13,870 | 166 | 27 |
下载次数 | 被引频次 | 阅读次数 |
目的尽可能全面地汇总国家及各省、自治区和直辖市,多位中医临床专家的新型冠状病毒肺炎(简称新冠肺炎)预防及诊疗方案,为该病的预防和治疗提供参考。方法检索2020年2月1日(含)之前网页及中国知网、万方数据库、维普数据库,收集国家及各省、自治区和直辖市卫生健康委员会(卫健委)、国家中医药管理局(中管局)及各省份卫健委、中管局的新冠肺炎相关诊疗方案,国医大师、院士、知名中医临床专家等通过公开渠道发表的见解,制定资料提取表,由两名研究者按照纳入排除标准独立进行文献筛选、资料提取,并达成共识。在筛选和资料提取过程中遇到分歧时,提请第三人共同决策。资料提取表内容包括基本信息(来源、发布时间、发布机构)、病机病位、分期、治法治则、症状、舌脉、注意事项、用药方式、药物加减、制定方法。结果本研究共纳入2020年2月1日(含)之前国家卫健委、国家中管局及17个省份的新冠肺炎防治方案以及14位中医专家的个人见解。其中江西、广东、广西、湖南、吉林、云南6个省和自治区根据《新型冠状病毒感染的肺炎诊疗方案(试行第三版)》、河北、山东、天津、甘肃、上海5个省和直辖市根根据《新型冠状病毒感染的肺炎诊疗方案(试行第四版)》制定了诊疗方案。官方防治方案的制定方法主要是组织专家讨论形成。16个省、自治区和直辖市的防治方案是在本省出现确诊病例的时点后颁布的。共提供预防方药83种、医学观察期方案8个、临床治疗初期方案31个、临床治疗中期方案22个、重症期方案17个以及恢复期方案16个。结论各方对该疾病的认识病位主要在肺,病因病机多为疫戾之气,以"湿"为主,但细节不尽相同,证型和处方亦不同,体现了本病的复杂性。大部分省、自治区和直辖市均根据疾病的发展情况(预防期、观察期、临床治疗初期、临床治疗中期、重症期、恢复期)发布了相对应的治疗方案,既体现出中医在用于新冠肺炎的防治过程中的积极参与,又体现出中医治疗的整体观念和同病异治的理念。权威机构需要及时将应急时的经验性诊疗方案快速升级为循证临床实践指南,以更好地服务临床急需。
Abstract:Objective To summarize as comprehensively as possible the traditional Chinese medicine(TCM) prevention and treatment interventions for COVID-19, to inform clinical practice, the public and health policymakers. Methods We searched internet web pages and online Chinese literature databases, such as CNKI、VIP and Wanfang Data, and included publicly available prevention and treatment opinions and interventions announced by the National and Provincial Health Commissions and administrations of Traditional Chinese medicine, as well as opinions of TCM clinical experts for the control of COVID-19 before February 1,2020(inclusive).We developed the data extraction form, and the authors in pair independently screened the relevant literature according to the inclusion and exclusion criteria, extracted data, reached consensus and the methods of development. Results This study included one national and 17 provincial's prevention and treatment interventions and protocols, as well as personal opinions from 14 TCM experts before February 1, 2020(inclusive). Among them, six(Jiangxi, Guangdong, Guangxi, Hunan, Jilin, Yunnan) were based on the national COVID-19 Diagnosis and Treatment Protocols(test version 3 rd)" and five(Hebei, Shandong, Tianjin, Shanghai, Gansu) were based on the national "COVID-19 Diagnosis and Treatment Program(test version 4 th)". The official treatment protocols were developed mainly based on organized expert discussions. Treatment protocols in 16 provinces were issued after confirmed cases in their provinces. Treatment options for the prevention period(83), medical observation period(8), early stage pneumonia(31), intermediate stage pneumonia(22), severe stage pneumonia(17) and recovery period(16)were identified and included. Conclusion Opinions on the affected organ of COVID-19 infections was the lung, TCM etiology and mechanism of disease onset and progression was mainly due to epidemic qi(Yi-li-zhi-qi) which was characterized as "dampness". However, there were discrepancies in details. Also, TCM syndromes and treatment protocols varied, which reflected the complexity of the disease conditions. With further understanding of the condition, the cognition of the disease may change and need to be continuously followed. In most provinces, the corresponding treatment protocols were developed to cover all clinical stages from prevention period to all the treatment stages. Authorities need to quickly update the existed protocols to be evidence-based guidelines to meet the urgent clinical requirements.
