中国医学科学院学报

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中国医学科学院学报

中国医学科学院学报 ›› 2020, Vol. 42 ›› Issue (4): 521-530.doi: 10.3881/j.issn.1000-503X.12915

• 全民健康助力全面小康专栏 • 上一篇    下一篇

中药使用时机对重症新型冠状病毒肺炎的治疗效果及预后的影响

张安1,李延萍2,邱敏3,刘华宝4,陈中沛5,万鹏6,陶杨6,王辉7,魏大荣8,李群堂9(),秦娅蓝1()   

  1. 1重庆医科大学附属第二医院重症医学科,重庆 400010
    2重庆市中医院风湿科,重庆 400021
    3重庆市中医院肿瘤科,重庆 400021
    4重庆市中医院肝病科,重庆 400021
    5重庆市中医院内分泌科,重庆 400021;重庆市北碚区中医院
    6脾胃病科,重庆 400021;重庆市北碚区中医院
    7肺病科,重庆 400700
    8重庆市三峡中心医院中医科,重庆 404100
    9重庆市中医院治未病中心,重庆 400021
  • 收稿日期:2020-04-29 出版日期:2020-08-30 发布日期:2020-09-08
  • 通讯作者: 李群堂,秦娅蓝 E-mail:326809469@qq.com;532039856@qq.com
  • 基金资助:
    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”(2020ZYLCYJ02-2);重庆市科学技术局“新型冠状病毒感染肺炎疫情应急科技攻关专项”(cstc2020jscx-fyzxX0012)

Impact of the Timing of Traditional Chinese Medicine Therapy on the Therapeutic Effect and Prognosis of Severe Coronavirus Disease 2019

ZHANG An1,LI Yanping2,QIU Min3,LIU Huabao4,CHEN Zhongpei5,WAN Peng6,TAO Yang6,WANG Hui7,WEI Darong8,LI Quntang9(),QIN Yalan1()   

  1. 1Department of Critical Care Medicine,the Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China
    2Department of Rheumatology,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China
    3Department of Oncology,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China
    4Department of Liver Disease,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China
    5Department of Endocrinology,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China
    6Department of Gastroenterology,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China
    7Department of Respiratory Medicine,Chongqing Beibei District Hospital of Traditional Chinese Medicine,Chongqing 400700,China
    8Department of Traditional Chinese Medicine,the Three Gorges Central Hospital of Chongqing,Chongqing 404100,China
    9Treating Potential Diseases Center,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China
  • Received:2020-04-29 Online:2020-08-30 Published:2020-09-08
  • Contact: LI Quntang,QIN Yalan E-mail:326809469@qq.com;532039856@qq.com
  • Supported by:
    Novel Coronavirus Pneumonia Emergency Special Project for Chinese Medicine of National Administration of Traditional Chinese Medicine(2020ZYLCYJ02-2);Novel Coronavirus Pneumonia Epidemic Emergency Project in Chongqing of Chongqing Science and Technology Bureau(cstc2020jscx-fyzxX0012)

摘要:

目的 探索中药治疗重症新型冠状病毒肺炎[又称2019冠状病毒病(COVID-19)]的最佳切入时机及其对治疗效果和预后的影响。方法 收集2020年1月20日至3月11日重庆市64例联合中药治疗的COVID-19重症患者临床资料,在首次诊断为重型/危重型COVID-19后,3 d以内(包括第3天)开始服用中药患者为早期干预组,在首次诊断为重型/危重型COVID-19后,7 d以后(包括第7天)开始服用中药患者为晚期干预组,比较两组患者的临床疗效及预后。结果 入组第14天,早期干预组氧合指数为292.5(252.0,351.0)mmHg(1 mmHg=0.133 kPa),明显高于晚期干预组的246.0(170.0,292.5)mmHg(P=0.005)。早期干预组住院时间[(18.56±1.11)d比(24.87±1.64)d,P=0.001]、住ICU时间[(14.12±0.91)d比(20.00±1.53)d,P=0.000]及病毒核酸转阴时间[(16.77±1.04)d比(22.48±1.66)d,P=0.001]均明显短于晚期干预组。早期干预组气管插管率(7.3%)较晚期干预组(30.4%)更低(P=0.028)。结论 初次诊断为重症COVID-19后3 d以内(早期)予以中药治疗可缩短患者的住院时间、住ICU时间、核酸转阴时间并降低插管率。

关键词: 新型冠状病毒肺炎, 中西医结合治疗, 中药治疗时机, 治疗效果, 预后

Abstract:

Objective To explore the optimal therapy time for the treatment of severe coronavirus disease 2019(COVID-19)by traditional Chinese medicine(TCM)and its influence on the therapeutic effect and prognosis. Methods The clinical data,laboratory findings,and outcomes of 64 patients with severe COVID-19 treated with TCM and western medicine in Chongqing from January 20,2020, to March 11,2020 were retrospectively analyzed.Patients were divided into early intervention group[TCM was initiated within 3 days (including day 3) after the first diagnosis of severe type/critical type COVID-19]and late intervention group[TCM was initiated after 7 days (including day 7) after the first diagnosis of severe type /critical type COVID-19].The changes in clinical parameters during the course of disease were compared between the two groups. Results On day 14,the oxygenation index was 292.5(252.0,351.0)mmHg in the early intervention group,which was significantly higher than that in the late intervention group [246.0(170.0,292.5)mmHg](P=0.005).The length of hospital stay [(18.56±1.11)d vs.(24.87±1.64)d,P=0.001],duration of ICU stay [(14.12±0.91)d vs.(20.00±1.53)d,P=0.000] and time to negativity [(16.77±1.04)d vs.(22.48±1.66)d,P=0.001] in the early intervention group were significantly shorter than those in the late intervention group.The intubation rate(7.3%)in the early intervention group was significantly lower than that in the late intervention group(30.4%)(P=0.028). Conclusion Early TCM therapy within three days after a diagnosis of severe COVID-19 can shorten the length of hospital stay,duration of ICU stay,and time to negativity and decrease intubation rate.

Key words: coronavirus disease 2019, therapy combined the traditional Chinese and western medicine, timing of traditional Chinese medicine therapy, therapeutic effect, prognosis

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