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

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

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。

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.