新型冠状病毒肺炎后时代：基础疾病带来的巨大挑战

新型冠状病毒流行已经造成全球超五亿人次感染。由于病毒变异等原因，我国基础疾病导致的高龄重症患者明显增加，给临床诊疗带来了巨大的挑战。高龄合并基础疾病患者进展为新型冠状病毒肺炎（简称新冠肺炎）重症或基础疾病重型，预后不佳，采用早期筛查和早期干预，预防高危患者重症化；强调重症规范管理和基础疾病的专科化诊疗，关注肺与肺外器官保护；同时加强营养支持和康复治疗，是降低患者重症率和病死率的关键。     

重症新冠肺炎患者血栓形成的预防及护理

目的:探讨重症新冠肺炎患者血栓形成的预防及护理方法。方法:对50例重症新冠肺炎患者进行风险评估及筛查、合理预防、并发症预防、抗凝治疗、心理护理、健康教育及防控措施,其中最关键的治疗和护理措施为合理预防。结果:本组重症新冠肺炎患者中无新发深静脉血栓形成(DVT),已存在血栓形成的2例重症新冠肺炎患者经过抗凝治疗,血栓面积逐渐缩小。结论:早期的血栓评估和筛查、有效的护理干预,对预防新冠肺炎重症患者血栓形成的发生是有效的,可改善患者血流动力学及凝血相关指标,降低DVT的发生风险,避免新冠肺炎患者发生肺栓塞性死亡,保障其生命安全。     

不同类型新冠肺炎临床病例特点分析

目的 通过回顾性分析不同类型新冠肺炎患者的临床资料,探讨新冠肺炎的临床病例特点。方法 收集我院119例非危重症新冠肺炎患者和30例危重症新冠肺炎患者基本人口学特征、基础疾病、临床表现,以及重要检验指标,对两组患者数据进行统计学分析。结果 两组之间不存在性别差异,危重症患者以高龄者居多,临床表现均以单个症状者较少,大多是数个症状共同或先后出现,但危重症患者程度更严重。新冠肺炎常伴有基础疾病,其中最多为高血压病,其次是冠心病及2型糖尿病,而51.3-63.3%的患者往往同时患有高血压病、冠心病及2型糖尿病等多种疾病。另外还发现,危重症患者淋巴细胞计数、淋巴细胞百分比明显低于非危重症患者,而白细胞计数、白细胞百分比、C反应蛋白、降钙素原,肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶及α-羟丁酸脱氢酶等指标,危重症患者则明显高于非危重症患者。结论 和非危重症新冠肺炎患者相比,危重症新冠肺炎患者年龄更大,临床表现和基础疾病更多、程度更重,炎性反应更明显,对肺、心及肝等重要器官功能影响更显著。     

老年危重型新冠肺炎患者救治病例报告

2020年2月8日,阳光融和医院收治1例重型新冠肺炎感染患者,病情进展迅速,短期内转为新冠肺炎危重型患者,后经精心治疗与护理,该患者2次咽拭子核酸检测阴性,解除隔离,转入隔离观察区继续治疗基础疾病,且参与本次救治的重症组所有医护人员无感染发生。本文回顾了该新冠肺炎危重型患者救治过程中的工作情景及细节,以病例讨论的形式,还原诊疗过程、护理记录,针对该患者护理中的重点、疑点、难点进行讨论分析,旨在总结新冠肺炎的护理要点,提高对危重型新冠肺炎患者在不同时期的护理管理,推广医护人员避免感染的防护措施,为临床救治新冠肺炎危重型患者提供医疗及护理经验,为医护人员职业防护提供依据。     

高龄新型冠状病毒肺炎患者重症护理：防“危”杜渐

高龄新型冠状病毒肺炎（简称新冠肺炎）患者由于原发病本身、生理因素、伴有多种基础疾病等原因，发病后容易在短期进展为重症。特殊时期的重症护理需要“关口前移”，加强早期筛查，同时制定个体化的护理方案，包括俯卧位等。针对这一特殊群体，还需加强多方位护理，包括气道管理、容量评估、营养治疗、康复锻炼、心理干预等。在疫情防控期间，重症护理应充分发挥核心作用，防“危”杜渐，改善高龄新冠肺炎患者的临床预后及生活质量。     

