87例新型冠状病毒感染儿童中医临床疗效回顾性分析

Retrospective Analysis of Clinical Efficacy of Traditional Chinese Medicine in 87 Children with Corona Virus Disease 2019

目的分析石家庄市人民医院87例新型冠状病毒感染儿童的中医证候特征,为中医药的临床辨证治疗提供参考依据。方法在国家救治指南的基础上,对87例新型冠状病毒感染儿童进行辨证论治。观察治疗前后的临床资料,包括一般资料,中医证候改善情况,舌象变化,外周血白细胞计数(WBC),中性粒细胞计数(NE#),淋巴细胞计数(LYMPH#),C反应蛋白(CRP),肌酸激酶同工酶(CKMB)及胸部CT影像改善情况。结果87例患儿其中男童36例,女童51例,平均年龄8岁1个月,包括轻型34例,普通型27例,无症状感染26例。发生率较高的症状依次是咳嗽19例(21.84%)、发热18例(20.69%)、流涕11例(12.64%);经治疗后,平均退热时间为3 d,咳嗽、咳痰及鼻塞、流涕症状发生率较治疗前明显降低。治疗前舌淡红(红)苔白(厚)腻72例(82.76%),治疗后舌淡红苔白微腻59例(67.82%);治疗前的中医证候以疫毒犯表证53例(60.92%)、疫毒郁肺证27例(31.03%)和疫毒困脾证7例(8.05%)为主,治疗后以肺脾气虚证78例(89.66%)和气阴两虚证9例(10.34%)为主。外周血常规提示白细胞计数降低2例,淋巴细胞绝对值降低8例,中性粒细胞绝对值升高10例,少数患儿出现C反应蛋白,肌酸激酶同工酶异常,经过2个疗程后(6 d),可以见到大部分患儿指标逐渐转为正常,其中白细胞计数、淋巴细胞绝对值、C反应蛋白与治疗前相比明显改善,经秩和检验,差异有统计学意义(P<0.05),而肌酸激酶同工酶数值改变不明显,差异不具统计学意义(P>0.05)。CT显示斑片状阴影25例(28.74%),磨玻璃样变2个(2.30%),治疗后斑片状阴影明显减少为11例(12.64%),磨玻璃样变效果不明显仍为2例(2.30%)。结论新型冠状病毒感染(COVID-19)属于中医“疫病”“温病”“瘟疫”范畴。收集的87例COVID-19儿童中,均为家族聚集感染性,主要为近亲属确诊后传染所致;病情表现较轻,以咳嗽、发热为主要临床表现。中医药在防治新冠肺炎中取得明显疗效,通过辨证论治,分期论治,个体化治疗,合理选方用药,对儿童新冠肺炎疗效颇佳。

Objective To analyze the TCM syndrome characteristics of 87 children infected with corona virus diaease 2019(COVID-19)in Shijiazhuang people's hospital,and provide a reference for clinical treatment based on syndrome differentiation of TCM.Methods Based on the national treatment guidelines,87 children with COVID-19 were treated according to syndrome differentiation.To observe clinical data before and after treatment,including general information,improvement of traditional Chinese medicine syndromes,changes in tongue images,peripheral blood leukocyte count(WBC),neutrophil count(NE#),and lymphocyte count(LYMPH#),C-reactive protein(CRP),creatine kinase isoenzyme(CKMB),and improvement in chest CT imaging.Results Among the 87 patients,51 were girls and 36 were boys,with an average age of 8 years and 1 month.There were 34 mild cases,27 common cases,and 26 asymptomatic infections.The symptoms with a higher incidence were cough in 19 cases(21.84%),fever in 18 cases(20.69%),and runny nose in 11 cases(12.64%);After treatment,the average fever relief time was 3 days,and the incidence of cough,sputum,nasal congestion,and runny nose symptoms was significantly reduced compared to before treatment.72 cases(82.76%)had light red(red),white(thick)and greasy tongue coating before treatment,and 59 cases(67.82%)had light red,white,and slightly greasy tongue coating after treatment;Before treatment,53 cases(60.92%)of traditional Chinese medicine syndromes were caused by epidemic toxin,27 cases(31.03%)were caused by epidemic toxin stagnation of the lung,and 7 cases(8.05%)were caused by epidemic toxin stagnation of the spleen.After treatment,78 cases(89.66%)were caused by lung spleen deficiency and 9 cases(10.34%)were caused by Qi and Yin deficiency.Peripheral blood routine examination showed a decrease in white blood cell count in 2 cases,a decrease in absolute lymphocyte count in 8 cases,and an increase in absolute neutrophil count in 10 cases.A small number of children showed abnormalities in C-reactive protein and creatine kinase isoenzymes.After 2 courses of treatment(6 days),most of the children's indicators gradually returned to normal,with significant improvements in white blood cell count,absolute lymphocyte count,and C-reactive protein compared to before treatment.After rank sum test,P<0.05,The difference was statistically significant,while the change in creatine kinase isoenzyme values was not significant(P>0.05),and the difference was not statistically significant.CT showed patchy shadows in 25 cases(28.74%)and ground glass like changes in 2 cases(2.30%).After treatment,patchy shadows were significantly reduced in 11 cases(12.64%),while the effect of ground glass like changes was not significant in 2 cases(2.30%).Conclusion COVID-19 belongs to the category of“epidemic disease”“febrile disease”and“plague”in traditional Chinese medicine.Among the 87 collected children with COVID-19,they were all familial clustered infections,mainly caused by infections confirmed by close relatives;The condition is mild,with cough and fever as the main clinical manifestations.Traditional Chinese medicine has achieved significant effect in the prevention and treatment of COVID-19.Through syndrome differentiation,treatment by stages,individualized treatment,and rational prescription,it has a good effect on children with COVID-19.