基于数据挖掘探讨ICU 48例新型冠状病毒肺炎患者中医用药规律

来源 :中华危重病急救医学 | 被引量 : 0次 | 上传用户:siman2008
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目的:通过对河北省石家庄市治疗新型冠状病毒肺炎(新冠肺炎)的中药处方进行数据分析,以期进一步指导临床运用中医药防治新冠肺炎。方法:将河北省中医院重症医疗队2021年1月7日至3月4日在河北省新冠肺炎定点救治医院河北省胸科医院重症监护病房(ICU)救治的确诊为新冠肺炎的48例出院患者为研究对象。收集患者的性别、年龄、临床分型、既往史以及住院期间首诊和复诊的全部中药处方。基于古今医案云平台(V2.2.1)建立数据库,用频次统计、关联分析、聚类分析、复杂网络分析等方法,对中药处方进行分析。结果:48例确诊新冠肺炎患者中,男性20例,女性28例;平均年龄(62.4±13.7)岁;病情普遍偏重,其中普通型17例、重型25例、危重型6例;大多合并高血压、冠心病、糖尿病、慢性阻塞性肺疾病等基础疾病。共纳入有效处方146张,涉及方剂59首、中药115味。对146张处方进行使用频次(使用率)分析显示,新冠肺炎患者常用方剂为清肺排毒汤(30次,20.55%)、宣白承气汤(10次,6.85%)、达原饮(10次,6.85%);常见中药为甘草(80次,54.79%)、茯苓(76次,52.05%)、石膏(70次,47.95%)、苦杏仁(70次,47.95%)、麻黄(57次,39.04%)、黄芩(56次,38.36%)、陈皮(53次,36.30%)、广藿香(50次,34.25%)、白术(50次,34.25%)、柴胡(43次,29.45%)。中药功效以清热解毒(129次)、清热泻火(129次)、利水渗湿(110次)为主;药性以温(509次)、平(287次)、寒(235次)为主;药味以辛(765次)、甘(654次)、苦(626次)为主;归经以肺(1 096次)、脾(785次)、胃(687次)为主。关联分析显示,共17对药物组合,其中支持度排在前3位的药对分别为苦杏仁-石膏(0.43)、麻黄-苦杏仁(0.38)、陈皮-茯苓(0.36)、麻黄-石膏(0.36)。聚类分析显示,共有3个聚类药物组合,分别为麻黄、苦杏仁、石膏,广藿香、茯苓、陈皮、白术,以及黄芩、炙甘草、枳实、泽泻、柴胡、生姜、桂枝;核心药物由茯苓、柴胡、陈皮、白术、广藿香、苦杏仁、黄芩、石膏、麻黄、甘草组成。结论:中老年新冠肺炎确诊患者正虚毒损,病机演变迅捷,湿浊毒邪多闭肺困脾、枢机不利,甚者内陷营血、阴竭阳脱;治以化浊解毒为要、补气养阴为则,使邪去而正气复。“,”Objective:To analyze the data of Chinese medicine prescriptions for the treatment of coronavirus disease 2019 (COVID-19) in Shijiazhuang City, Hebei Province, with a view to further guide the clinical use of Chinese medicine in the prevention and treatment of COVID-19.Methods:Forty-eight patients diagnosed with COVID-19 who were treated by critical care team of Hebei Traditional Chinese Medicine Hospital in the intensive care unit (ICU) of Hebei Chest Hospital (Hebei Provincial COVID-19 designated hospital) from January 7 to March 4, 2021, were enrolled in this study. The patients\' gender, age, clinical classification, past history, and all Chinese medicine prescriptions for the first visit and follow-up visits during the hospitalization were collected. A database was established based on the Ancient and Modern Medical Records Cloud Platform (V2.2.1), and the methods of frequency analysis, correlation analysis, cluster analysis, and complex network analysis were used to analyze the prescriptions of traditional Chinese medicine.Results:Among the 48 patients with COVID-19, 20 were males and 28 were females; the average age was (62.4±13.7) years old. The patients\' condition was generally severe, including 17 cases of common type, 25 cases of severe type, and 6 cases of critical type, most of whom were combined with hypertension, coronary heart disease, diabetes, chronic obstructive pulmonary disease and other basic illnesses. A total of 146 valid prescriptions were included, involving 59 prescriptions and 115 Chinese medicines. Frequency analysis of 146 prescriptions showed that the commonly used prescriptions for patients with COVID-19 were Qingfei Paidu decoction (30 times, 20.55%), Xuanbai Chengqi decoction (10 times, 6.85%), and Dayuan Yin (10 times, 6.85%). The common Chinese medicines were liquorice (80 times, 54.79%), tuckahoe (76 times, 52.05%), gypsum (70 times, 47.95%), bitter almond (70 times, 47.95%), ephedra (57 times, 39.04%), scutellaria (56 times, 38.36%), tangerine peel (53 times, 36.30%), patchouli (50 times, 34.25%), atractylodes macrocephala (50 times, 34.25%), and bupleurum (43 times, 29.45%). The main effects were clearing heat and detoxification (129 times), clearing heat-fire (129 times) and eliminating dampness and diuresis (110 times). The medicinal properties were mainly warm (509 times), flat (287 times), and cold (235 times). The medicinal tastes were mainly pungent (765 times), sweet (654 times), and bitter (626 times). The medicinal channel tropism were mainly lung (1 096 times), spleen (785 times), and stomach (687 times). The correlation analysis showed that there were 17 drug combinations in total, among which the top 3 drug pairs in support were bitter almond-gypsum (0.43), ephedra-bitter almond (0.38), tangerine peel-poria (0.36), and ephedra-gypsum (0.36). Cluster analysis showed that there were 3 groups of clustering formulas. The first group was ephedra, bitter almond, and gypsum. The second group was patchouli, tuckahoe, tangerine peel, and atractylodes macrocephala. The third group was scutellaria, licorice, immature orange fruit, oriental waterplantain rhizome, bupleurum, ginger, and cassia twig. The core drugs were composed of tuckahoe, bupleurum, tangerine peel, atractylodes macrocephala, patchouli, bitter almond, scutellaria, gypsum, ephedra, and licorice.Conclusions:Middle-aged and elderly patients with COVID-19 are accompanied by Qi deficiency and internal invasion of toxins, and the pathogenesis evolves rapidly. Damp and turbid toxins often block the lungs and trap the spleen, leading to disorder of Qi movement, and even invaginate Ying and Xue, drain Yin and Yang. The treatment is based on removing turbidity and detoxification, and replenishing Qi and nourishing Yin are the principle treatments, so that the evil is eliminated and the Qi is restored.
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