收治重症新型冠状病毒肺炎患者隔离病区的病房管理

目的探讨收治重症新型冠状病毒肺炎(简称新冠肺炎)患者的隔离病区的病房有效管理。方法在医院感染管理科、护理部等职能科室的指导下,根据科室的实际情况对隔离病区进行科学有效的管理。结果提高了病区收治重症新冠肺炎患者的时效性,保障了护理质量和医务人员的安全。结论在医院救治新冠肺炎的特殊时期,通过科学的病区布置、积极有效的防护培训,保证了重症新冠肺炎患者及疑似新冠肺炎患者的及时抢救治疗和医务人员的自身安全。     

集束化防控措施在新型冠状病毒肺炎合并多重耐药菌患者中的应用

2019年12月在湖北省武汉市发现新型冠状病毒肺炎(COVID-19),病毒传播性极强,迅速蔓延中国乃至全球,对人类的健康及生命安全造成严重威胁。合并基础疾病患者易重症化,对患者抗病毒诊疗过程中,易增加多重耐药菌感染风险。本文通过制定《新冠患者多重耐药菌管理制度》,落实新冠肺炎合并多重耐药菌患者集束化防控措施,明确防控流程及评价标准,以期为疫情期间降低新冠肺炎合并多重耐药菌感染风险提供借鉴。     

早期清醒俯卧位联合经鼻高流量氧疗治疗重型新型冠状病毒肺炎一例

在新型冠状病毒肺炎（简称“新冠肺炎”）疫情防控的早期阶段,由于对疾病的认识不足,重症患者治疗难度大、病死率高,这对ICU医师提出了挑战。皖南医学院弋矶山医院在疫情防控早期阶段收治1例重型新冠肺炎患者,结合既往急性呼吸窘迫综合征（ARDS）的处理经验,采用早期清醒俯卧位联合经鼻高流量氧疗（HFNC）治疗,成功避免气管插管和机械通气,最终患者康复出院。本文报告该病例的综合救治过程,并结合文献,分析清醒俯卧位联合HFNC治疗重型新冠肺炎的循证医学依据、注意事项和及时转为有创机械通气的时机,提出“俯卧位前移”的概念,为重症新冠肺炎患者救治提供有力的医疗决策。     

新型冠状病毒肺炎重症患者的救治及随访体会

目的 了解新型冠状病毒肺炎(新冠肺炎)患者的流行病学和临床特征以及预后.方法 收集2020年1月至2月收治于贵州医科大学附属医院重症监护病房(ICU)的新冠肺炎患者的临床资料,包括流行病学特征、症状体征、治疗措施及6个月随访情况,分析疾病发展动态并总结救治经验.结果 共纳入6例新冠肺炎患者,年龄33～83岁,均有明确的...     

重症新型冠状病毒肺炎救治:用好重症超声

截至2020年2月24日24时,全国新型冠状病毒肺炎(简称:新冠肺炎,COVID-19),累计报告确诊病例77779例,其中重症患者超过10%。由于呼吸道传播疾病的特殊性,重症新冠肺炎患者的救治过程出现很多与重症患者日常管理不同的特殊困难。作为近十年来急危重症领域的重要进展之一,重症超声以其动态、实时、可重复、多目标导向、不受环境因素制约等突出优势,在重症新冠肺炎的救治中起到了重要作用。     

新型冠状病毒肺炎合并心血管疾病的临床治疗观察

目的 探讨新型冠状病毒肺炎(COVID-19)合并心血管疾病患者治疗措施.方法 收集155例COVID-19患者临床资料,分析155例患者治疗用药情况,并对21例合并心血管疾病患者临床治疗进行分析.结果COVID-19合并心血管疾病单中心发病率13.5％,其中高血压患者较多(95.2％),老年COVID-19患者合并心...     

