新型冠状病毒肺炎心血管并发症研究现状

新型冠状病毒肺炎是由严重急性呼吸综合征冠状病毒2引起的一种传染性疾病,目前的临床证据表明,新型冠状病毒肺炎合并基础心血管系统疾病的患者死亡风险明显增加,大部分患者在病程中会发生心肌炎、心肌损伤、心律失常和心肌病等。该文主要阐述新型冠状病毒肺炎心血管并发症的研究现状。     

新型冠状病毒肺炎合并心肌损伤的诊疗进展

新型冠状病毒肺炎(COVID-19)是由严重急性呼吸综合征冠状病毒2引起的新发传染病,可引起急性心肌损伤.COVID-19合并心肌损伤时往往病情进展迅速,严重者可出现急性心力衰竭、心源性休克或恶性心律失常,预后极差.通过监测相关指标早期识别心肌损伤,尽早实施综合救治方法,包括抗病毒药物、营养心肌药物、血管活性药物、免疫...     

新型冠状病毒肺炎对心血管系统影响的中医认识与防治策略

新型冠状病毒肺炎可能会造成心脏损伤,且具有心血管基础疾病的新型冠状病毒肺炎患者预后明显较差。针对新型冠状病毒肺炎对心血管系统所造成的影响,通过阐述其与心血管疾病之间的关系及中医对其病理机制的认识,为新型冠状病毒肺炎中医药防治系统化提供指导。     

新型冠状病毒感染合并心血管系统疾病防治中国专家建议

本专家建议将从新型冠状病毒(新冠病毒)感染影响心血管系统的机制、危险因素和预防, 心血管系统损伤, 常见心血管疾病、心血管疾病急重症或需要手术者合并新冠病毒感染的诊断和治疗, 新冠病毒感染药物治疗及心血管相关注意事项, 心血管系统后遗症及康复等方面详细介绍新冠病毒感染合并心血管系统疾病的预防、诊治和管理, 目的是为广大医务工作者临床实践提供指导和参考。     

新型冠状病毒肺炎患者肝功能损伤的发生机制

自2019年12月以来,新型冠状病毒肺炎(COVID-19)疫情发展迅速。随着病例资料的积累,我们发现COVID-19患者除表现出典型呼吸系统症状和体征,还出现了不同程度的肝功能异常表现。本文将结合新型冠状病毒(SARS-CoV-2)感染所致的肝功能损伤表现及相关文献进行总结和分析,提出SARS-CoV-2可能引起肝损伤的机制。     

冠状病毒及新型冠状病毒肺炎防控策略

随着科学技术的发展和医学研究不断取得新进步,人们认识到病毒引发的传染性疾病仍然对人类健康构成巨大威胁,据世界卫生组织(World Health Organization,WHO)宣布,地球上对人类危害最大的有九大病毒:(1)克里米亚-刚果出血热病毒(Crimean-Congo haemorrhagic fever virus,CCHFV);(2)埃博拉病毒(Ebola virus,EBOV);(3)马尔堡病毒(Marburg virus,MBV);(4)艾滋病病毒(Human immunodeficiency virus,HIV);(5)寨卡病毒(Zika virus,ZKV);(6)狂犬病毒(rabies virus,RBV);(7)流感病毒(influenza virus,FLV);(8)尼帕病毒和裂谷热病毒(Nipah virus and riftvelley fever virus,NV-RFV);(9)冠状病毒(coronavirus,CoV),其中包括中东呼吸综合征(Middle East respiratory syndrome,MERS)和重症急性呼吸综合征(severe acute respiratory syndrome,SARS)等。特别是EBOV和CoV传播较快,病死率高,造成了严重公共健康危机[1-3]。     

新型冠状病毒肺炎疫情下心血管外科疾病的诊治流程

2019年12月以来,湖北省武汉市陆续出现新型冠状病毒(2019-nCoV)感染病例,疫情持续蔓延至湖北省内乃至全国各地。新型冠状病毒肺炎(COVID-19)疫情,给心血管外科的临床诊疗工作带来了巨大挑战,门急诊需要加强对就诊患者特别是发热患者的筛查。疫情期间严格把握手术指征,推迟择期手术;急诊手术,术前完善术前准备的同时进行COVID-19标本留取,术中严密防护,术后隔离治疗,并严格开展手术消毒隔离措施。在住院患者中,积极排查发热及相关症状病例。通过制定相应流程,在心血管外科临床工作中提高警惕,规范操作,科学防治,阻断病毒传播,并发挥自身心肺重症治疗方面的优势,早日打赢这场疫情防控阻击战。     

新型冠状病毒肺炎合并心血管外科急重症相关指南分析及经验总结

新型冠状病毒造成的严重急性呼吸道感染(COVID-19)是目前中国乃至全球的临床关注焦点.世界卫生组织及国家卫生健康委员会(卫健委)均发布了关于COVID-19诊疗的临时指南和管理策略建议.这些综合性指导意见为一线临床工作制定了基本规范.然而心血管外科疾病有其特殊病理生理特点,针对急危重症心血管疾病的外科治疗策略需要专门性指南.自2020年1月16日至2月12日,武汉协和医院心血管外科共完成心血管外科急诊手术13例,围术期成功率100%,基于临床实践体会,我们总结相关经验,并与世卫组织和国家卫健委指南进行对比,希望能与之互为补充,为抗击疫情一线的心血管外科医师治疗急重症患者提供参考.     

