清肺排毒汤联合西医常规疗法治疗老年新型冠状病毒肺炎157例临床疗效回顾性研究

Qingfei Paidu Decoction(清肺排毒汤)Combined with Western Routine Treatment for Elderly Patients with Coronavirus Disease 2019:A Retrospective Study

目的回顾性分析清肺排毒汤联合西医常规治疗老年新型冠状病毒肺炎(新冠肺炎)的临床疗效。方法回顾性收集2020年1月21日至3月18日9个省(直辖市) 36家医院确诊的老年新冠肺炎病例,并根据临床分型分为重型组(包括重型和危重型)和非重型组(包括轻型和普通型)进一步分层探讨。描述患者的一般资料,对比分析患者服用清肺排毒汤治疗前及治疗3天、6天后临床症状(包括发热、咳嗽、乏力、厌食、气喘),实验室指标变化(包括白细胞计数、中性粒细胞计数、淋巴细胞计数、丙氨酸氨基转氨酶、门冬氨酸氨基转氨酶、肌酐、尿素氮、乳酸脱氢酶、降钙素、C反应蛋白),肺部病灶吸收情况。记录患者治疗转归情况及核酸转阴时间、住院时间及不良事件发生情况。结果共纳入157例老年新冠肺炎病例,其中非重型组131例(83.4%),重型组26例(16.6%)。与治疗前比较,清肺排毒汤联合西医常规治疗3天、6天后发热、咳嗽、乏力、气喘症状人数减少(P<0.05或P<0.01);患者完全退热时间为1.0 (1.0,3.0)天,气喘缓解时间为1.0 (1.0,4.0)天,重型组与非重型组患者完全退热时间和气喘缓解时间比较差异有统计学意义(P<0.05)。与治疗前比较,157例患者治疗6天后淋巴细胞计数、乳酸脱氢酶及C反应蛋白改善明显(P<0.05)。治疗6天后,共获得肺部CT影像学资料完整患者114例,其中94例患者肺部病灶呈现不同程度的吸收,吸收率为82.5%。155例患者痊愈出院,2例重症患者死亡,痊愈患者第一次核酸转阴中位时间为11.0 (3.0,16.0)天,平均住院时间为19.0 (6.0,23.0)天。痊愈患者治疗期间均未发生严重不良事件。结论清肺排毒汤联合西医常规疗法可改善老年新冠肺炎患者的临床症状,改善炎症指标,促进肺部病灶的吸收,改善预后,且安全性好。

Objective western routine treatment for elderly patients with coronavirus disease 2019(COVID-19).MethodsClinical data of elderly COVID-19 patients were retrospectively collected from 36 hospitals in 9 provinces(municipalities)from January 21 to March 18,2020.Patients were classified into severe group(severe and critically ill cases)and non-severe group(mild and moderate cases)for further analyses.Data on the general information,clinical symptoms including fever,cough,fatigue,anorexia and asthma,laboratory indexes including white blood cell count,neutrophil count,lymphocyte count,alanine aminotransferase,aspartate aminotransferase,creatinine,urea nitrogen,lactate dehydrogenase,calcitonin and C-reactive protein,and absorption of lung lesions were assessed and compared between baseline and three days as well as six days after treatment.The time to negative conversion of nucleic acid test result and hospitalization duration were calculated,and adverse events were recorded.ResultsA total of 157 elderly COVID-19 cases were included,with 131(83.4%)patients in the non-severe group and 26 patients(16.6%)in the severe group.Compared to those before treatment of Qingfei Paidu Decoction and routine therapy,the number of patients with fever,cough,fatigue and asthma after 3-day and 6-day treatment significantly decreased(P<0.05 or P<0.01).The time to relief of fever was 1.0(1.0,3.0)day,and that of asthma was 1.0(1.0,4.0)day;there were significant differences between severe and non-severe group in the relief time of fever and asthma(P<0.05).After six days of treatment,the lymphocyte count,lactate dehydrogenase and C-reactive protein were significantly improved(P<0.05);different degrees of absorption were seen in 94 out of 114(82.5%)patients whose lung imaging results were available.Of the 157 patients,155 were cured and discharged,while two severe patients died;for discharged patients,the median time to first negative conversion of nucleic acid test result was 11.0(3.0,16.0)days,and the average hospitalization duration was 19.0(6.0,23.0)days.No serious adverse events occurred.Conclusion Qingfei Paidu Decoction combined with western routine treatment can improve clinical symptoms of elderly COVID-19 patients,improve inflammation indicators,promote the absorption of lung lesions,improve prognosis,and is considered to be safe.