78例重型和危重型新型冠状病毒肺炎患者中医临床特点分析

Analysis of Chinese Medical Characteristics of 78 Patients with severe COVID-19

目的对78例重型和危重型新型冠状病毒肺炎(COVID-19)患者中医证候进行分析,为临床辨证论治提供科学依据。方法以2020年2月8日至2020年3月1日收治于武汉协和医院的78例重型和危重型新型冠状病毒肺炎患者为研究对象,统计基本信息、基础疾病情况、症状、体征及舌象等信息,分析重型和危重型患者证型分布。结果重型和危重型患者主要临床症状占比排前5位:胸闷气喘(92.30%)、纳呆(82.05%)、自汗(76.92%)、咳嗽(64.10%)、发热(43.59%),其余还有咯痰(41.03%)、咽干咽痛(38.46%)、胸痛(23.07%)、乏力(15.38%)、肌肉酸痛(10.26%)、心悸(7.69%)、便秘(8.97%)等全身症状。舌象方面,舌质以淡红舌(43.58%)和暗红舌(38.46%)多见,另有紫暗舌8例(10.26%),红绛舌6例(7.69%);舌苔多为腻苔(71.79%),其中黄腻苔有38例(48.72%),白腻苔26例(33.33%),少或无苔者6例(7.69%);另有舌体胖大者18例(23.08%),齿痕舌22例(51.28%)。中医证型分布为湿热壅肺证(23.08%)、疫毒闭肺证(64.10%)、内闭外脱证(10.26%)、阴竭阳脱证(2.56%)。结论重型COVID-19中医证候以湿热壅肺证、疫毒闭肺证为多见,疾病至危重期,可能出现内闭外脱、阴竭阳脱等危症。

Objective:To analyze the Chinese medical syndromes of 78 patients with severe COVID-19,providing scientific basic for clinical diagnosis and treatment of diseases.Methods:The data was collected from February 8,2020 to Mar 1,2020,including basic diseases,clinical manifestations and tongue image.The distribution of syndromes was analyzed by cluster analysis.Result:The top five clinical features were wheezing breath(92.30%),poor appetite(82.05%),spontaneous perspiration(76.92%),cough(64.10%),fever(43.59%),and some other symptoms,covering expectoration(41.03%),pharynx-ache(38.46%),chest pain(23.07%),weak(15.38%),bodily pain(10.26%),palpitation(7.69%),constipation(8.97%).In terms of tongue picture,light red tongue(43.58%)and dark red tongue(38.45%)were the most common,and there were 8 cases(10.26%)of purple tongue and 6 cases(7.69%)of red and crimson tongue;the tongue coating was mostly greasy(71.79%),including 38 cases of yellow greasy coating(48.72%),26 cases of white greasy coating(33.33%),6 cases of little or no coating(7.69%);18 cases of fat tongue(23.08%)and 22 cases of tooth mark tongue(51.28%).The TCM were divided into four types,i.e.accumulation of phlegm-heat syndrome(64.10%),heat stasis syndrome(23.08%),flaring heat in qifen and yingfen syndrome(10.26%),syndrome of depletion of yin causing yang collapse(2.56%).Conclusion:Among the 78 COVID-19 cases,the syndromes of dampness-heat obstructing the lung and epidemic virus closing the lung are most common.In the critical stage,there may be some dangerous diseases,such as inner closure and outer detachment,Yin exhaustion and Yang withdrawal.