海南省1155例新型冠状病毒Omicron(BA.5.1.3)变异株感染的中医证候特征及诊疗策略

Traditional Chinese Medicine syndromes and treatment strategies in 1155 patients infected with the Omicron(BA.5.1.3)variant in Hainan Province

目的 分析海南省新型冠状病毒奥密克戎变异株(BA.5.1.3)感染者中医证候特征及中医治法治则。方法 纳入海南省三亚市2022年8月4至19日方舱医院、定点医院收治的感染奥密克戎变异株(BA.5.1.3)的成人病例,收集病例中医证候信息,通过潜在类别分析探讨此次疫情的核心病机。结果 共纳入1 155例病例,其平均年龄(46.1±15.5)岁,临床分型以轻型(77.1%)和无症状感染者(21.7%)为主。症状以咳嗽(57.6%)、咳痰(42.3%)、咽痛(21.7%)、鼻塞流涕(17.6%)为主。舌质为舌淡红(59.8%)、舌红(33.4%)、舌紫暗(2.3%),舌苔多为苔薄白(43.7%)、苔薄黄(25.8%)、苔白腻(11.4%)。脉以滑脉(36.8%)、浮脉(29.4%)、弱脉(11.9%)为主。在证候演变上,发热多出现病程早期,随后咳嗽、鼻塞流涕、咽干、纳差占比上升,而至发病7 d以后,各症状占比均呈下降趋势。胸闷、气短、纳差、便秘、滑脉、舌紫暗、苔白腻多见于重症高危病例。结论 新型冠状病毒奥密克戎变异株(BA.5.1.3)感染的核心病机为暑热夹湿,以上焦病变为核心,早期疫疠邪气挟风热袭表,随后病邪逐渐由表入里侵犯肺及脾胃,暑湿表现较为明显,采取清热透邪、化湿解毒之法。而重症高危人群多表现阳气受损,湿毒未清的特点,予以益气温阳,化湿解毒。

Objective To analyze the Traditional Chinese Medicine(TCM)Syndromes in patients infected with the Omicron(BA.5.1.3)variant in Hainan province.Methods From August 4 to 19,2022,1155 adults infected with the Omicron variant(BA.5.1.3)in Sanya were included.The latent class analysis was used to investigate the core pathogenesis of the epidemic.Results Mean age of the 1155 patients was(46.1±15.5)years.Most of them were mild(77.1%)and asymptomatic(21.7%).Cough(57.6%),expectoration(42.3%),sore throat(21.7%)and stuffy and runny nose(17.6%)were the main symptoms with light red(59.8%),red(33.4%)and purple(2.3%)tongue body.The tough coatings were thin white(43.7%),thin yellow(25.8%)and white-greasy(11.4%).The pulses were slippery(36.8%),floating(29.4%),followed by a weak pulse(11.9%).In terms of the evolution of the symptoms,fever tended to appear in the early phase,followed by an increase in the proportion of cough,stuffy and runny nose,dry throat and poor appetite,and a decrease in the proportion of symptoms after 7 days.The proportion of chest tightness,shortness of breath,poor appetite,constipation,slippery pulse,purple tongue and white-greasy coating were higher in high-risk patients.Conclusion The core pathogenesis of the Omicron(BA.5.1.3)variant infection was summer-heat and dampness.The treatment principle was clearing heat,removing toxin and dampness for non-high-risk cases.High-risk cases presented with impaired yang energy with dampness and toxins,and these cases were treated with supplementing Qi and Warm Yang in the basis of removing toxin and dampness.