| 吴小翠,白一春,唐翠兰.四川省首例新型冠状病毒肺炎危重型患者诊治过程探析[J].浙江中医药大学学报,2020,44(10):935-940. |
| 四川省首例新型冠状病毒肺炎危重型患者诊治过程探析 |
| Diagnosis and Treatment of the First Case of Severe Coronavirus Disease 2019 in Sichuan Province ?摇 |
| DOI：10-16466/j.issn1005-5509-2020-10-002 |
| 中文关键词: 2019冠状病毒病 新型冠状病毒肺炎 严重急性呼吸综合征冠状病毒-2 危重型 临床表现 影像学特点 中西结合治疗 |
| 英文关键词: COVID-19 novel coronavirus pneumonia SARS-CoV-2 severe clinical characteristics imaging features integrated treatment of traditional Chinese medicine and western medicine |
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| 中文摘要: |
| [目的]探讨新型冠状病毒肺炎(coronavirus disease 2019，COVID-19)患者的临床特点，提高临床医师对该病的认识。[方法]通过回顾性分析四川省首例COVID-19确诊病例的流行病学史、临床表现、诊治经过、随访过程中影像学检查的动态变化，并追踪严重急性呼吸综合征冠状病毒-2(severe acute respiratory syndrome coronavirus-2，SARS-CoV-2)核酸检测结果，从而增强临床医师对该病的认识，减少重症肺炎的发生，提高治愈率，降低病死率。[结果]患者有明确的武汉居住流行病学史，有发热、咳嗽、咳痰等临床症状，影像学检查提示双肺磨玻璃样影，符合COVID-19典型的影像学表现。入院后予以单间隔离，血气分析提示低氧血症，立即予以呼吸支持。根据COVID-19相关诊治指南，加强抗病毒、营养支持以及联合中药汤剂协同治疗。急性期疫毒闭肺，予以麻杏石甘汤，重在辛凉宣泄、清瘟解毒；恢复期邪去正虚，予以人参五味散，重在益气健脾。患者各项辅助检查指标随病情好转呈均衡性恢复，后连续两次痰、口咽拭子SARS-CoV-2核酸阴性，成功治愈出院。院外继续居家隔离，出院20d复查SARS-CoV-2核酸(鼻咽拭子、痰)阴性。[结论]目前为止，诊疗指南所推荐抗病毒药物只有少数经过临床试验，前期疗效无法预测，因而足够的支持及中医药干预仍是COVID-19的治疗关键。SARS-CoV-2传播迅速，然而疫苗尚处于研发阶段，故SARS-CoV-2感染者早诊断、早隔离仍是COVID-19的主要控制方法。 |
| 英文摘要: |
| [Objective]To investigate the clinical features of coronavirus disease 2019(COVID-19) and improve clinicians’ knowledge of the disease. [Methods]A retrospective analysis was performed for the first confirmed case of COVID-19 in Sichuan Province， including epidemiologic history， clinical characteristics， imaging features， diagnosis and treatment and following up. So as to enhance clinicians’ understanding of the disease， reduce the incidence of severe pneumonia， improve the cure rate and reduce the mortality.[Results] The patient had a clear epidemiological history of living in Wuhan， with fever， cough， expectoration and other clinical symptoms. The imaging features showed massive ground glass appearance in both lungs which was consistent with the typical imaging performance of COVID-19. After admission， the patient was isolated in a single room. Blood gas analysis indicated that there was hypoxemia， and respiratory support was given immediately. According to COVID-19 related diagnosis and treatment guidelines， antiviral and nutritional support were strengthened and combined with traditional Chinese medicine decoction. The symptom of acute period was epidemic toxin obstructing the lung， and the patient was treated with Maxing Shigan Decoction to relieve the exterior syndrome with drugs of pungent flavor and cool nature， and clear away pestilence and detoxification. In recovery period， the pathogenic factors were removed and the deficiency of vital Qi was caused， it aimed to replenish Qi and invigorate the spleen with Renshen Wuwei Powder. All the auxiliary examination indexes of the patients recovered in a balanced way with the improvement of the condition. After that， SARS-CoV-2 nucleic acid of sputum and oropharyngeal swab were negative for two consecutive times， and the patient was successfully cured and continued home isolation after discharge. SARS-CoV-2 nucleic acid(nasopharynx swab， sputum) was negative 20 days after discharge. [Conclusion]Until now， a small part of drugs recommended by guidelines for diagnosis and treatment were confirmed by clinical trial and the efficacy is hard to predict. Thus enough support and Chinese medicine intervention is the key treatment of COVID-19. SARS-CoV-2 is spreading readily and the vaccine is still in the development stage. Therefore， the early diagnosis and isolation for SARS-CoV-2 infectors are still the main control methods. |
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