中西医结合治疗传染性非典型肺炎的临床实践与探讨

Clinical Observation of Integrated Chinese and Western Medicine for Severe Acute Respiratory Syndrome

【目的】探索制定传染性非典型肺炎(severe acute respiratory syndrome,SARS)的中西医结合治疗方案。【方法】在依据广东省非典型肺炎诊治指导原则进行西医治疗的基础上,根据该病证候特点,初步确定该病早期、中期、极期、恢复期的中医病机,并据此拟定治疗方案。【结果】初步发现该病早期病机以湿热遏阻、卫气同病为主,治疗宜重在宣透清化;中期病机以湿热蕴毒、邪阻募原及少阳为主,治疗宜重在清化湿热、宣畅气机;极期病机以湿热毒盛、耗气伤阴、重则内闭喘脱为主,治疗应重在祛邪扶正;恢复期病机为正虚邪恋,易挟湿挟瘀,治疗宜重在扶正透邪、化湿、活血。按此方案辨证施治共103例,治愈96例,治愈率为93.2％;死亡7例,病死率为6.8％;从发热到体温恢复正常的时间为(9.86±4.14)d,入院治疗后,退热时间为(6.72±3.95)d;96例出院患者最后胸部X线复查,94例病灶完全消失,病灶吸收时间为(18.18±8.99)d,2例吸收不完全,呈纤维条索状改变。【结论】初步形成的SARS中西医结合治疗方案对SARS的症状改善及预后均有积极作用。

[Objective] To draw up a plan of applying integrated traditional Chinese and western medicine for severe acute respiratory syndrome (SARS). [Methods] By following the Guideline for Diagnosis and Treatment for SARS laid out by Guangdong Province and by analyzing its clinical manifestations, the pathogenesis of SARS at different stages was clarified from the angle of traditional Chinese medical science. And accordingly, programms for different stages were worked out. [Results] Pathogenesis is characterized by stagnation of damp-heat and involvement of both defensive phase and Qi phase in early SARS, by stagnation of virulent damp-heat and involvement of Moyuan and Shaoyang Meridian in intermediate stage, by excessive virulent damp-heat and deficiency of Qi and yin and even internal obstruction and collapse due to asthma in the fastigial stage. And in the restoration stage, dampness-stagnation and blood-stasis are often concurrent because of the healthy-Qi deficiency with lingering pathogenic factors. Thus, treatment principles for different stages are as follows: dredging Qi phase, clearing away heat and resolving dampness in the early stage; enlivening the activities of Qi, clearing away heat and resolving dampness in the intermediate stage; expelling pathogenic factors and supporting healthy Qi in the fastigial stage and resolving dampness, activating blood on the basis of expelling pathogenic factors and supporting healthy qi in the stage of recovery. After treatment, % (93.2%) cases were cured and 7 (6.8%) were dead among 103 cases. The time from fever to narmal temperature was (9.86 ± 4.14) d and after treatment the average time for abating fever was (6.72 ± 3.95) d. The results of chest X-ray reexamination showed that the foci in 94 cases were completely absorbed, the average absorption time being (18.18 ± 8.99) d. Streak-like lesion was found in 2 cases, the foci being incompletely absorbed. [Conclusion] The integrated Chinese and western medical treatment for SARS plays a positive role in the relief of symptoms, with a favorable prognosis.