BACKGROUND In December 2019,the first patient with 2019-novel coronavirus(2019-nCoV)was reported in Wuhan,China,and the disease spread rapidly across the country and surrounding countries within 2 mo.As of February 29...BACKGROUND In December 2019,the first patient with 2019-novel coronavirus(2019-nCoV)was reported in Wuhan,China,and the disease spread rapidly across the country and surrounding countries within 2 mo.As of February 29,2020,a total of 91 confirmed cases had been reported in Gansu Province.This case report of the diagnosis and treatment of an elderly patient with 2019-nCoV pneumonia complicated by acute exacerbation of chronic obstructive pulmonary disease in Gansu Province aims to provide a better reference for the treatment of patients in the future.CASE SUMMARY The patient,a 94-year-old female,lived in Maiji District of Tianshui,Gansu Province,China.On January 30,2020,she was admitted to the Fourth People’s Hospital of Tianshui after 9 d of close contact with a patient with 2019-nCoV pneumonia.She was subsequently admitted to Gansu Provincial Hospital of Traditional Chinese Medicine for isolation and transferred to Tianshui Gansu Provincial Hospital of Infectious Diseases on February 3,2020 for treatment.Upon initial examination,her body temperature was 36.7°C,pulse was 80,breathing was 20,and blood pressure was 130/80 mmHg.She was conscious with normal development and normal nutrition.The pharynx was not red,and bilateral tonsils were not red and swollen.The lungs sounded slightly coarse with no dry or wet rales.The first symptoms were cough and fatigue on 2 February.The patient was hospitalized for 12 d.After active treatment,she was discharged on February 14 with a good prognosis.CONCLUSION A history of exposure to the affected area or patient is a major cause of 2019-nCoV infection,and population clustering is a high risk factor for transmission.Patients may not necessarily have respiratory system symptoms as the only clinical manifestation but may also have concomitant or first onset digestive symptoms.Attention should be paid to the prevention and treatment of multiple organ dysfunction syndrome.Nucleic acid testing is extremely important and needs to be repeated several times.Laboratory and auxiliary examination indicators during the first week of admission are extremely important.It is feasible to carry out dynamic and continuous index monitoring,which can predict and guide the prevention and treatment of multiple organ dysfunction and the prognosis of the disease.展开更多
文摘BACKGROUND In December 2019,the first patient with 2019-novel coronavirus(2019-nCoV)was reported in Wuhan,China,and the disease spread rapidly across the country and surrounding countries within 2 mo.As of February 29,2020,a total of 91 confirmed cases had been reported in Gansu Province.This case report of the diagnosis and treatment of an elderly patient with 2019-nCoV pneumonia complicated by acute exacerbation of chronic obstructive pulmonary disease in Gansu Province aims to provide a better reference for the treatment of patients in the future.CASE SUMMARY The patient,a 94-year-old female,lived in Maiji District of Tianshui,Gansu Province,China.On January 30,2020,she was admitted to the Fourth People’s Hospital of Tianshui after 9 d of close contact with a patient with 2019-nCoV pneumonia.She was subsequently admitted to Gansu Provincial Hospital of Traditional Chinese Medicine for isolation and transferred to Tianshui Gansu Provincial Hospital of Infectious Diseases on February 3,2020 for treatment.Upon initial examination,her body temperature was 36.7°C,pulse was 80,breathing was 20,and blood pressure was 130/80 mmHg.She was conscious with normal development and normal nutrition.The pharynx was not red,and bilateral tonsils were not red and swollen.The lungs sounded slightly coarse with no dry or wet rales.The first symptoms were cough and fatigue on 2 February.The patient was hospitalized for 12 d.After active treatment,she was discharged on February 14 with a good prognosis.CONCLUSION A history of exposure to the affected area or patient is a major cause of 2019-nCoV infection,and population clustering is a high risk factor for transmission.Patients may not necessarily have respiratory system symptoms as the only clinical manifestation but may also have concomitant or first onset digestive symptoms.Attention should be paid to the prevention and treatment of multiple organ dysfunction syndrome.Nucleic acid testing is extremely important and needs to be repeated several times.Laboratory and auxiliary examination indicators during the first week of admission are extremely important.It is feasible to carry out dynamic and continuous index monitoring,which can predict and guide the prevention and treatment of multiple organ dysfunction and the prognosis of the disease.
文摘目的:了解1990~2020年近30年来我国冠心病中医证的流行病学调查研究概况。方法:系统检索CNKI、VIP、WANFANG DATA、PubMed等数据库,纳入我国冠心病中医证的流行病学调查研究文献,对其调查目的、调查对象、调查方法及主要调查结果等进行描述统计。根据NICE推荐的研究质量评价标准以及STROBE声明第四版对纳入文献的方法学质量和报告质量进行评价。结果:①最终纳入139篇目标文献,最早发表于1992年,2007~2020年之间发表130篇(93.5%);调查地区涵盖全国28个省市自治区,主要集中在华北(44.6%)、中南(44.6%)、华东(33.8%)共纳入100546例冠心病患者,累计覆盖707个研究中心,住院或门诊患者占91.0%;②61.9%的调查采用横断面调查研究方法,其余分别采用队列研究方法(28.0%)、病例对照研究方法(10.1%);77.7%的调查主要研究证的分布特征,其余分别为研究证或临床表征的演变规律(28.8%),研究证与理化指标的关系(15.8%),明确辨证依据(10.8%)以及研究证对心血管事件的影响(5%);③主要调查结果显示,频数排名前四位的证为血瘀证(64.2%)、气虚证(57.3%)、痰浊(湿)证(37.8%)、阴虚证(26.7%),呈血瘀证>气虚证>痰浊(湿)证>阴虚证>阳虚证>气滞证>热证>水饮证>寒凝证>血虚证的趋势。不同阶段冠心病患者中医证分布结果显示,稳定性冠心病患者痰浊(湿)证(58.6%)和阳虚证(26.8%)比例高于其他阶段;至急性冠脉综合征阶段开始出现热证(2.8%);冠心病心力衰竭患者气虚证比例最高(81.2%),且近1/3(33.1%)患者出现水饮证。介入术后3个月内,血瘀证比例显著下降(术前68.3%→术后1 d 46.7%→术后1周44.7%→术后1个月35.1%→术后3个月26.2%),但术后6个月又升至42.6%,总体呈先降后升趋势。此外,气虚证成为介入术后各时间点最主要的单元证,且术后6个月比例最高达64.4%;气滞证比例于术后3个月、术后6个月呈上升趋势,热证、血虚证比例术后1 d最高,分别为9.0%、7.7%之后呈下降趋势;④方法学质量评价结果显示,有55.4%的文献是多中心研究,明确纳入排除标准的占81.3%,分别有100.0%、95.0%、99.3%的文献对研究目的、测量结局,以及研究的主要发现进行了明确说明,仅15.1%的文献对结局指标进行了分层分析,没有文献明确声明患者是否为连续招募。报告质量评价结果显示,所有文献均未“在论文中较早陈述研究设计的要素”“偏倚”“研究对象”(各阶段数量等)和“可推广性”;报告率为100%的内容有“结局资料”“主要结果”“重要结果”“解释”。结论:近30年我国冠心病中医证的流行病学调查研究已在证候分布等方面积累了一定基础,为今后的深入研究提供了有力支撑。但同时也存在缺乏冠心病全程中医证候演变规律研究,纵向研究样本量较少、地域代表性不足、缺乏随机抽样,以及中医辨证标准不规范、不统一、缺乏诊断权重等问题,研究质量及报告规范亟需进一步提升。
