How to treat SARS

Treatment of SARS Although the cause of SARS is basically clear, the pathogenesis is still unclear, and the treatment of the cause is still lacking. Based on the above understanding, clinical treatment should focus on symptomatic treatment and complications treatment. At present, the curative effect is not clear, so long-term and high-dose combined use of various drugs (such as antibiotics, antiviral drugs, immunomodulators, glucocorticoids, etc.) should be avoided as far as possible. ). (1) General treatment and disease monitoring Stay in bed, pay attention to maintaining water and electrolyte balance, and avoid hard and severe cough. Closely observe the changes of the disease (many patients may be in the advanced stage within 2 ~ 3 weeks after onset). Generally, continuous nasal catheter oxygen inhalation is given in the early stage (the oxygen inhalation concentration is generally 1 ~ 3l/min), and pulse volume oxygen saturation (SpO2) is monitored regularly or continuously every day according to the condition. Check blood routine, urine routine, blood electrolyte, liver and kidney function, myocardial enzyme spectrum, T lymphocyte subsets (if possible) and X-ray chest film regularly. (2) Symptomatic treatment 1, fever > 38.5℃, or obvious body aches, antipyretic and analgesic drugs can be used. Physical cooling measures such as ice compress, alcohol bath and cooling blanket are given to people with high fever, and salicylic acid antipyretic and analgesic drugs are prohibited for children. 2. Cough and expectoration can be given antitussive and expectorant drugs. 3, heart, liver, kidney and other organ dysfunction, corresponding treatment measures should be taken. 4, diarrhea patients should pay attention to rehydration, correct the imbalance of water and electrolyte. (III) Use of glucocorticoids The purpose of using glucocorticoids is to inhibit abnormal immunopathological reactions and alleviate the state of systemic inflammatory reactions, thereby improving the general condition of the body, reducing the exudation and injury of the lungs, and preventing or alleviating pulmonary fibrosis in the later period. The application indications are: ① Poisoning symptoms are serious, with persistent high fever. After symptomatic treatment for more than 3 days, the maximum body temperature still exceeds 39℃; ②X-ray chest film showed multiple or larger shadows, which progressed rapidly. Within 48 hours, the focus area on chest radiograph increased by more than 50% and accounted for more than 1/3 of the total area of both lungs. ③ Meet the diagnostic criteria of acute lung injury (ALI) or ARDS. It can be applied to one of the above indications. The recommended dose for adults is equivalent to 80 ~ 320 mg/d of methylprednisolone, and the specific dose for intravenous administration can be adjusted according to the condition and individual differences. When the clinical manifestations improve or the chest radiograph shows that the lung shadow has been absorbed, the drug should be gradually reduced. Generally, the dosage of 1/3 is reduced every 3 ~ 5 days, and oral prednisone or prednisone can be changed after intravenous injection of 1 ~ 2 weeks. Generally, it does not exceed 4 weeks, and it is not advisable to use too much dose or too long a course of treatment. Acidifier and gastric mucosal protective agent should be used at the same time, and secondary infections, including bacterial and/or fungal infections, should be alert, and the spread of potential tuberculosis infections should be noted. (d) At present, no specific drug for SARS-CoV has been found. Clinical retrospective analysis shows that ribavirin and other commonly used antiviral drugs have no obvious therapeutic effect on this disease. Try using protease inhibitors, such as Kaletra, Lopinavir and Ritonavir. (5) The curative effect of nonspecific immune enhancers such as thymosin, interferon and gamma globulin on this disease has not been confirmed, so routine use is not recommended. The clinical efficacy of serum in the recovery period of SARS has not been confirmed, and it can be tried under close observation for high-risk patients with clear diagnosis. (VI) Use of Antibacterials The application of antibacterial drugs has two main purposes. First, experimental treatment of suspected patients to help differential diagnosis; Secondly, it is used to treat and control secondary bacterial and fungal