新型冠状病毒肺炎二次感染恢复期老年患者50例临床特征分析

Approach to clinical characteristics of convalescent COVID-19-caused secondary infection in 50 elderly patients

目的:分析山西白求恩医院新型冠状病毒性肺炎二次感染恢复期老年患者的临床特征和中医证候特征,为新型冠状病毒性肺炎感染恢复期老年患者的康复治疗提供参考。方法:选取符合纳入标准的新型冠状病毒性肺炎二次感染恢复期的老年患者50例,于入院第1日采集流行病史、血常规、血气分析等检查、临床表现及中医证候等信息,分析患者基本特征及中医证候特点。结果:新型冠状病毒性肺炎二次感染恢复期老年患者的男女比例为1.63∶1,年龄平均(72.70±9.28)岁,78%的患者合并有基础疾病,且合并基础疾病越多,病情越重。实验室检查中血常规以白细胞正常者(64.00%)、淋巴细胞降低者(74.00%)居多,血气分析以氧分压降低者(86.00%)为主,约半数患者红细胞沉降率增快(48.00%),细胞因子以白介素10(30.00%)、白介素6(26.00%)升高为主,凝血功能趋于正常,大多数患者25羟基维生素D缺乏或不足(92.00%)。胸部CT影像学表现以磨玻璃影为主(48.00%)。临床症状以咳嗽(96.00%)、纳差(90.00%)、乏力(74.00%)、发热(58.00%)等为主。中医证候学分析病位证素最常见的是肺、脾、肾,最常见的病性证素有阴虚、气虚、湿、热。结论:新型冠状病毒性肺炎二次感染的老年患者与年龄及基础疾病密切相关,中医证候以肺脾两虚、气阴两虚为主,兼有湿、热、气滞、痰、瘀等特点。

Objective:To approach the clinical characteristics and TCM syndrome characteristics of convalescent COVID-19-caused secondary infection of elderly patients treated in Shanxi Bethune Hospital,in order to provide a reference for rehabilitation treatment of convalescent COVID-19-caused secondary infection of elderly patients.Methods:50 cases of eligible elderly patients with convalescent COVID-19-caused secondary infection were selected as studied subjects.On the 1st day of admission,the data of medical examination for the patients were collected such as epidemiological history,blood routine,analysis of blood gas,chest CT,etc.,in addition,inclusive of informations on clinical manifestations and TCM syndromes,etc.The basic characteristics and TCM syndrome characteristics of patients were analysed.Results:The male-to-female ratio of elderly patients with convalescent COVID-19-caused secondary infection was 1.63∶1.The average age was(72.70±9.28)years.78.00%of the patients were complicated with co-morbid underlying diseases.Laboratory test showed that the patients with normal leukocytes(64.00%)and patients with decreased lymphocytes(74.00%)dominated in blood routine;the patients with decreased oxygen partial pressure(86.00%)dominated in analysis of blood gas,and the erythrocyte sedimentation rate of about half of patients(48.00%)increased faster;cytokines were dominated by elevated interleukin 10(30.00%)and interleukin 6(26.00%);coagulation function tended to be normal;25-hydroxy vitamin D of the majority of patients(92.00%)was lacked or inadequate;manifestation of chest CT imaging was dominated by ground-glass opacity(48.00%).Clinical symptoms were dominated by cough(96.00%),ano rexia(90.00%),fatigue(74.00%),fever(58.00%),etc.The analysis of TCM syndromes showed that the most common syndrome elements of disease location were the lung,spleen and kidney,while the most common pathogenic syndrome elements were deficiency of yin,deficiency of qi,dampness and heat.Conclusion:COVID-19-caused secondary infection of elderly patients is closely related to age and underlying diseases.Its TCM syndrome is characterized by deficiency of both lung and spleen as well as deficiency of both qi and yin mainly,and which is intermingled with dampness,heat,stagnation of qi,phlegm and blood stasis,etc.