[关键词]
[摘要]
【目的】 分析新型冠状病毒(简称新冠病毒)感染合并哮喘患者性别、年龄、证候要素、中医证型的分布特点及用药规律,为新冠病毒感染合并哮喘临床诊疗方案的制定提供参考。【方法】 收集深圳市中医院2022年12月至2023年1月呼吸科及急诊科门诊治疗新冠病毒感染合并哮喘患者的性别、年龄、证候要素、中医证型和用药频次等信息,进行统计分析,并对结果进行网络可视化展示。【结果】 共纳入病例 63例,男性 27例,女性 36例,平均年龄 51.8岁。涉及 13种中医证型,其中分布频次最高的3种证型分别为风痰证(17例)、脾虚湿蕴证(11例)、痰热郁肺证(8例)。涉及病位证素4个,居前2位的分别为肺(36例)、脾(12例)。涉及病性证素8个,居前3位的分别为风(36例)、痰(28例)、气虚(24例)。涉及中药128味,性味以辛、苦、甘,寒为主,归经以肺、脾、肝、胃为主,功效类别以化痰止咳平喘类为主。频次较高的前4位中药依次为甘草(51次)、麻黄(47次)、燀苦杏仁(44次)、五味子(40次)等;核心二联药对有麻黄-甘草、麻黄-五味子、燀苦杏仁-半夏等;核心三联药对有半夏-燀苦杏仁-麻黄、麻黄-五味子-甘草等。【结论】 痰邪伏肺为新冠病毒感染合并哮喘的核心病机贯穿始终,风邪为其发生发展过程的驱动要素,中后期易夹热邪、气虚、气阴两虚、蒙蔽神窍等复杂证候表现。治疗上以解表清热、化痰止咳平喘为基本原则,以恢复五脏六腑之气机,扶助正气,祛邪顾本。
[Key word]
[Abstract]
Objective To investigate the distribution of gender,age,and traditional Chinese medicine(TCM) syndrome elements and syndrome types in patients suffering from novel coronavirus infection complicated with asthma, and to explore the medication rules for the patients, thus to provide reference for the formulation of clinical diagnosis and treatment plans for novel coronavirus infection complicated with asthma. Methods From December 2022 to January 2023,the information of gender,age,syndrome elements,TCM syndrome types and medication frequency of the herbal medicine was collected among the patients suffering from novel coronavirus infection complicated with asthma who were treated in outpatient clinics of the respiratory department and emergency department of Shenzhen Traditional Chinese Medicine Hospital. The information data were statistically analyzed and then the network visualization of results was presented. Results A total of 63 cases were included including 27 males and 36 females,with an average age of 51.8 years old. Thirteen TCM syndrome types were involved, of which the three with the leading occurrence frequency were wind-phlegm syndrome(17 cases), spleen deficiency with dampness accumulation syndrome(11 cases), and phlegm-heat stagnation in the lung syndrome(8 cases). There were four disease-location syndrome elements,and the top two were lung(36 cases) and spleen(12 cases). Eight disease-nature syndrome elements were involved, and the top three were wind (36 cases),phlegm(28 cases)and qi deficiency(24 cases). A total of 128 Chinese herbal medicines were used, and their properties and flavors were predomiated by being pungent,bitter,sweet and cold. Most of the Chinese herbal medicines had the meridian tropism of lung, spleen, liver and stomach meridians, and most of the Chinese herbal medicines had the therapeutic actions of resolving phlegm,easing cough and relieving asthma. The top four Chinese herbal medicines with higher medication frequency were Glycyrrhizae Radix et Rhizoma(51 times), Ephedrae Herba(47 times), blanching Armeniacae Semen Amarum(44 times), and Schisandrae Chinensis Fructus(40 times). The core two-drug groups were Ephedrae Herba-Glycyrrhizae Radix et Rhizoma,Ephedrae Herba-Schisandrae Chinensis Fructus,and blanching Armeniacae Semen Amarum-Pinelliae Rhizoma. The core three-drug groups were Pinelliae Rhizoma-blanching Armeniacae Semen Amarum-Ephedrae Herba, and Ephedrae Herba-Schisandrae Chinensis Fructus-Glycyrrhizae Radix et Rhizoma. Conclusion Pathogenic phlegm retention in lung is the core pathogenesis of novel coronavirus infection complicated with asthma, which is protracted through the disease. The pathogenic wind is the driving factor of the disease’s development and progression, and in the middle and late stages of the disease,the complicated syndrome manifestations of pathogenic heat,qi deficiency,qi and yin deficiency,and blockage of upper orifice are commonly seen. Its therapeutic principles are to relieve exterior syndrome and clear heat,resolve phlegm,ease cough and relieve asthma,thus to restore the qi movement of the zang-fu organs,support the healthy qi,eliminate pathogens and strengthen body resistance.
[中图分类号]
R259.631
[基金项目]
国家自然科学基金青年科学基金项目(编号:82204983);广东省自然科学基金面上项目(编号:2023A1515011576);深圳市科技创新委员会新型冠状病毒肺炎疫情应急防治项目(编号:JSGG20220226085800001);深圳市科技创新委员会基础研究面上项目(编号:JCYJ20220531091811025)