[1]ZHU N,ZHANG D,WANG W,et al.A Novel Coronavirus from Patients with Pneumonia in China,2019[J/OL].N Engl J Med.(2020-01-24)[2020-02-01].doi:10.1056/NEJMoa2001017.
[2] CUI J,LI F,SHI ZL.Origin and evolution of pathogenic coronaviruses[J].Nat Rev Microbiol,2019,17(3):181-192.
[3]WONG G,LIU W,LIU Y,et al.MERS,SARS,and Ebola:the role of super-spreaders in infectious disease[J].Cell Host Microbe,2015,18(4):398-401.
[4]华中科技大学同济医学院附属同济医院救治医疗专家组.新型冠状病毒感染的肺炎诊疗快速指南(第三版)[J/OL].医药导报.(2020-01-31)[2020-02-01].http://kns.cnki.net/kcms/detail/42.1293.r.20200130.1803.002.html.
[5]丁香园.新型冠状病毒感染肺炎疫情实时动态[EB/OL].(2020-02-01) [2020-02-02].https://3g.dxy.cn/newh5/view/pneumonia?scene=1&clicktime=1579705686&enterid=1579705686&from=singlemessage &isappinstalled=0.
[6]北京市中医管理局.北京市中医管理局关于印发《北京市新型冠状病毒感染的肺炎防治方案(试用第二版)》的通知 [EB/OL] .(2020-01-24) [2020-02-02].http://zyj.beijing.gov.cn/sy/tzgg/202001/t20200130_1621630.html.
[7]山东省卫生健康委员会.山东省2020年冬春流感、新型冠状病毒感染的肺炎中医药预防方案 [EB/OL] .(2020-01-27) [2020-02-01].http://wsjkw.shandong.gov.cn/ztzl/rdzt/qlzhfkgz/fkzs/202001/t20200129_2512312.html.
[8]天津市卫生健康委员会.市卫生健康委关于印发天津市新型冠状病毒感染的肺炎中医药防治方案(试行)的通知[EB/OL] .(2020-01-29) [2020-02-02].http://www.tjnk.gov.cn/wjw/system/2020/01/29/02583 3910.shtml.
[9]河南省卫生健康委员会.河南省发布新型冠状病毒感染的肺炎中医药预防方案[EB/OL] .(2020-01-27) [2020-02-01].http://www.tcm.gov.cn/hydt/1700.htm.
[10]河北省卫生健康委员会.关于印发河北省新型冠状病毒感染的肺炎诊疗方案(试行第二版)的通知 [EB/OL] .(2020-02-01) [2020-02-01].http://www.hebwst.gov.cn/index.do?templet=content&id=396243&cid=43.
[11]甘肃省卫生健康委员会.关于印发甘肃省新型冠状病毒感染的肺炎中医药防治方案(试行第二版)的通知[EB/OL] .(2020-02-01) [2020-02-01].http://wsjk.gansu.gov.cn/file.jsp?contentId=83488&from=singlemessage&isappinstalled=0&scene=1&clicktime=1580997793&enterid=1580997793.
[12]广东省中医药局.关于印发广东省新型冠状病毒感染的肺炎中医药治疗方案(试行第一版)的通知 [EB/OL] .(2020-01-25) [2020-02-01].http://szyyj.gd.gov.cn/zwgk/gsgg/content/post_2879085.html.
[13]陕西省卫生健康委员会.陕西省新型冠状病毒感染的肺炎中医药治疗方案(试行第一版)[EB/OL].(2020-01-23) [2020-02-01].http://sxwjw.shaanxi.gov.cn/art/2020/1/23/art_10_67378.html.