Timing of convalescent plasma therapy-tips from curing a 100-year-old COVID-19 patient using convalescent plasma treatment: A case report

BACKGROUNDConvalescent plasma therapy is used for the treatment of critically ill patients for newly discovered infectious diseases, such as coronavirus disease 2019 (COVID-19) pneumonia, under the premise of lacking specific treatment drugs and corresponding vaccines. But the best timing application of plasma therapy and whether it is effective by antiviral and antibiotic treatment remain unclear. CASE SUMMARYWe describe a patient with COVID-19, a 100-year-old, high-risk, elderly male who had multiple underlying diseases such as stage 2 hypertension (very high-risk group) and infectious pneumonia accompanied by chronic obstructive pulmonary disease and emphysema. We mainly describe the diagnosis, clinical process, and treatment of the patient, including the processes of two plasma transfusion treatments.CONCLUSIONThis provides a reference for choosing the best timing of convalescent plasma treatment and highlights the effectiveness of the clinical strategy of plasma treatment in the recovery period of patients with COVID-19 pneumonia.     

Beta receptor blocker therapy for the elderly in the COVID-19 era

When the coronavirus disease 2019 (COVID-19) pandemic spread globally from the Hubei region of China in December 2019, the impact on elderly people was particularly unfavorable. The mortality associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was highest in older individuals, in whom frailty and comorbidities increased susceptibility to severe forms of COVID-19. Unfortunately, in older patients, the course of COVID-19 was often characterized by significant cardiovascular complications, such as heart failure decompensation, arrhythmias, pericarditis, and myopericarditis. Ensuring that the elderly have adequate therapeutic coverage against known cardiovascular diseases and risk factors is particularly important in the COVID-19 era. Beta blockers are widely used for the treatment and prevention of cardiovascular disease. The clinical benefits of beta blockers have been confirmed in elderly patients, and in addition to their negative chronotropic effect, sympathetic inhibition and anti-inflammatory activity are theoretically of great benefit for the treatment of COVID-19 infection. Beta blockers have not been clearly shown to prevent SARS-CoV-2 infection, but there is evidence from published studies including elderly patients that beta blockers are associated with a more favorable clinical course of COVID-19 and reduced mortality. In this minireview, we summarize the most important evidence available in the literature on the usefulness of beta blocker therapy for older patients in the context of the COVID-19 pandemic.     

新型冠状病毒感染肺炎流行时期居家老年人群营养膳食紧急推荐

我国新型冠状病毒感染肺炎(COVID-19)疫情严峻,老年人群和有慢病基础的感染者易成为COVID-19重症高危患者,是防控的重点人群。本指南收集现有研究证据,基于2001年牛津证据分级与推荐意见强度,为居家老年人和合并慢性基础疾病老年人在COVID-19流行期间的营养膳食提供紧急推荐意见,旨在为医疗和社区相关机构工作人员指导广大老年居民在此特殊时期合理安排膳食提供依据。     

Predisposing factors of important invasive fungal coinfections in COVID-19 patients: a review article

Severe acute respiratory syndrome coronavirus-2 has caused a devastating pandemic lasting for more than a year. To date, 47 million individuals have been infected and 1.2 million individuals have died worldwide. Some of the most important coinfections in patients with coronavirus disease 2019 (COVID-19) are opportunistic invasive fungal infections (OIFIs), which are sometimes not rapidly diagnosed and are often diagnosed after death. Aspergillosis and candidiasis are the most prevalent OIFIs in patients with COVID-19. Mycormycosis, cryptococcosis, and other fungal diseases have also been documented more rarely. This review aimed to summarize factors affecting COVID-19 transmission, prevalence, morbidity, and mortality in Iran as well as to review common OIFIs in patients with COVID-19. Immunological factors, underlying diseases, and social, cultural, and environmental factors can affect COVID-19 transmission. There is a need to improve diagnostic and therapeutic criteria for OIFIs and to optimize management procedures so that patients with OIFIs can receive treatment as rapidly as possible. Screening of patients with confirmed COVID-19 for OIFIs at the treating physician’s discretion could enable early OIFI diagnosis, treatment, and mortality reduction.     

