关理论,总结其病因为湿毒之邪,病位在肺,累及脾胃;病机特点为湿、热、毒、瘀。西医以抗病毒、调节免疫、对症支持等治疗为主,中医以分期分型辨证论治为主,临床采取中西协同治疗,取得显著疗效。     

中西医结合对新型冠状病毒肺炎治疗的研究

新型冠状病毒肺炎是由2019新型冠状病毒感染所致的肺炎。主要临床表现为发热、乏力、干咳,亦可见鼻塞、流涕、咽痛、肌肉痠痛及胃肠道症状,甚者演变为不可逆性多器官功能衰竭而致人死亡。本文参照国家卫健委发布的《新型冠状病毒肺炎诊疗方案(试行第七版)》及中国知网数十篇研究报告整理得出结论:目前临床所见主要以湿邪致病为主,中医治疗以中药汤剂为主、辅以中成药;西医治疗以支持疗法、氧疗、药物治疗为主。现将结果汇报如下,以期对日后临床诊断、治疗有所帮助。     

中西医结合治疗新型冠状病毒肺炎临床研究

目的观察中西医结合治疗新型冠状病毒肺炎(以下简称新冠肺炎)的疗效。方法将22例新冠肺炎患者随机分为2组。治疗组11例采用西医综合疗法联合清肺排毒汤治疗,对照组11例采用西医综合疗法联合加参败毒汤治疗,10 d为1个疗程,比较2组临床疗效及平均住院日。结果治疗组治愈率100%,对照组治愈率90.91%,2组治愈率比较差异无统计学意义(P> 0.05)。治疗组平均住院日(21.91±6.86) d,对照组平均住院日(14.09±5.52) d,治疗组平均住院日多于对照组(P <0.05)。结论西医综合疗法联合清肺排毒汤和西医综合疗法联合加参败毒汤2种方案治疗新冠肺炎均有效。清肺排毒汤更适合新冠肺炎危重型、伴随基础疾病、病机复杂患者的治疗。     

中西医结合治疗新型冠状病毒肺炎作用的思考

新型冠状病毒肺炎属于中医学"疫病"范畴,中西医结合治疗具有明确疗效。对于普通型患者,中西医结合治疗可改善症状,缩短疗程,促进治愈;对于重症、危重症患者,可减轻肺部渗出,控制炎症过度反应,防止病情恶化;对于恢复期患者,可清除余邪,扶助正气,促进康复进程。     

新型冠状病毒肺炎中医辨治思考

新型冠状病毒肺炎属中医“湿毒疫”范畴。因其传染性强,病情进展迅速,死亡率高而成为临床急性疑难病症。其发病条件与运气学说对天时的认识有关,也与水系众多的地理环境有关。主要病性为湿毒,病位在肺脾,主要病机为湿犯上焦,湿困中焦。治法以分消化湿,宣畅气机为主。围绕早期、中期及时截断,是减少危重症,降低死亡率的关键。笔者团队力求精准辨证论治,优选中医古方加减应用,取得了较满意的疗效,初步表明中医药治疗新冠肺炎有独特优势,安全有效。     

中西医结合治疗新型冠状病毒肺炎二则

十二指肠溃疡穿孔、尿毒症患者感染COVID-19临床少见,但病情凶险,单纯中医或西医疗效欠佳.选取两例COVID-19基础上伴有十二指肠溃疡穿孔及肾功能损伤患者,患者除了咳嗽发热等症状外,兼有大小便不利.中医辨其属肺肠合病及肺肾合病,因此治疗上不仅要驱邪,还要兼顾肠与肾.在抗病毒、血液透析、手术及对症治疗的同时...     