新型冠状病毒与血管紧张素转换酶2对心血管系统的影响

自2019年12月起,爆发由新型冠状病毒(SARS-CoV-2)感染的新型冠状病毒肺炎(COVID-19),疫情迅速蔓延至全球。COVID-19以呼吸系统症状为主,但部分病例出现心血管系统损害。合并心血管系统基础疾病患者,会导致死亡率增加。SARS-CoV-2属于冠状病毒科β冠状病毒属,SARS-CoV-2与严重急性呼吸综合征冠状病毒具有79.5%的同源性,通过受体血管紧张素转换酶2(ACE2)入侵人体细胞。而表达ACE2的Ⅱ型肺上皮细胞是SARS-CoV-2感染的主要靶细胞。因此,了解SARS-CoV-2所致心血管系统损害及相关的机制,对SARS-CoV-2疫苗和药物的研制及降低病死率具有重要的意义。     

Association between platelet parameters and mortality in coronavirus disease 2019: Retrospective cohort study

Abstract

Background

Thrombocytopenia has been implicated in patients infected with severe acute respiratory syndrome coronavirus 2, while the association of platelet count and changes with subsequent mortality remains unclear.     

Clinical characteristics,treatment, and prognosis of 74 2019 novel coronavirus disease patients in Hefei: A single-center retrospective study

Since December 2019, pneumonia caused by a novel coronavirus (SARS-CoV-2), namely 2019 novel coronavirus disease (COVID-19), has rapidly spread from Wuhan city to other cities across China. The present study was designed to describe the epidemiology, clinical characteristics, treatment, and prognosis of 74 hospitalized patients with COVID-19.Clinical data of 74 COVID-19 patients were collected to analyze the epidemiological, demographic, laboratory, radiological, and treatment data. Thirty-two patients were followed up and tested for the presence of the viral nucleic acid and by pulmonary computed tomography (CT) scan at 7 and 14 days after they were discharged.Among all COVID-19 patients, the median incubation period for patients and the median period from symptom onset to admission was all 6 days; the median length of hospitalization was 13 days. Fever symptoms were presented in 83.78% of the patients, and the second most common symptom was cough (74.32%), followed by fatigue and expectoration (27.03%). Inflammatory indicators, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) of the intensive care unit (ICU) patients were significantly higher than that of the non-ICU patients (P < .05). However, 50.00% of the ICU patients had their the ratio of T helper cells to cytotoxic T cells (CD4/CD8) ratio lower than 1.1, whose proportion is much higher than that in non-ICU patients (P < .01).Compared with patients in Wuhan, COVID-19 patients in Anhui Province seemed to have milder symptoms of infection, suggesting that there may be some regional differences in the transmission of SARS-CoV-2 between different cities.     

Peritonsillar abscess caused by Prevotella bivia during home quarantine for coronavirus disease 2019: Case report

Rationale:Since late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had rapidly spread worldwide, resulting in a pandemic. Patients with coronavirus disease 2019 (COVID-19) have difficulty in visiting clinics in person during pandemic because they might be encouraged to quarantine at home with supportive care. Peritonsillar abscess rarely coexists with COVID-19; however, patients with SARS-CoV-2 infection could get co-infections or become superinfected with other microorganisms which could cause peritonsillar abscess. We herein describe a case of peritonsillar abscess caused by Prevotella bivia that occurred as a co-infection with COVID-19 during home quarantine.Patient concerns:A 32-year-old Asian woman who was diagnosed with COVID-19 was instructed to stay home for quarantine. Her pharyngeal discomfort worsened, and she experienced trismus and dysphagia. An emergent visiting doctor referred her to our hospital. Contrast-enhanced computed tomography showed peritonsillar abscess findings, following which we referred her to an ear, nose, throat specialist. Prevotella bivia was identified on needle aspiration pus culture; however, two sets of blood and throat cultures were negative.Diagnosis:A definitive diagnosis of acute COVID-19 and peritonsillar abscess due to Prevotella bivia was made.Interventions:An antibiotic drug, antiviral drug, and adjunctive steroid were administered intravenously.Outcomes:Her symptoms improved without the need for incision and drainage, and she was discharged on day 7.Conclusion:Patients with suspected peritonsillar abscess should be triaged and referred to ear, nose, throat specialists appropriately. Scoring systems, such as modified Liverpool peritonsillar abscess score or the guidelines criteria might be useful tools to triage patients. During the early phase of SARS-CoV-2 infection, administration of corticosteroids is not recommended. When adjunctive steroids are considered for peritonsillar abscess, prior to or simultaneous use of the antiviral agent remdesivir for COVID-19 might be recommended.     

