世界中医药
世界中醫藥
세계중의약
WORLD CHINESE MEDICINE
2014年
3期
275-277
,共3页
马月霞%刘清泉%王玉光%郭玉红
馬月霞%劉清泉%王玉光%郭玉紅
마월하%류청천%왕옥광%곽옥홍
H7N9禽流感%证候%演变规律%病因病机
H7N9禽流感%證候%縯變規律%病因病機
H7N9금류감%증후%연변규률%병인병궤
H7N9 Avian influenza%TCM Syndrome%Etiology and pathogenesis
目的：通过H7N9禽流感病例回顾性研究，初步探讨甲型H7N9流感的证候特点及核心病机。方法：回顾性整理2013年2月26日至2013年5月1日期间北京、上海等8个省市收治的36例采用中医药治疗的甲型H7N9流感患者的流行病学、症候学及中医治疗情况，分析其中医病证和病机特点。结果：36例H7N9患者流行病学特点，患者平均发病后第6天入院，入院后第2天入住ICU，病毒核酸转阴时间为发病后15 d；症候学特点，患者100％发热，最高体温（39.14±0.62）℃，伴咳嗽，咳痰，恶寒轻或不恶寒，但头痛、周身酸痛、咽痛、鼻塞流涕等风热束表上犯症状少见；3～6d后高热寒战，渐次出现痰中带血、短气、胸闷、呼吸困难，舌红苔腻，病情转重；6～14 d患者痰中带血，胸闷喘憋、呼吸困难加重，并出现皮肤红疹、花斑，舌质深红或紫，少津；10～14 d后患者身热渐退，痰血减少甚则消失，进入恢复期，以倦怠乏力，舌质红、苔薄少津为特点。结论：中医证候演变符合温病卫气营血传变规律，该病病情加重的拐点可能在4～5 d左右，8～10 d病情最重，始动因素及根本为温热疫毒，热毒、瘀毒为关键，病理因素为热、毒、瘀、虚兼夹且始终贯穿整个病程，核心病机为毒热犯肺，壅肺、损肺，甚则伤及其他脏腑。
目的：通過H7N9禽流感病例迴顧性研究，初步探討甲型H7N9流感的證候特點及覈心病機。方法：迴顧性整理2013年2月26日至2013年5月1日期間北京、上海等8箇省市收治的36例採用中醫藥治療的甲型H7N9流感患者的流行病學、癥候學及中醫治療情況，分析其中醫病證和病機特點。結果：36例H7N9患者流行病學特點，患者平均髮病後第6天入院，入院後第2天入住ICU，病毒覈痠轉陰時間為髮病後15 d；癥候學特點，患者100％髮熱，最高體溫（39.14±0.62）℃，伴咳嗽，咳痰，噁寒輕或不噁寒，但頭痛、週身痠痛、嚥痛、鼻塞流涕等風熱束錶上犯癥狀少見；3～6d後高熱寒戰，漸次齣現痰中帶血、短氣、胸悶、呼吸睏難，舌紅苔膩，病情轉重；6～14 d患者痰中帶血，胸悶喘憋、呼吸睏難加重，併齣現皮膚紅疹、花斑，舌質深紅或紫，少津；10～14 d後患者身熱漸退，痰血減少甚則消失，進入恢複期，以倦怠乏力，舌質紅、苔薄少津為特點。結論：中醫證候縯變符閤溫病衛氣營血傳變規律，該病病情加重的枴點可能在4～5 d左右，8～10 d病情最重，始動因素及根本為溫熱疫毒，熱毒、瘀毒為關鍵，病理因素為熱、毒、瘀、虛兼夾且始終貫穿整箇病程，覈心病機為毒熱犯肺，壅肺、損肺，甚則傷及其他髒腑。
목적：통과H7N9금류감병례회고성연구，초보탐토갑형H7N9류감적증후특점급핵심병궤。방법：회고성정리2013년2월26일지2013년5월1일기간북경、상해등8개성시수치적36례채용중의약치료적갑형H7N9류감환자적류행병학、증후학급중의치료정황，분석기중의병증화병궤특점。결과：36례H7N9환자류행병학특점，환자평균발병후제6천입원，입원후제2천입주ICU，병독핵산전음시간위발병후15 d；증후학특점，환자100％발열，최고체온（39.14±0.62）℃，반해수，해담，악한경혹불악한，단두통、주신산통、인통、비새류체등풍열속표상범증상소견；3～6d후고열한전，점차출현담중대혈、단기、흉민、호흡곤난，설홍태니，병정전중；6～14 d환자담중대혈，흉민천별、호흡곤난가중，병출현피부홍진、화반，설질심홍혹자，소진；10～14 d후환자신열점퇴，담혈감소심칙소실，진입회복기，이권태핍력，설질홍、태박소진위특점。결론：중의증후연변부합온병위기영혈전변규률，해병병정가중적괴점가능재4～5 d좌우，8～10 d병정최중，시동인소급근본위온열역독，열독、어독위관건，병리인소위열、독、어、허겸협차시종관천정개병정，핵심병궤위독열범폐，옹폐、손폐，심칙상급기타장부。
Objective:To explore the specialties and core pathogenesis of traditional Chinese medicine ( TCM) in treating H7N9 avian influenza infection .Methods:Thirty six cases of H7N9 avian influenza patients from Beijing , Shanghai and other eight provinces who were given TCM therapy between February 26, 2013 to May 1,2013 were collected.According to the epidemiology , syndrome and treat-ment of these patients , characteristics of TCM syndromes and pathogenesis were analyzed .Results:Epidemiology characteristics were as follows:Averagely, patients were admitted to hospital on the 6th day of their onset, and taken to ICU on the 2nd day of admission, and the virus turned to negative on the 15th day of the onset.Symptomatology characteristics were that 100%of patients would have fever, and the highest temperature was (39.14 ±0.62)℃.Patients had cough, phlegm, aversion to cold, but seldom had symptoms of head-ache, sore throat, running nose; patients usually had high fever on the 3rd to 6th day with more severe conditions such as blood in phlegm, short breath, dyspnea, greasy and red tongue;on the 6th to 14th day, patients got more severe conditions with rashes in the skin;on the 10th to 14th day, the fever was getting away , blood in phlegm decreased , and patients were recovering with fatigue feeling and red tongue .Conclusion:The change of syndrome fits the principle of TCM warm disease .The turning point of getting severe is on the 4th to 5th day.The most dangerous condition usually occurs on the 8th to 10th day.The core pathogenesis is virus invading lung to stuff and hurt it .
