36例H7N9禽流感患者中医证候学特征

目的:通过H7N9禽流感病例回顾性研究,初步探讨甲型H7N9流感的证候特点及核心病机。方法:回顾性整理2013年2月26日至2013年5月1日期间北京、上海等8个省市收治的36例采用中医药治疗的甲型H7N9流感患者的流行病学、症候学及中医治疗情况,分析其中医病证和病机特点。结果:36例H7N9患者流行病学特点,患者平均发病后第6天入院,入院后第2天入住ICU,病毒核酸转阴时间为发病后15 d;症候学特点,患者100%发热,最高体温(39.14±0.62)℃,伴咳嗽,咳痰,恶寒轻或不恶寒,但头痛、周身酸痛、咽痛、鼻塞流涕等风热束表上犯症状少见;3~6 d后高热寒战,渐次出现痰中带血、短气、胸闷、呼吸困难,舌红苔腻,病情转重;6~14 d患者痰中带血,胸闷喘憋、呼吸困难加重,并出现皮肤红疹、花斑,舌质深红或紫,少津;10~14 d后患者身热渐退,痰血减少甚则消失,进入恢复期,以倦怠乏力,舌质红、苔薄少津为特点。结论:中医证候演变符合温病卫气营血传变规律,该病病情加重的拐点可能在4~5 d左右,8~10 d病情最重,始动因素及根本为温热疫毒,热毒、瘀毒为关键,病理因素为热、毒、瘀、虚兼夹且始终贯穿整个病程,核心病机为毒热犯肺,壅肺、损肺,甚则伤及其他脏腑。

TCM Syndrome Characteristics of 36 Cases of H7N9 Avian Influenza

Objective： To explore the specialties and core pathogenesis of traditional Chinese medicine （TCM） in treating H7N9 avian influenza infection. Methods： Thirty six cases of H7N9 avian influenza patients from Beijing, Shanghai and other eight provinces who were given TCM therapy between February 26, 2013 to May 1,2013 were collected. According to the epidemiology, syndrome and treat- ment of these patients, characteristics of TCM syndromes and pathogenesis were analyzed. Results： Epidemiology characteristics were as follows： Averagely, patients were admitted to hospital on the 6th day of their onset, and taken to ICU on the 2nd day of admission, and the virus turned to negative on the 15th day of the onset. Symptomatology characteristics were that 100% of patients would have fever, and the highest temperature was （39. 14 ~ 0. 62 ）~C. Patients had cough, phlegm, aversion to cold, but seldom had symptoms of head- ache, sore throat, running nose; patients usually had high fever on the 3rd to 6th day with more severe conditions such as blood in phlegm, short breath, dyspnea, greasy and red tongue; on the 6th to 14th day, patients got more severe conditions with rashes in the skin; on the 10th to 14th day, the fever was getting away, blood in phlegm decreased, and patients were recovering with fatigue feeling and red tongue. Conclusion： The change of syndrome fits the principle of TCM warm disease. The turning point of getting severe is on the 4th to 5th day. The most dangerous condition usually occurs on the 8th to 10th day. The core pathogenesis is virus invading lung to stuff and hurt it.