infections. In view of the fact that SARS is often confused with community-acquired pneumonia (CAP), which is usually caused by Streptococcus pneumoniae, Mycoplasma and Haemophilus influenzae. When the diagnosis is not clear, we can choose new quinolones or β -lactams combined with macrolides for experimental treatment. The pathogens of secondary infection include Gram-negative bacilli, Gram-positive cocci, fungi and Mycobacterium tuberculosis, and appropriate antimicrobial agents should be selected accordingly. (seven) psychological treatment of suspected cases, should be reasonable arrangements for admission conditions, reduce the pressure of patients worried about cross-infection in the hospital; For confirmed cases, it is necessary to strengthen nursing and explanation, and guide patients to deepen their understanding of the self-limitation and cure of the disease. (8) The treatment of this disease by TCM accords with the statement that "five epidemics are easy to infect each other, regardless of their size and similar symptoms", which belongs to the category of epidemic heat in TCM. Due to the evil of epidemic poison, the disease enters from the nose and mouth, mainly in the lungs, and can also involve other viscera; The basic pathogenesis is that evil toxin blocks the lung, phlegm and blood stasis, lung qi stagnation and deficiency of both qi and yin. The principle of TCM treatment is to treat early, eliminate pathogenic factors, strengthen the body resistance early and prevent transmission. 1, Syndrome Differentiation and Treatment (1) Syndrome of epidemic drugs invading the lung: more common in the early stage. Symptoms: fever at first, or aversion to cold; Headache, general pain, and drowsiness of limbs; Dry cough, scanty phlegm, or sore throat; Shortness of breath, fatigue and dry mouth. White or yellow tongue coating, slippery pulse. Treatment: clearing lung, detoxifying and eliminating dampness. Basic prescription and reference dosage: honeysuckle 15g along the border 15g Scutellaria baicalensis Georgi 10g Bupleurum chinense 10g Artemisia annua 15g cardamom 6g (beaten) fried almonds 9g raw coix seed 15g radix adenophorae 15g plus or minus: (3) For those with greasy fur, Xiang Lei and Eupatorium odoratum are added; (4) removing Rhizoma Anemarrhenae and adding Rhizoma Coptidis and Rhizoma Zingiberis Preparata; (5) Pinellia ternata and bamboo shavings are added to patients with nausea and vomiting. (2) Syndrome that the epidemic toxin blocks the lung: it is more common in the early and advanced stages. Symptoms: high fever, sweating and fever, and general pain; Cough, less phlegm, chest tightness and shortness of breath; Diarrhea, nausea and vomiting, or bloating, or constipation, or loose stool's discomfort; Dry mouth does not want to drink, shortness of breath, fatigue; Even restless. The tongue is red or crimson, the coating is yellow and greasy, and the pulse is slippery. Treatment: clearing away heat and toxic materials, dispersing lung and eliminating dampness. Basic prescription and reference dosage: gypsum 45g (decocted first), Rhizoma Anemarrhenae 10g, Herba Ephedrae 6g, Flos Lonicerae 20g, fried almond 10g, raw Coicis Semen 10g, Fritillaria thunbergii 10g, Radix Pseudostellariae 10g, and raw licorice/0g. (2) For those who are short of breath, weak and thirsty, go to Radix Pseudostellariae and Radix Panacis Quinquefolii; (3) Pinellia ternata is added to patients with nausea and vomiting; (4) Fructus Trichosanthis and Radix et Rhizoma Rhei are added for constipation; (5) Areca catechu and Radix Aucklandiae are added for patients with abdominal distension and loose stool discomfort. (3) Pulmonary obstruction syndrome: it is more common in advanced and severe SARS. Symptoms: high fever persists or begins to decline; Dyspnea, chest tightness and shortness of breath; Or dry cough, less sputum, or blood in sputum; Shortness of breath and fatigue, purple and dark lips, red or dark tongue, yellow and greasy fur, and slippery pulse. Treatment: clearing away heat and purging lung, removing blood stasis and turbidity, strengthening body resistance and consolidating constitution. Basic prescription and reference dosage: Lepidium 15g Cortex Mori 15g Scutellariae Radix 10g Fructus Trichosanthis 30g Yujin 10g Rhizoma Dioscoreae Septemlobae 12g Bombyx mori/KLOC-. (2) Cortex Magnolia Officinalis and Fructus Hordei Germinatus are added to patients with abdominal distension and