308例新型冠状病毒肺炎病例回顾性分析及抗疫强身功运动处方的临床应用方案

Retrospective analysis on 308 cases of COVID-19 and clinical application protocol of Kangyi Qiangshen Gong exercise prescription

目的通过回顾性分析308例湖北黄石地区新型冠状病毒肺炎(简称"新冠肺炎")病例的临床特征,结合中医传统功法的核心要素和研究证据,形成安全有效、简单易学的抗疫强身功临床应用方案。方法收集湖北省黄石市中医医院2020年1月25日至2020年2月20日期间收治的308例新冠肺炎病例的出入院病历资料(分类为轻型、普通型、重型、危重型四大类),分析统计各类型病例的临床资料、辅助检查及治疗方案。临床资料包括患者的一般资料(性别、年龄)、入院体征、病情程度、中医辨证分型、主要临床症状、症状好转时间、症状出院遗留情况、肺部CT变化情况、治疗转归等。结果①入院时普通型和轻型患者合计所占比例达到61%,而且随着重型患者的不断康复,普通型和轻型病例占比进一步增加;随着轻型到危重型病情的加重,患者的平均住院时间不断延长。②危重型死亡患者的平均年龄为74.1岁,与重型死亡年龄相比差异有统计学意义,危重型死亡患者的年龄普遍偏大(P<0.05),且病情进展迅速,平均住院时间9.2 d后死亡;死亡病例均为重型、危重型的患者,此类患者确诊前均有基础疾病。③本研究中308例患者的病死率达5.19%,高于国家疾控中心统计的全国平均病死率3.83%;危重型的病死率为57.14%,重型的病死率为4.82%;轻型与普通型的病死例数为0、无病情转为重型者,重型中有4例转为危重型后死亡。④308例患者的中医证型以寒湿郁肺型为主,占比达82%;同时还有国家卫生健康委版诊疗方案中未提到的风热犯肺型占13%,湿邪郁肺型占5%。⑤咳嗽、发热、胸闷和乏力是最主要、最多见症状;其中发热和腹泻相对好转更快、持续时间更短,且出院症状遗留少;咳嗽、胸闷和乏力好转所需的时间更长,且出院症状遗留更多见,尤其咳嗽的出院遗留比例最高,与其他症状相比,差异具有统计学意义(P<0.05)。⑥典型病例治疗后肺部CT示感染灶范围稍缩小、密度减低,但双肺仍呈磨玻璃样改变,提示患者后期肺功能会降低,会有胸闷和呼吸困难的症状遗留问题。⑦在回顾古代文献和现代中医功法文献证据的基础上,结合湖北地区新冠肺炎病例临床特点,可从普通型、轻型和出院居家患者的角度设计功法运动处方。结论基于湖北地区新冠肺炎病例临床特征,从中医传统功法中设计出的有针对性的抗疫强身功,有望缓解新冠肺炎患者的主要临床症状,尤其咳嗽、胸闷、乏力等常见的出院遗留症状,进而促进患者的早日康复。

Objective To design a safe,effective,simple and easy-to-learn Kangyi Qiangshen Gong(anti-epidemic and body-strengthening exercise)for clinical application to combat epidemic and strengthen body function through a retrospective analysis of 308 coronavirus disease 2019(COVID-19)cases in Huangshi,Hubei province and with the combination of core elements and research evidence of traditional Chinese medicine(TCM)Qigong exercises.Methods The medical records of 308 COVID-19 cases(classified into four types:mild,moderate,severe and critical)admitted to Huangshi Hospital of Traditional Chinese Medicine from January 25,2020 to February 20,2020 were collected,and the clinical data,auxiliary examinations and treatment plans of each type were analyzed statistically.The clinical data included each patient’s general information(gender,age),admission signs,degree of illness,TCM syndrome differentiation and classification,main clinical symptoms,time required for symptom improvement,residual symptoms at discharge,CT image changes of the lungs,and treatment outcomes,etc.Results①On admission,the total proportion of patients with moderate and mild COVID-19 reached 61%,and with the continuous recovery of severe cases,the proportion of moderate and mild cases further increased.With the aggravation of the disease from mild to critical,the average hospitalization duration of patients was continuously prolonged.②The average age of the dead patients with critical COVID-19 was 74.1 years old,which was significantly different from that of dead patients with severe COVID-19.The age of dead patients of critical type was older(P<0.05),and before death the average hospitalization time was 9.2 days which showed a rapid progress of disease.The death cases were all patients with severe or critical COVID-19,and all of these patients were diagnosed with basic diseases before the confirmation of infection.③The mortality rate of 308 cases in this study reached 5.19%,which was higher than the national average mortality rate of 3.83%issued by the National Center for Disease Control and Prevention.The mortality rate of critical cases was 57.14%,while the mortality rate of severe cases was 4.82%.The number of death cases of mild and moderate type was 0 and no case changed to severe type,but there were 4 death cases of critical type changing from severe type.④The TCM syndromes of 308 patients were mainly cold-dampness stagnating in the lungs,accounting for 82%.There were also 13%of wind-heat invading the lungs syndrome and 5%of dampness-pathogen stagnating in the lungs syndrome,which were syndromes unmentioned in the Diagnosis and Treatment Protocol for COVID-19 issued by the National Health Committee.⑤Cough,fever,chest tightness and fatigue were the most important and common symptoms.Among them,fever and diarrhea relatively had faster improvement with shorter duration and less residual symptoms at discharge.Cough,chest tightness and fatigue took longer to improve with longer persistence of symptoms at discharge.Cough,in particular,had the longest persistence at discharge compared with other symptoms and the difference was statistically significant(P<0.05).⑥In typical cases,lung CT showed slightly reduced scope of infection foci and reduced density after treatment,but both lungs still showed ground glass-like changes suggesting that the lung function of patients would decrease in the later stage and there would be chest tightness and dyspnea.⑦By reviewing ancient and modern literature of TCM Qigong exercises and methods,and combining the clinical characteristics of COVID-19 cases in Hubei province,TCM Qigong exercises can be respectively designed for different types of patients,ranging from moderate type,mild type to discharged ones.Conclusion Based on the clinical characteristics of COVID-19 cases in Hubei province,the designed Kangyi Qiangshen Gong(anti-epidemic and body-strengthening exercise)are expected to relieve the main clinical symptoms of patients with COVID-19,especially those persistent symptoms at discharge such as cough,chest tightness and fatigue,thus promoting the early recovery of patients.