[14]湖南省中医药管理局.关于印发《湖南省新型冠状病毒感染的肺炎中医药诊疗方案(试行第二版)》的通知[EB/OL] .(2020-01-26) [2020-02-01].http://tcm.hunan.gov.cn/tcm/xxgk/tzgg/202001/t2020 0126_11164462.html.
[15]健康贵州.公布贵州公布预防新型冠状病毒肺炎中医药、民族医药处方[EB/OL] .(2020-01-23) [2020-02-01].https://view.inews.qq.com/w2/PGZ2020012300941900 tbkt=D&strategy=&openid=o04IBAFtMRRYx9iara_fVpWFwRPU&uid=&refer=wx_hot.
[16]云南中医.云南省卫生健康委发布新型冠状病毒感染的肺炎中医药防治方案[EB/OL] .(2020-01-23) [2020-02-01].https://mp.weixin.qq.com/s/TEbHrEdw170n0c3Dto8b_w.
[17]吉林省卫生健康委员会.吉林省中医药积极参与新型冠状病毒感染肺炎救治工作[EB/OL] .(2020-01-27) [2020-02-01].http://wsjkw.jl.gov.cn/xwzx/xwfb/202001/t20200127_6655067.html.
[18]四川省人民政府.《四川省新型冠状病毒感染的肺炎中医药干预建议处方(试行第一版)》发布 [EB/OL].(2020-01-25) [2020-02-01].http://www.sc.gov.cn/10462/12771/2020/1/25/0d37953ca2534d5382 ba744e81725469.shtml.
[19]西藏自治区藏医药管理局.自治区藏医药管理局公布新型冠状病毒感染的肺炎藏医药防治方案 [EB/OL].(2020-01-27) [2020-02-01].https://china.huanqiu.com/article/9CaKrnKp5s9.
[20]梅斯.上海发布新型冠状病毒感染的肺炎中医诊疗方案[EB/OL] .(2020-01-30) [2020-02-01].http://www.medsci.cn/article/show_article.do?id=763518699894.
[21]江西省卫生健康委员会.关于印发《江西省新型冠状病毒感染的肺炎中医药防治方案(试行)》的通知 [EB/OL] .(2020-01-25) [2020-02-01].http://hc.jiangxi.gov.cn/doc/2020/01/25/137657.shtml.
[22]广西壮族自治区卫生健康委员会.自治区中医药局关于印发新型冠状病毒感染的肺炎中医药治疗方案(试行)的通知[EB/OL] .(2020-01-24) [2020-02-01].http://wsjkw.gxzf.gov.cn/zwgk/zfxxgkml/wsjszh/zyzy/2020/0124/1694.html.
[23]健康中国.关于印发新型冠状病毒感染的肺炎诊疗方案(试行第四版)的通知 [EB/OL] .(2020-01-28).[2020-02-01] .https://mp.weixin.qq.com/s/i5oAQLkMVQIi7sc0gZQNsA.
[24]湖北中医药大学.湖北中医药大学校长吕文亮编制中医药预防新型肺炎居家预防养护简易手册[EB/OL].(2020-01-30)[2020-02-01].https://www.hbtcm.edu.cn/info/1044/10158.htm.
[25]长江日报.“国医大师”王琦院士开的预防药方来了[EB/OL].(2020-01-29)[2020-02-01].https://mp.weixin.qq.com/s/W9t8WPWVWnIxw78Ldak9bg.
[26]广西新闻网.广西中医专家公布新型肺炎预防方剂,含人参,黄芪,苏叶等[EB/OL].(2019-01-28)[2020-02-01].https://search.weixin.qq.com/k/RldQWlRNalVeR1JTRVVbZkZbSkdSaUdQUlFlRVVQb1 ZYXlw2VSlbJD9vXQ#wechat_redirect.
[27]健康报.健康报独家专访仝小林院士:中医治疗方案即将更新(附中医预防处方)[EB/OL].(2020-01-26)[2020-02-01].https://mp.weixin.qq.com/s/OSPjdLKu2Gjyxxh3-HfDdw.
