Treating Severe COVID-19 Cases from the Perspective of "Carbuncle"
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1.Center for Integrated Chinese and Western Medicine, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
2.Fever Clinics of Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700, China
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刘洋,梁腾霄.从“肺痈”论治重症肺炎[DB/OL].(2023-12-18)[2023-12-18].https://cccl-tcm.cacm.org.cn/thesisDetails?columnId=46082810&Fpath=home&index=0&lang=zh
LIU Yang,LIANG Tengxiao.Treating Severe COVID-19 Cases from the Perspective of "Carbuncle"[J].,
刘洋,梁腾霄.从“肺痈”论治重症肺炎[DB/OL].(2023-12-18)[2023-12-18].https://cccl-tcm.cacm.org.cn/thesisDetails?columnId=46082810&Fpath=home&index=0&lang=zh DOI:
LIU Yang,LIANG Tengxiao.Treating Severe COVID-19 Cases from the Perspective of "Carbuncle"[J]., DOI:.
病史摘要,2,患者,女性,84岁,主因“流涕、咳痰2天,发热1天”于2023年5月20日收入院。入院后发热、咳嗽咳痰,血氧饱和度低,Ⅰ型呼吸衰竭,予气管插管通气。T 38.7℃,P 108次/分,R 28次/分,BP 114/62 mmHg,SpO2 87 %。双肺呼吸音粗,双下肺可闻及湿啰音。全腹软,下腹部轻度压痛,全腹无反跳痛,腹部未触及包块。肠鸣音4次/分。余无特殊。舌瘦红苔薄黄,脉沉弦。2023年5月20日:胸部CT:双肺感染;血常规+CRP:WBC 18.73×10,9,/L,NE% 93.1 %,CRP 102.35 mg/L,HGB150 g/L,PLT 194×10,9,/L。新型冠状病毒抗原检测:阳性。中医诊断 疫病,喘脱,气阴两虚,痰热壅肺。西医诊断 重症肺炎;急性呼吸窘迫综合征Ⅰ型呼吸衰竭;脓毒症;新型冠状病毒感染;冠状动脉粥样硬化性心脏病 急性心肌损伤 心功能Ⅳ级(NYHA分级);高血压3级 很高危组;2型糖尿病。干预措施 抗感染:Paxlovid抗病毒,哌拉西林钠舒巴坦钠联合盐酸莫西沙星抗感染,后升级抗生素美罗培南联合莫西沙星抗感染。氧疗:鼻导管吸氧-面罩吸氧-无创呼吸机(5月22日),气管插管有创机械通气(5月26日)。依诺肝素抗凝;予普通胰岛素泵入调节血糖;高侧位通气;夜间镇静镇痛,日间唤醒。中医予清热益气养阴为主,加以清热排脓,方用《千金》苇茎汤加减。疗效转归 第一阶段为普通病房治疗(8天):一般治疗为抗感染,中药益气养阴,清肺解毒化痰治疗,患者痰多,感染情况逐步加重,转入ICU。第二个阶段为ICU治疗(23天):中医扶正祛邪,宣肺排脓,呼吸机辅助通气12天,拔管脱机,感染逐步好转,功能锻炼,好转出院。
Summary of case history, The patient, female, 84 years old, was admitted to the hospital on May 20, 2023, with the chief complaint of "runny nose and cough for 2 days, fever for 1 day". After admission, she had fever, cough and sputum, low blood oxygen saturation, and was given endotracheal intubation and ventilation. T 38.7℃, P 108 beats/min, R 28 breaths/min, BP 114/62mmHg, SpO2 87%. Coarse breath sounds in both lungs, moist rales in both lower lungs. The abdomen was soft, with mild tenderness in the lower abdomen, no rebound pain in the whole abdomen, and no mass was palpated. Bowel sounds were 4 times/min. No other abnormalities. The tongue was thin and red with thin yellow coating, and the pulse was deep and stringy. May 20, 2023: Chest CT: bilateral lung infection; CBC+CRP: WBC 18.73×10,9,/L, NE% 93.1%, CRP 102.35mg/L, HGB150g/L, PLT 194×10,9,/L. Novel coronavirus antigen test: positive.,TCM diagnosis, epidemic disease dyspnea qi and yin deficiency, phlegm-heat obstructing the lungs,Western medicine diagnosis, severe pneumonia ;acute respiratory distress syndrome type I respiratory failure ;sepsis ;novel coronavirus infection ;coronary atherosclerotic heart disease acute myocardial injury heart function class IV (NYHA classification);hypertension grade 3 very high risk group ;type 2 diabetes,Therapeutic methods, Anti-infection: Paxlovid antiviral, piperacillin sodium and tazobactam sodium combined with moxifloxacin hydrochloride anti-infection, later upgraded antibiotics meropenem combined with moxifloxacin anti-infection. Oxygen therapy: nasal cannula oxygen inhalation-face mask oxygen inhalation-non-invasive ventilator (May 22)-endotracheal intubation invasive mechanical ventilation (May 26). Enoxaparin anticoagulation; given regular insulin pump to regulate blood glucose; high lateral position ventilation; nocturnal sedation and analgesia, daytime awakening. Traditional Chinese medicine mainly clear heat and nourished qi and yin, and also clear heat and drained pus, using modified Qianjin Weijing Decoction.,Clinical outcomes, The first stage was general ward treatment (8 days): The general treatment was anti-infection, traditional Chinese medicine to nourish qi and yin, clear lung detoxification and phlegm treatment, the patient had a lot of sputum, the infection gradually worsened, and was transferred to ICU. The second stage was ICU treatment (23 days): ventilator-assisted ventilation (12 days), extubation and weaning, infection gradually improved, functional exercise, discharged after improvement.
新冠重症肺炎中医药
COVID-19severe pneumoniaTraditional Chinese medicine
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