中西医结合治疗新型冠状病毒肺炎临床观察

目的:观察中西医结合治疗新型冠状病毒肺炎(以下简称新冠肺炎)的临床疗效。方法:采用非随机对照的研究方法,将178例普通型新冠肺炎患者按意愿分为治疗组和对照组,对照组予西医常规治疗,治疗组在对照组治疗基础上联用温阳化湿方及清热宣肺方治疗,比较两组患者临床症状缓解率,淋巴细胞比率恢复情况及病情转归。结果:两组患者发热、咳嗽、乏力、胸闷气短、咽痛、肌肉酸痛等临床症状缓解率治疗组高于对照组,差异具有统计学意义(P0.05);食欲下降改善两组患者比较差异无统计学意义(P0.05)。淋巴细胞恢复情况治疗组优于对照组,差异具有统计学意义(P=0.012)。进展为重型、危重型患者对照组多于治疗组,两组比较差异有统计学意义(P=0.034)。结论:西医常规联用温阳化湿方及清热宣肺方能明显缓解新冠肺炎患者临床症状,促进淋巴细胞恢复,降低病情进展风险,但在改善食欲方面无明显优势。     

温州地区中西医结合治疗新型冠状病毒肺炎临床研究

根据温州地区地处沿海、以湿为主的气候特点,笔者阐述了该地区新型冠状病毒肺炎的中医病因病机、辨证分型和治法方药,并分析病案1则.该地区新型冠状病毒肺炎可归属于中医学疫病、湿疫范畴,病位在肺,可伤及心、肝、胃、肠,主要病机为寒、热、湿、毒四者错杂,但化热伤津为其根本,当早期投大剂量清热解毒之品,以断其热势,不令传变.初期证...     

中医药干预新型冠状病毒肺炎临床研究方案分析

对中医药防治新型冠状病毒肺炎临床研究方案注册情况进行分析,为提高相关研究设计质量提供参考和建议。检索中国临床试验注册中心网站(www.chictr.org.cn)以及美国临床试验注册中心网站(clinicaltrials.gov),以新型冠状病毒肺炎、2019-nCoV等为检索词,检索新型冠状病毒肺炎中医药相关临床研究方案。按照纳入排除标准筛选文献,并提取研究注册时间、研究目的、研究类型、申办单位、研究对象、样本量、干预措施、评价指标等数据,采用描述性分析方法。共纳入新型冠状病毒肺炎中医药相关研究方案49个,研究负责单位以湖北、北京、浙江等地医院或高等院校为主。研究具体实施单位属地集中在湖北、广东、浙江、河南等地医院。研究设计以干预性试验研究为主(共40个),其中随机平行对照研究30个,非随机对照试验7个,单臂研究2个,连续入组1个;观察性研究6个;卫生服务研究2个;预防性研究1个。总样本量30562例,单个研究样本量最大20000例,最小30例。49个方案的研究对象包括健康人群(3个)、隔离观察人群(1个)、疑似病例(10个)、确诊病例(31个)、康复期病例(4个)。31个拟纳入确诊病例的研究方案中,有16个研究未明确病情分级,3个研究明确排除危重症,4个研究纳入普通型,2个研究纳入轻型、普通型或重型,1个研究纳入轻型和普通型,1个研究纳入普通型或重型,3个研究纳入重型,1个研究纳入重症或危重症。评价的干预措施包括中成药(连花清瘟胶囊/颗粒、藿香正气滴丸/口服液、八宝丹、固表解毒灵、金蒿解热颗粒、复方鱼腥草合剂、金叶败毒颗粒、疏风解毒胶囊、双黄连口服液、痰热清注射液、血必净注射液、热毒宁注射液、喜炎平注射液)、汤药、太极拳疗法。主要疗效指标以退热时间、临床症状缓解、新型冠状病毒核酸转阴、重症转化率、胸部CT影像为主。结果表明中医药防治新冠肺炎的临床研究响应快速,当前注册方案涵盖了疾病预防、治疗和康复全过程。但存在人群定义不清,研究目标不明确,干预方案需要细化,疗效评价指标需要优化等问题;另外,需要考虑疫情救治的实际困难和工作负担,在符合医学伦理条件下,优化流程,提高研究方案的可操作性。     