[28] 广安门医院急诊科.齐文升:关于新型冠状病毒肺炎的中医认识(二)(附治疗,预防及熏蒸方)[EB/OL].(2019-01-26)[2020-02-01].https://mp.weixin.qq.com/s/TlvrL2pFM2jrdSYR9ARgjw.
[29]山东中医药大学.快来看我校校长、岐黄学者高树中给出的防控疫情的中医药外治方法![EB/OL].(2019-01-25)[2020-02-01].https://mp.weixin.qq.com/s/kKSyDMXpymuU6YnCjIRo2A.
[30]谷晓红.中医药预防新型冠状病毒感染[EB/OL].(2020-01-23)[2020-02-01].https://mp.weixin.qq.com/s/OLPax2H3GkM3LUD6b_LTMA.
[31]杨宇飞.杨宇飞主任预防“新型冠状病毒感染的肺炎”的建议[EB/OL].(2020-01-23)[2020-02-01].https://mp.weixin.qq.com/s/dYE4RuVr2OAL8ttYxOzNbg.
[32]广东省中医院珠海医院.医院门急诊流感患者增加,广东省中医院专家开出中医预防方[EB/OL].(2019-01-23)[2020-02-01].http://www.360doc.com/content/20/0122/16/7105784_887469914.shtml.
[33]中国党刊网.贵州省中医药管理局组织国医大师,中医药专家讨论公布预防“新型冠状病毒肺炎”处方[EB/OL].(2019-01-22)[2020-02-01].http://www.dkcpc.cn/zhengzhi/202001/t20200122_789460.shtml.
[34]腾讯网.疫情来袭,国医大师熊继柏授权养天和发布预防流感中药方助您科学预防[EB/OL].(2019-01-23)[2020-02-01].https://new.qq.com/rain/a/20200123A0DM2500.
[35]医师报.冷静应对新型冠状病毒:专访首都国医姜良铎教授[EB/OL].(2020-01-22) [2020-02-01].https://mp.weixin.qq.com/s/HOXtXAf_H2L-LdCioUjnNw.
[36]中医出版.顾植山:从五运六气分析此次新型冠状病毒感染疫情[EB/OL].(2020-01-26) [2020-02-01].https://mp.weixin.qq.com/s/aW8GnO8QKcyFM m2N77-Cmg.
[37]王玉光,齐文升,马家驹,等.新型冠状病毒(2019-nCoV)肺炎中医临床特征与辨证治疗初探[J/OL].中医杂志.(2020-01-29) [2020-02-01].http://kns.cnki.net/kcms/detail/11.2166.R.20200129.1258.002.html.
[38]谷晓红.防控与防误治并重:温病专家谷晓红教授谈新型冠状病毒肺炎治疗的五点注意事项 [EB/OL].(2020-01-27) [2020-02-01].https://mp.weixin.qq.com/s/nOy4kqsH6K8YmO1yuXYrsw.
[39]广安门医院急诊科.齐文升:关于新型冠状病毒肺炎的中医认识(一) [EB/OL].(2020-01-26) [2020-02-01].https://mp.weixin.qq.com/s/4WA4lj 5Cr3E1nlxFbvpE_w.
[40]湖湘中医.省中医药管理局第二次召开新型冠状病毒肺炎中医药防治专家会商会 [EB/OL].(2020-01-29) [2020-02-01].https://mp.weixin.qq.com/s?-biz=MzI5MDYwNDEwOQ==&mid=2247484475& idx=1&sn=5e364b46085186ac16702e3 f216f1b00.
[41]The Centre for Evidence-Based Medicine develops,promotes and disseminates better evidence for healthcare.OCEBM Levels of Evidence[EB/OL].(2016-05-01) [2020-02-01].https://www.cebm.net/2016/05/ocebm-levels-of-evidence/-evidence.asp.
基本信息:
DOI:10.13288/j.11-2166/r.2020.05.003
中图分类号:R259
引用信息:
[1]于明坤,柴倩云,梁昌昊等.新型冠状病毒肺炎中医预防及诊疗方案汇总分析[J].中医杂志,2020,61(05):383-387.DOI:10.13288/j.11-2166/r.2020.05.003.
基金信息:
国家自然科学基金(81830115)