危重症新型冠状病毒肺炎的治疗思考(二)

新型冠状病毒肺炎(COVID-19)危重型患者的救治面临严峻挑战。循环状态需严密监测并鉴别不同类型的休克,合理应用血管收缩药物,警惕并发症。评估静脉血栓栓塞症(VTE)风险,高危者需实施有效预防,对突然出现氧合恶化、呼吸窘迫、血压下降等临床表现者需警惕肺血栓栓塞症(PTE)的发生,但对D-二聚体异常增高的解读需结合疾病的严重状态综合分析。营养支持作为基础治疗手段,应制定个体化营养方案,评估并动态调整。当前疫情下,恢复期血浆只能经验性应用,适应证需严格把控,输血过程中严密监测并动态评估疗效。

The keypoints in treatment of the critical coronavirus disease 2019 patient(2)

The treatment of critically ill patients with coronavirus disease 2019(COVID-19)faces compelling challenges.In this issue,we′d like to share our first-line treatment experience in treating COVID-19.Hemodynamics need be closely monitored and different types of shock should be distinguished.Vasoconstrictor drugs should be used rationally and alerting of complications is of the same importance.The risk of venous thromboembolism(VTE)needs to be assessed,and effective prevention should be carried out for high-risk patients.It is necessary to consider the possibility of pulmonary thromboembolism(PTE)in patients with sudden onset of oxygenation deterioration,respiratory distress,reduced blood pressure.However,comprehensive analysis of disease state should be taken into the interpretation of abnormally elevated D-Dimer.Nutritional support is the basis of treatment.It′s important to establish individual therapy regimens and to evaluate,monitor and adjust dynamically.Under the current epidemic situation,convalescent plasma can only be used empirically,indications need to be strictly screened,the blood transfusion process should be closely monitored and the curative effect should be dynamically evaluated.