Liver dysfunction-related COVID-19: A narrative review

The coronavirus 2019 disease (COVID-19) is caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2. This disease was designated by the World Health Organization as a pandemic on March 11, 2020, which is not seen before. There are no classical features among the cases of the disease owing to the involvement of nearly all body tissues by the virus. Hepatic involvement is one of the characteristics of the COVID-19 course. There are six possible mechanisms of such involvement: Direct virus injury, drug-induced effect, inflammatory cytokine storm, hypoxia-ischemic destruction, abnormalities in liver function tests, and pre-existing chronic liver diseases. Liver abnormalities are seen commonly in the severe or critical stage of COVID-19. Therefore, these abnormalities determine the COVID-19 severity and carry a high rate of morbidity and mortality. The elderly and patients with comorbidities like diabetes mellitus and hypertension are more vulnerable to liver involvement. Another issue that needs to be disclosed is the liver manifestations following the COVID-19 vaccination, such as autoimmune hepatitis. Of note, complete vaccination with third and fourth booster doses is necessary for patients with previous chronic liver diseases or those who have been subjected to liver transplantation. This review aims to explore the various aspects of liver dysfunction during the COVID-19 course regarding the epidemiological features, predisposing factors, pathophysiological mechanisms, hepatic manifestations due to COVID-19 or following vaccination, role of liver function tests in the assessment of COVID-19 severity, adverse effects of the therapeutic agents for the disease, and prognosis.     

Insight into appropriate medication prescribing for elderly in the COVID-19 era

Coronavirus disease 2019 (COVID-19) complicates clinical management in elderly population. There is an additional need to properly treat and monitor elderly COVID-19 patients. This paper discusses the inappropriate medication prescribing in the elderly and suggests an updated valid assessment tool considering COVID-19 and its treatment.     

COVID-19 combined with liver injury: Current challenges and management

Coronavirus disease 2019 (COVID-19) combined with liver injury has become a very prominent clinical problem. Due to the lack of a clear definition of liver injury in patients with COVID-19, the different selection of evaluation parameters and statistical time points, there are the conflicting conclusions about the incidence rate in different studies. The mechanism of COVID-19 combined with liver injury is complicated, including the direct injury of liver cells caused by severe acute respiratory syndrome coronavirus 2 replication and liver injury caused by cytokines, ischemia and hypoxia, and drugs. In addition, underlying diseases, especially chronic liver disease, can aggravate COVID-19 liver injury. In the treatment of COVID-19 combined with liver injury, the primary and basic treatment is to treat the etiology and pathogenesis, followed by support, liver protection, and symptomatic treatment according to the clinical classification and severity of liver injury. This article evaluates the incidence, pathogenesis and prevention and treatment of COVID-19 combined with liver injury, and aims to provide countermeasures for the prevention and treatment of COVID-19 combined with liver injury.     

Risk factors associated with hospitalization in patients with asymptomatic or mild COVID-19 in public accommodation facilities in Tokyo

IntroductionIn Japan, patients with coronavirus disease 2019 (COVID-19) who do not require medical intervention are provided care in recovery accommodation facilities (RAFs). However, some patients may require hospitalization if their symptoms become more severe during their stay. We conducted an observational study using epidemiological data of patients with COVID-19 admitted to RAFs in Tokyo.MethodsThis was an observational cohort study using data from COVID-19 patients admitted to one of the RAFs in Tokyo from December 2020 to November 2021. Admissions to the facilities were limited to patients with asymptomatic or mild COVID-19 with no underlying disease or at least stable underlying disease at the time of admission. Patients were hospitalized when they required oxygen administration or when they had, or persistent fever, or severe respiratory symptoms. We evaluated the association between hospitalization and the risk factors for hospitalization using a Cox regression model.ResultsThe number of patients with COVID-19 admitted to the RAF was 6176. The number of hospitalized patients was 393 (6.4%), and the median length of stay was 5.50 days (IQR: 4.50, 6.50). In the Cox regression analysis, the hazard ratio increased with age and was significantly higher among patients aged >60 years (HR = 10.23, 95% CI: 6.72–15.57) than those in other age groups. This trend is similar to that observed in the sensitivity analysis.ConclusionPatients with diabetes, the elderly, obesity, and medications for gout and psychiatric diseases may be at a high risk of hospitalization. In particular, an age over 60 years was strongly associated with hospitalization.