anorexia; (3) Oral cyanosis plus Notoginseng Radix and Herba Leonuri. (4) Internal adduction and external detachment syndrome: seen in severe SARS. Symptoms: respiratory distress, shortness of breath, hyperventilation and less inspiration; The voice is deep, dry and disturbing, even vaguely, sweating and cold limbs. The lips are purple and dark, the tongue is dark red, the fur is yellow and greasy, and the pulse is heavy and thin. Treatment: benefiting qi and astringing yin, returning yang to dissipate stagnation, and clearing away turbidity. Basic prescription and reference dosage: Ginseng Radix Rubri/KOOC-0/0 ~ 30g (decocted in water), Radix Aconiti Preparata/KOOC-0/0g Cornus officinalis 30g Ophiopogon japonicus/KOOC-0/5g Yujin/KOOC-0/0g Sanqi6g plus or minus:/KOOC-0/g Angong Niuhuang Pill is taken above the stunned person; (2) cold sweat of the forged keel; Ramulus Cinnamomi and Rhizoma Zingiberis Recens are added for those with cold limbs; 4 add monkey jujube powder to those with phlegm in throat. (5) Deficiency of both qi and yin, phlegm and blood stasis blocking collaterals syndrome: more common in convalescence. Symptoms: chest tightness, shortness of breath, fatigue, and asthma when moving; Or see a cough; Conscious fever or low fever, spontaneous sweating, anxiety, insomnia, anorexia, dry mouth and throat. Red tongue with little body fluid, yellow or greasy tongue coating, heavy and thin pulse. Treatment: Yiqi Yangyin, Huatan Tongluo. Basic prescription and reference dose: Codonopsis pilosula 15g Adenophora adenophora 15g Ophiopogon japonicus 15g Radix Rehmanniae 15g Radix Paeoniae Rubra 12g Aster 15g Fritillaria thunbergii 10g malt/kloc-0. (2) Artemisia annua, Gardenia jasminoides Ellis, and Cortex Moutan are added for patients with spontaneous fever or heart-heat and dark tongue; (3) Poria cocos and Atractylodes macrocephala in loose stool; (4) add vinegar Bupleurum chinense and Cyperus rotundus for anxious people; (5) For patients with insomnia, stir-fried Semen Ziziphi Spinosae and Radix Polygalae are added; (6) Herba Artemisiae Scopariae and Fructus Schisandrae Chinensis are added for patients with liver function injury and elevated transaminase. 2, the application of Chinese patent medicine should be dialectical use of Chinese patent medicine, can be combined with traditional Chinese medicine decoction. (1) antipyretic: suitable for early and high fever, and can be selected from Guashuangtuireling capsule, Zi Xue, Xue Xin granule, Xiaozihu tablet (or granule) and Ziyin oral liquid. (2) Clearing away heat and toxic materials: it is suitable for the early and late stages of epidemic diseases, lung diseases, lung diseases and lung asthma. The injection can be Qingkailing injection, Houttuynia cordata injection, Shuanghuanglian powder injection and compound Sophora flavescens injection. Oral preparations can be Qingkailing oral liquid (capsule), Qingrejiedu oral liquid (granule), Shuanghuanglian oral liquid, Jinlian Qingre granule, Kumou granule, Gegen Qinlian micro pill, Meihua Dianshe pill, purple chip, etc. (3) Promoting blood circulation, removing blood stasis, eliminating dampness and resolving phlegm: It is suitable for lung obstruction, asthma and asphyxia in the late and severe SARS. The injection can be Danshen injection, Xiangdan injection, Chuanxiong injection and Erigeron breviscapus injection. The oral preparation can be Xuefu Zhuyu oral liquid (or granules), compound Danshen dripping pills, Huoxiang Zhengqi oral liquid (capsules), Houzao powder, etc. (4) Righteousness category: it is suitable for those with insufficient righteousness in each period. The injection can be Shengmai injection, Shenmai injection, Shenfu injection and Astragalus injection. Oral preparations can be selected from Shengmai Yin, Bailing Capsule, Jinshuibao Capsule, Ningxinbao Capsule, Nuodikang Capsule, Liuwei Dihuang Pill, Buzhong Yiqi Pill, etc. Treatment principle of severe SARS Although most SARS patients can be relieved naturally, about 30% are still severe, and some may progress to acute lung injury or ARDS or even death. Therefore, close observation, intensive monitoring, timely respiratory support, rational use of glucocorticoids, enhanced nutritional support and organ function protection, attention to water, electrolyte and acid-base balance, prevention and treatment of secondary infections, and timely treatment of complications are necessary for critically ill patients.