CAJ | 학술논문

目的：通过对我国广东地区1例输入性 MERS 病例回顾性研究，初步探讨本例 MERS 传遍特点及核心病机。方法：回顾性整理该例患者入院前流行病学特点及2015年5月28日入院第1天至2015年6月11日入院第15天住院期间的临床症状及治疗经过。结果：本例患者流行病学特点主要表现为中年男性，有甲亢基础病史，与 MERS 患者有明确接触史。该例病程发展具有一定阶段性，根据病情的变化分为以下四期：初期，进展期，极期和恢复期。初期：病程1～5 d，病位在肺，患者发热、肌肉酸痛，无恶寒，无咳嗽咳痰咽痛，此期主要特点为热邪侵犯肺卫，表邪轻而里热已盛。2）进展期：病程7～12 d，病位在肺，高热，无恶寒寒战，干咳少痰，口渴口苦，活动后气促，热邪深入气分。3）极期：病程12～22 d，病位在肺、胃、大肠，此期患者逐渐热退或低热，时有烦躁，气促开始减轻，头痛，咳少量血丝痰，腹胀无腹痛，腹泻，热邪入营血分。在此期间，发病第17～18天为病情最重的时期，主要表现为头痛剧烈，咳血丝痰，腹泻，此期应用抗病毒、抗感染、免疫增强剂治疗。4）恢复期：病程第22天后，无发热，血丝痰消失，偶有干咳、头痛，头痛休息可缓解，腹泻减轻。结论：本例MERS 患者始动因素及根本因素为温热疫毒，热邪为本病的关键，毒、瘀表现不明显，中医证候演变符合温病卫气营血传变规律，卫气同病，营血分症状不重，与 SARS、甲型 H1N1流感、H7N9禽流感相比病情稍轻。
목적：통과대아국엄동지구1례수입성 MERS 병례회고성연구，초보탐토본례 MERS 전편특점급핵심병궤。방법：회고성정리해례환자입원전류행병학특점급2015년5월28일입원제1천지2015년6월11일입원제15천주원기간적림상증상급치료경과。결과：본례환자류행병학특점주요표현위중년남성，유갑항기출병사，여 MERS 환자유명학접촉사。해례병정발전구유일정계단성，근거병정적변화분위이하사기：초기，진전기，겁기화회복기。초기：병정1～5 d，병위재폐，환자발열、기육산통，무악한，무해수해담인통，차기주요특점위열사침범폐위，표사경이리열이성。2）진전기：병정7～12 d，병위재폐，고열，무악한한전，간해소담，구갈구고，활동후기촉，열사심입기분。3）겁기：병정12～22 d，병위재폐、위、대장，차기환자축점열퇴혹저열，시유번조，기촉개시감경，두통，해소량혈사담，복창무복통，복사，열사입영혈분。재차기간，발병제17～18천위병정최중적시기，주요표현위두통극렬，해혈사담，복사，차기응용항병독、항감염、면역증강제치료。4）회복기：병정제22천후，무발열，혈사담소실，우유간해、두통，두통휴식가완해，복사감경。결론：본례MERS 환자시동인소급근본인소위온열역독，열사위본병적관건，독、어표현불명현，중의증후연변부합온병위기영혈전변규률，위기동병，영혈분증상불중，여 SARS、갑형 H1N1류감、H7N9금류감상비병정초경。
Objective:To explore the epidemiological characteristics and major pathogenesis in Chinese Medicine according to the retrospective study of the first imported MERS case from Guodong province.Methods:The data from May 28,2015 to June 11, 2015 of the epidemiology,syndromes and treatment of the case were collected and analyzed.Results:The patient was a middle-aged man with epidemiology characteristics roughly consistent with the previous investigation and had a history of hyperthyroidism and contact with confirmed cases of MERS.There were four stages as follows in the course of disease according to his changes of health condition.Firstly,at initial stage,disease location was in lung in the duration of first to fifth days.The patient was in fever with aching muscle but no chills,no sore throat,no cough or expectoration.The case in this period was mainly characterized with invading lung,light external pathogen while heavy interior evil.Secondly,in the developing period,the disease location was still in the lung,in the duration from seventh to 12th days.The patient had high fever without chills,dry cough with a little phlegm, thirst and bitter taste,shortness of breath.In this period heat evil was deep in qi.Thirdly,the very period,12th to 22th days du-ration,the disease location was in the lung,stomach and large intestine.The patient had mild fever and abatement of fever,irrita-bility,shortness of breath began to ease,headache,cough with a small amount of blood sputum,abdominal distension,no abdom-inal pain,diarrhea,fever,blood into the camp.During this period,the the 17th-18th was the most severe period,mainly manifes-ted with headache,cough blood sputum,diarrhea,and was treated with antiviral,anti infection,immune enhancement agents. Fourthly,the recovering stage,the patient in this course after 22 days had no fever,disappeared sputum with blood,occasional dry cough,endurable headache and diarrhea alleviated.Conclusion:The initiating and fundamental factors in this case were warm febrile and epidemic toxin.Heat pathogen was the critical factor rather than toxin and blood stasis.The transform of symptoms con-formed to defense-qi-nutrient-blood mode in febrile disease in TCM.Qi and defense level became ill at the same time.And the nu-trient and blood level were not severe.Therefore,the patient’s condition in this case was not as severe as SARS,H1N1 influenza, H7N9 avian influenza.