国医大师刘志明辨证施治重型与危重型新型冠状病毒肺炎的CT动态变化半定量分析

Semi-quantitative analysis of CT imaging dynamic changes to the curative effect of treatment based on disease differentiation to severe and critical COVID-19 patients by Chinese Medicine Master Dr.LIU Zhiming

目的:回顾性分析经国医大师刘志明采用中医药治疗的重型与危重型新型冠状病毒肺炎(简称新冠肺炎)的临床及胸部CT动态变化特征。方法:收集国医大师刘志明诊治的2例重型及4例危重型新冠肺炎的临床和CT资料。重点观察服用中药前与服用中药1周后患者的临床症状及影像表现变化。结果:服用中药1周后患者临床症状明显改善,呼吸机逐步撤除,服中药后3~10 d出院。中药治疗前后CT表现:服中药前患者以磨玻璃影伴混杂密度居多,部分伴明显实变;随病程进展,条索样改变逐渐增多,2例存在胸腔积液;病变分布以右肺中上区多见。中药治疗后1周左右CT示磨玻璃影及实变明显吸收,康复期表现为少许磨玻璃影改变及纤维条索状影。结论:新冠肺炎患者在加服中药治疗后临床症状明显改善,肺部病灶逐步吸收,达到临床治愈。

Objective:To retrospectively analyze the clinical data and chest CT imaging dynamic changes of severe and critical patients with COVID-19 treated by Chinese Medicine Master Dr.LIU Zhiming,and to explore the relationship between imaging and therapeutic effect.Methods:Clinical and CT data were collected for 2 cases of severe and 4 cases of critical COVID-19 treated by Dr.LIU Zhiming with traditional Chinese medicine(TCM).The changes of clinical symptoms and semi-quantitative imaging results of patients were analyzed and compared between before and after one week taking herbal medicine.Results:After taking herbal medicine,the patient’s clinical symptoms were significantly improved within 1 week,especially fever.The leukocyte gradually returned to normal,the ventilator was gradually removed,and the patients were discharged from hospital in about 10 days.The CT imaging findings before and after herbal medicine:the images of severe patients were generally less serious than those of critical patients.Before taking herbal medicine,most patients showed the ground-glass opacity(GGO)and some had obvious consolidation,or the mixed density with both of GGO and consolidation.in the disease course,the stripes pattern gradually increased,and 2 patients had pleural effusion.About 1 week after taking herbal medicine,CT showed obvious absorption of ground-glass opacity and consolidation,and the sparse ground glass change and fiber stripes in the recovery period.The distribution of the lesion was mainly in the upper and middle right lung.Conclusion:After taking herbal medicine,the pulmonary inflammation was absorbed and the clinical symptoms were significantly improved for COVID-19 severe and critical patients.