新型冠状病毒肺炎（COVID-19）中医药防治的思考

对2019年底于中国武汉发现并蔓延到全球的新型冠状病毒肺炎(coronavirusdisease2019,COVID-19)的疾病范畴、病邪性质和疾病发展进行阐述,鉴于中医药在历年来"瘟疫"中的应用,分析了中医药在此次COVID-19疾病中的治疗优势,即"扶正祛邪,以不变应变"和"辨证施治,以变应变",减少因激素等药物带来的后遗症,降低患者病死率等。并提出应用清热解毒类中药发挥其对COVID-19未感染者的预防优势;早期介入,通过抑制"细胞因子风暴"控制疾病向重症发展;根据"卫气营血辨证"理论指导临床辨证分型,发挥中医药防治COVID-19的个体化优势;关注COVID-19中药防治中的合理用药问题;收集临床真实世界数据,中医药为主,中西医结合,获得中西医结合防治COVID-19数据库等思路。     

Clinical characteristics of coronavirus disease 2019 in patients aged 80 years and older

ObjectiveCoronavirus disease 2019 (COVID-19) has raised concern around the world as an epidemic or pandemic. As data on COVID-19 has grown, it has become clear that older adults have a disproportionately high rate of death from COVID-19. This study describes the early clinical characteristics of COVID-19 in patients with more than 80 years of age.MethodsEpidemiological, clinical, laboratory, radiological, and treatment data from 17 patients diagnosed with COVID-19 between January 20 and February 20, 2020 were collected and analyzed retrospectively. Treatment outcomes among subgroups of patients with non-severe and severe symptoms of COVID-19 were compared.ResultsOf the 17 hospitalized patients with COVID-19, the median age was 88.0 years (interquartile range, 86.6–90.0 years; range, 80.0–100.0 years) and 12 (70.6%) were men. The age distribution of patients was not significantly different between non-severe group and severe group. All patients had chronic pre-existing conditions. Hypertension and cardiovascular diseases were the most common chronic conditions in both subgroups. The most common symptoms at the onset of COVID-19 were fever (n = 13; 76.5%), fatigue (n = 11; 64.7%), and cough (n = 5; 29.4%). Lymphopenia was observed in all patients, and lymphopenia was significantly more severe in the severe group than that in non-severe group (0.4 × 10⁹/L vs 1.2 × 10⁹/L, P = 0.014). The level of serum creatinine was higher in the severe group than in the non-severe group (99.0 μmol/L vs 62.5 μmol/L, P = 0.038). The most common features of chest computed tomography images were nodular foci in 10 (58.8%) patients and pleural thickening in 7 (41.2%) patients. All patients received antiviral therapy, while some patients also received intravenous antibiotics therapy (76.5%), Chinese medicinal preparation therapy (Lianhuaqingwen capsule, 64.7%), corticosteroids (35.3%) or immunoglobin (29.4%). Eight patients (47.1%) were transferred to the intensive care unit because of complications. Ten patients (58.8%) received intranasal oxygen, while 3 (17.6%) received non-invasive mechanical ventilation, and 4 (23.5%) received high-flow oxygen. As of June 20, 7 (41.2%) patients had been discharged and 10 (58.8% of this cohort, 77.8% of severe patients) had died.ConclusionThe mortality of patients aged 80 years and older with severe COVID-19 symptoms was high. Lymphopenia was a characteristic laboratory result in these patients, and the severity of lymphopenia was indicative of the severity of COVID-19. However, the majority of patients with COVID-19 in this age cohort had atypical symptoms, and early diagnosis depends on prompt use of a viral nucleic acid test.     

State-of-the-art evidence of traditional Chinese medicine for treating coronavirus disease 2019

Traditional Chinese medicine has widely been used internationally in the treatment of coronavirus disease 2019 (COVID-19) since January 2020. There has been great interest in initiating clinical studies testing different Chinese medicine therapies for COVID-19, but the majority of registered studies have yet to move forward due to a lack of COVID-19 patients in mainland China. The aim of this article was to systematically review the current clinical research evidence on Chinese medicine for treating COVID-19 from international and domestic bibliographic databases to reflect on the advances in this field.     

