ABSTRACT
Objective:To evaluate the clinical effect of awake prone positioning (APP) for common coronavirus disease 2019 (COVID-19) caused by Omicron variant.Methods:Retrospectively analyze the clinical data of patients with COVID-19 caused by Omicron variant admitted by medical team of Tianjin Third Central Hospital during the period of supporting Tianjin COVID-19 designated hospital from January 8 to February 20, 2022. Patients who met the diagnostic criteria for common COVID-19 and had risk factors for developing severe disease or had pulse oxygen saturation (SpO 2) ≤0.93 after exercise without supplementary oxygen were enrolled. Patients were divided into APP group and control group according to whether they completed the daily 12-hours APP in the first three days after enrollment. Demographic characteristics, clinical symptoms, COVID-19 vaccination status, laboratory examination, disease progression (progression to severe), time to nucleic acid negative conversion, length of hospital stay, and adverse reactions and tolerability [visual analog scale (VAS) score (the higher the score, the worse the tolerability] during APP were evaluated in two groups. Interleukin-6 (IL-6), C-reactive protein (CRP), SpO 2/inhaled oxygen concentration (FiO 2) ratio and ROX index (ROXI) were compared between two groups at enrollment, 3rd and 7th day after enrollment. Results:There were no significant differences in demographic characteristics, clinical symptoms, vaccination rates of COVID-19 and laboratory tests between the two groups. There were no statistically significant differences in IL-6, CRP, SpO 2/FiO 2 ratio and ROXI between two groups at the time of enrollment. Compared with the group at the time of enrollment, SpO 2/FiO 2 ratio and ROXI in APP group increased significantly at the 3rd day after enrollment [SpO 2/FiO 2 ratio: 461.90 (457.10, 466.70) vs. 446.67 (437.14, 457.10), ROXI: 25.40 (23.33, 25.93) vs. 22.57 (21.86, 24.40), all P < 0.05], and the levels of IL-6 and CRP in control group were significantly increased [IL-6 (ng/L): 18.30 (6.50, 37.75) vs. 7.40 (5.10, 11.15), CRP (mg/L): 11.46 (2.11, 17.96) vs. 4.11 (1.72, 9.05), all P < 0.05]. At the 3rd day of enrollment, the levels of IL-6 and CRP in APP group were significantly lower than those in control group [IL-6 (ng/L): 7.35 (4.35, 12.80) vs. 18.30 (6.50, 37.75), CRP (mg/L): 4.52 (1.98, 9.66) vs. 11.46 (2.11, 17.96), all P < 0.05], while SpO 2/FiO 2 ratio and ROXI were significantly higher than those in control group [SpO 2/FiO 2 ratio: 461.90 (457.10, 466.70) vs. 446.67 (441.90, 459.52), ROXI: 25.40 (23.33, 25.93) vs. 23.31 (22.10, 24.66), all P < 0.05]. At the 7th day of enrollment,there were no significant differences in IL-6, CRP, SpO 2/FiO 2 ratio and ROXI between two groups. There were no severe cases in both groups. The time of nucleic acid negative conversion and length of hospital stay in APP group were significantly shorter than those in control group [10.0 (8.0, 12.0) days vs. 11.0 (9.0, 13.0) days, 12.0 (10.0, 14.0) days vs. 14.0 (12.0, 16.0) days, respectively, all P < 0.05]. The main adverse reaction during APP was back pain, and the incidence in APP group was slightly lower than that in control group, but the difference was not statistically significant [17.9% (17/95) vs. 26.5% (27/102), P = 0.149]. VAS score in control group was significantly higher than that in APP group [score: 2.5 (2.0, 4.0) vs. 2.0 (1.0, 3.0), P = 0.004]. Conclusions:In common COVID-19 patients caused by Omicron variant with high risk factors for progression to severe disease or decreased oxygen reserve capacity, early APP can shorten the time of nucleic acid negative conversion and the length of hospital stay, but its effect on preventing disease progression cannot be determined.
ABSTRACT
Objective:To analyze the clinical efficacy of Ganlu Xiaodu decoction combined with western medicine in the treatment of common coronavirus disease-2019（COVID-19）. Method:With the propensity score matching method，the clinical data of patients with common COVID-19 admitted to Wuhan Third Hospital from January 25，2020 to March 18，2020，were screened out. 115 patients with Ganlu Xiaodu decoction combined with conventional therapy were enrolled in the treatment group according to the inclusion and exclusion criteria，and 115 patients treated with conventional therapy were enrolled in the control group. The disappearance rate of main symptoms（fever，cough，expectoration，chest tightness，fatigue and panting），days of syndrome disappearance，effective rate and disappearance rate of other symptoms，laboratory indexes before treatment and after 7 days' treatment，effective rate in computed tomography（CT） of the lungs，rate of conversion to severe illness and total hospitalization time were compared between the two groups. Result:The baseline data between the two groups showed no statistically significant difference，but were comparable. After 7 days of treatment，the symptom disappearance rate of fever，cough，expectoration，chest tightness，fatigue and panting in the treatment group was significantly higher than that in the control group（P<0.01）.The average number of days to disappearance of main symptoms in treatment group was significantly less than that in the control group（P<0.01）. The effective rate of main symptoms was 93.9%（108/115）in treatment group, significantly higher than 75.7%（87/115，P<0.01）in control group. In the treatment group，the rate of conversion to severe illness was 0, significantly lower than 16.5% (19/115) in the control group (P<0.01). After treatment for 7 days，the white blood cell count，red blood cell count，c-reactive protein，calcitonin，and D-dimer in treatment group were significantly reduced（P<0.05），while lymphocyte count was significantly increased as compared with those before treatment（P<0.01）, the lymphocyte count in control group was also increased significantly in control group（P<0.01），while C-reactive protein，calcitonin and D-dimer were significantly reduced（P<0.05）. As compared with the control group，C-reactive protein and calcitonin levels in the treatment group were significantly down-regulated（P<0.01），and lymphocyte count rose significantly（P<0.05）.The improvement rate of pulmonary CT in the treatment group was 93.9%（108/115），which was significantly higher than 75.7%（87/115）in the control group（P<0.001）. After treatment，the patients in both groups were cured and discharged，and the average length of stay in the treatment group was（14.70±2.76） d，significantly less than（15.80±4.37） d in the control group （P<0.05）. No adverse events occurred in the treatment group but 6 cases occurred in the control group. Conclusion:Ganlu Xiaodu decoction combined with western medicine can significantly improve the clinical symptoms of common COVID-19 patients such as fever，cough，expectoration，chest tightness，fatigue, panting and shortness of breath，alleviate the main symptoms effectively，reduce the rate of conversion from common to serious COVID-19，regulate the expressions of relevant peripheral inflammation factors，promote absorption of lung inflammation，shorten hospitalization time，and improve the cure rate，indicating that Ganlu Xiaodu decoction can be effective in the treatment of patients with common COVID-19.