2108例新型冠状病毒奥密克戎变异株感染患者的中医证候特征及诊疗策略探析

Characteristics of TCM Syndromes and Diagnosis and Treatment Strategies in 2108 Cases of 2019-nCoV Omicron Variant Infection

目的分析2108例新型冠状病毒奥密克戎变异株(SARS-CoV-2 Omicron BA.2)感染患者的中医证候特征,探讨其病机特点,为该病的中医防治提供临床依据,为其他地区抗疫工作提供参考。方法收集2022年3月16日—2022年3月31日长春通源方舱医院收治的新型冠状病毒奥密克戎感染患者2108例作为研究对象,收集、分析患者的基本信息、流行病学史、入院时中医证候特征及舌象等,采用描述性分析方法,观察本次新型冠状病毒奥密克戎感染患者的中医证候特征,分析其病机特点[1]。结果中医临床症状出现频次最高的6种依次为:咳嗽1616次(76.66%)、咳痰1379次(65.42%)、口干渴1230次(58.35%)、乏力1011次(47.96%)、鼻塞喷嚏989次(46.92%)、咽痛975次(46.25%)。舌色出现频次由高到底依次为:淡红舌(608/2076,29.29%)、绛舌(505/2076,24.33%),红舌(390/2076,18.79%)、青紫舌(382/2076,18.40%)、淡白舌(234/2076,11.27%);舌形多见胖大舌(719/2076,34.63%)、齿痕舌(666/2076,32.08%)、瘦薄舌(367/2076,17.68%)、裂纹舌(202/2076,9.73%)、质嫩舌(188/2076,9.06%)、其他(133/2076,6.41%)。舌苔出现频次由高到底依次为:白腻苔(824/2076,39.69%)、白滑苔(250/2076,12.04%)、薄白苔(417/2076,20.09%)、黄腻苔(209/2076,10.07%)、少苔(162/2076,7.08%)、薄黄苔(160/2076,7.71%)、其他(102/2076,4.91%)。中医证型出现频次依次为邪郁肌腠,肺经郁火证、疫毒外袭,寒湿内盛证、气阴两伤,疫毒痹肺证、脾肾虚冷,瘀毒化痈证。结论吉林省新型冠状病毒奥密克戎变异株感染患者的中医证候特征具有一定规律性,“肺脾气虚、寒湿偏盛”的状态为发病基础,病机特点为在寒湿基础上,以“邪郁肌腠,寒热错杂”为主,呈现出“寒、湿、瘀、虚、痹”等病证表现。结合吉林地区环境及人群特点,制定了以“消除症状、截断病情、快速转阴”为目的,以“分层辨证,分方而治,先表后里,或表里同治,内外通透”为治疗原则的诊疗策略,取得较好疗效,明显缩短住院时间。

Objective The characteristics of TCM syndromes of 21082019-nCoV omicron variant infection cases were analyzed to explore the pathogenesis of the disease,providing clinical basis for TCM prevention and treatment of the disease and reference for anti-epidemic work in other areas.Methods A total of 2108 patients with 2019-nC oV omicron variant infectionadmitted to Changchun Tongyuan MTB from March 16,2022 to March 31,2022 were collected as research objects.Their basic information,epidemiological history,characteristics of TCM syndromes and tongue image on admission were collected and analyzed by descriptive analysis.The TCM syndrome characteristics of these patients wereobserved andtheir pathogenesis was analyzed[1].Results The six most frequent clinical symptoms of traditional Chinese medicine were 1616 times of cough(76.66%),1379 times of expectoration(65.42%),1230 times of thirst(58.35%),1011 times of fatigue(47.96%),989 times of nasal obstruction and sneezing(46.92%)and 975 times of sore throat(46.25%).The frequency of tongue color from high to low was light red tongue(608/2076,29.29%),dark red tongue(505/2076,24.33%),red tongue(390/2076,18.79%),cyan tongue(38/2076,18.40%)and light white tongue(234/2076,11.27%).The tongue shape was mostly fat tongue(719/2076,34.63%),tooth-marked tongue(666/2076,32.08%),thin tongue(367/2076,17.68%),cracked tongue(202/2076,9.73%),tender tongue(188/2076,9.06%)and others(133/2076,6.41%).The frequency of tongue coating from high to low was white greasy coating(824/2076,39.69%),white slippery coating(250/2076,12.04%),thin white coating(417/2076,20.09%),yellow greasy coating(209/2076,10.07%),less coating(162/2076,7.08%),thin yellow coating(160/2076,7.71%)and others(102/2076,4.91%).The frequency of TCM syndrome types included evil stagnation in muscles,stagnation of fire in lung meridian,external attack of epidemic toxin,internal excess of cold and dampness,both injury of Qi and Yin,stagnation of lung by epidemic toxin,deficiency and cold of spleen and kidney,and blood stasis and toxin transforming carbuncle.Conclusion The TCM syndromes of patients infected with 2019-nC oV omicronvariant strain in Jilin Province have a certain regularity,the state of“deficiency of lung Qi and excessive cold and dampness”is the basis of the disease,and the pathogenesis is based on the cold and dampness,with“evil stagnation in muscles,cold and heat mixing”as the main feature,presenting the syndromes of“cold,dampness,blood stasis,deficiency and Bi syndrome”.Combined with the environment and population characteristics in Jilin,the diagnosis and treatment strategy was formulated for the purpose of“eliminating symptoms,cutting off the condition and turning to be negative quickly”,and the treatment principle was“layered syndrome differentiation,treatment by prescriptions,treatment from the outside to the inside,or treatment from the outside to the inside,or simultaneous treatment of the interior and the exterior”,which achieved good curative effect and significantly shortened the length of hospital stay.