中医药分期防治新型冠状病毒肺炎的药性功效分析

新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)疫情严峻复杂,探讨中医药防治COVID-19处方的用药规律及特点具有重要意义。该研究收集2020年1月1日至2月18日国家卫生健康委员会,7个省市卫生健康委员会、国家中医管理局发布的和《新型冠状病毒肺炎中医诊疗手册》收录的中医药防治COVID-19诊疗方案以及3位国医大师、4位知名中医药专家所拟的方药,按照纳入、排除标准进行筛选,应用EpiData 3.0软件,建立"防治新型冠状病毒肺炎中医处方库""防治新型冠状病毒肺炎常用中药库",共收集有效中药处方93首,组成药物共计157味。应用SPSS 18.0软件进行数据分析,结果发现:①药性寒、温居多,其中性寒69味,占43.95%;性温57味,占36.31%;性热较少,仅占1.27%;②味苦、辛、甘药物较多,不同时期药味有异,初期以辛味居多,中期、重症期以苦味为主,恢复期多用甘味药;③归经以入肺、胃、心者多,入肺经最多,占24.55%;初、中期多入肺胃,重症期则入心肾;④口服药物多无毒,仅6味药物具有毒性,分别是苦杏仁、绵马贯众、重楼、细辛、半夏、炮附片;⑤以具有解表、化湿、清热、补虚、化痰止咳平喘5类功效的药物居多,初期解表与清热并重,各占18.81%;中期化痰止咳平喘药物使用多,占29.61%;重症期清热使用最多,占33.33%;恢复期补虚使用最多,占36.47%。中药防治COVID-19的药性特点和功效分布与中医对其病因、病位、病机的认识紧密相关,临证辨治尤需注重分期用药及因地制宜。     

Dangers of scientific bias against herbal drugs for coronavirus disease 2019

On May 15, 2020, the Lancet published an article titled Use of Herbal Drugs to Treat COVID-19 Should be with Caution. While this is true of all drugs, herbal and otherwise, the data may be biased and deserve a scientific response. We believe these types of reports will unfairly and negatively impact the field of integrative medicine as a whole, and must be answered with facts and statistics that more accurately represent the current situation.     

“顾护阳气”思想在新型冠状病毒肺炎证治中的应用探析

结合杭州市西溪医院所收治的新型冠状病毒肺炎(以下简称"新冠肺炎")的临床实践,笔者认为新冠肺炎以寒湿证为主,寒湿伤阳,且阳气是正气的重要组成部分,故治疗宜始终"顾护阳气",既重视阳气量之充足,又注重阳气运行之宣通。本病早、中、危重及恢复期4个阶段皆需顾护阳气:早期宜辅助阳气、透邪外出,温补卫阳或宣通阳气解表之凝滞。中期正邪交争剧烈,既要顾护阳气以防邪气内陷,又要祛除邪气以使正气来复:寒湿重者宜温阳散寒、利水渗湿;热势弥漫者宜清热泻火止汗,以截阳气外泄之势;热结成实者阳气功能异常,宜通降腑气,使阳气功能来复;同时邪正交争之证,需顾护胃气以滋卫阳、抵御疠气。危重期真阳厥脱,需回阳救逆、求得生机。恢复期注重瘥后防护,滋补阳气、阳复则阴生、清除余邪。     

莪术油注射液协同治疗新型冠状病毒肺炎(COVID-19)可行性浅析

当前新型冠状病毒肺炎(COVID-19)的治疗尚无特效药,国家医疗救治主管部门陆续发布多个针对COVID-19的诊疗方案。莪术油及其制剂在抗病毒、治疗肺纤维化等方面的疗效已被多项基础研究及临床应用所证实,推测在COVID-19的临床治疗中可试用莪术油注射液,特别是治疗肺间质改变造成的肺纤维化、促进止泻、减少患者发热时间等。此外,与抗病毒、抗生素等临床配伍使用的经验提示,莪术油注射液可用于减少COVID-19患者在治疗过程中药物引发性肝损伤,提高治疗效果。为莪术油及其制剂在协同治疗COVID-19中的科学使用提供理论依据。