Digestive system involvement of novel coronavirus infection: Prevention and control infection from a gastroenterology perspective

An epidemic of an acute respiratory syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) in Wuhan, China, now known as coronavirus disease 2019 (COVID‐19), beginning in December 2019, has attracted an intense amount of attention worldwide. As the natural history and variety of clinical presentations of this disease unfolds, extrapulmonary symptoms of COVID‐19 have emerged, especially in the digestive system. While the respiratory mode of transmission is well known and is probably the principal mode of transmission of this disease, a possibility of the fecal‐oral route of transmission has also emerged in various case series and clinical scenarios. In this review article, we summarize four different aspects in published studies to date: (a) gastrointestinal manifestations of COVID‐19; (b) microbiological and virological investigations; (c) the role of fecal‐oral transmission; and (d) prevention and control of SARS‐CoV‐2 infection in the digestive endoscopy room. A timely understanding of the relationship between the disease and the digestive system and implementing effective preventive measures are of great importance for a favorable outcome of the disease and can help climnicians to mitigate further transmission by taking appropriate measures.     

2019冠状病毒病研究纪实:至2020年3月11日

2019年12月1日,武汉市出现首例不明原因肺炎病例,2020年1月8日确认病原体为新型冠状病毒,2020年1月31日世界卫生组织(WHO)将病原体暂命名为2019新冠病毒(2019-nCoV),2020年2月8日国家卫健委将该不明原因肺炎命名为新型冠状病毒肺炎(简称新冠肺炎,novel coronavirus pneumonia),2020年2月11日,WHO依据规则将新冠肺炎正式命名为2019冠状病毒病(COVID-19),同一天,国际病毒分类委员会将2019新冠病毒正式命名为严重急性呼吸综合征冠状病毒2(severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)。2020年3月11日,WHO将新冠疫情流行趋势升级为全球大流行状态。新冠疫情暴发后,国内外研究人员迅速开展流行病学调查、短时间内分离鉴定病毒、开展病原学研究、建立检测方法、完善诊疗方案、探索致病机制、研发药物和疫苗,有效阻止了国内疫情蔓延,也为世界疫情防控赢得了时间窗口。本文拟以时间为轴线,从病原体、病毒宿主、流行病学、检测方法、致病机制和临床诊疗6个方面记述2019冠状病毒病研究的重要进展。     

Multi-system inflammatory syndrome in children during the coronavirus disease 2019 in Saudi Arabia: Clinical perspective from a case series

Most of the reports about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children reported mild-to-moderate disease manifestations. However, recent reports explored a rare pediatric multisystem syndrome possibly associated with SARS-CoV-2 infection termed multisystem inflammatory syndrome in children (MIS-C).The study prospectively enrolled 5 patients with clinical and laboratory evidence of MIS-C associated with SARS-CoV-2 infection. They were admitted to the pediatric intensive care unit (PICU). Their clinical presentation, laboratory, and outcome were described.All patients shared similar clinical presentations such as persistent documented fever for more than 3 days, respiratory symptoms, gastrointestinal involvement, and increased inflammatory markers (CRP, ESR, and ferritin). Three patients had concurrent positive coronavirus disease 2019 (COVID-19) infection, and the other 2 patients had contact with suspected COVID-19 positive patients. They were all managed in the PICU and received intravenous immunoglobulin, systemic steroid, and hydroxychloroquine. The hospital stays ranged between 3 and 21 days. One patient died due to severe multiorgan failures and shock, and the other 4 patients were discharged with good conditions.Pediatric patients with SARS–CoV-2 are at risk for MIS-C. MIS-C has a spectrum of clinical and laboratory presentations, and the clinicians need to have a high index of suspicion for the diagnosis and should initiate its early treatment to avoid unfavorable outcomes. Long-term follow-up studies will be required to explore any sequelae of MIS-C, precisely the cardiovascular complications.     

关注感染新型冠状病毒的糖尿病患者

新型冠状病毒(2019-nCoV)感染是一种重大传染病。目前临床研究显示,糖尿病是其一种常见合并症。高血糖是导致重症感染的危险因素,也是轻症进展为重症的独立危险因素。这可能与糖尿病患者存在免疫缺陷有关。此外,病毒可能对胰岛产生直接损害,诱发应激性高血糖。因此要特别关注新型冠状病毒感染患者中的糖尿病患者。系统性类固醇类激素在新型冠状病毒感染者中,尤其是合并糖尿病的患者中应慎用。     

Coronavirus disease 2019 pandemic,restriction, and orthopedic trauma: Retrospective observational study

In 2019, the Coronavirus disease 2019 (Covid-19) was reported in Wuhan, China. Governments in various countries had taken many safeguards. This study investigated the incidence of orthopedic trauma in a rural region epidemiologically and guided source distribution and medical professionals to sustain healthcare systems.Between December 2019 and August 2020, 1651 patients admitted to orthopedics and traumatology clinics with trauma were evaluated in this study. Patients were grouped into 3 groups: pre-covid, restriction, and permitted groups. Age, sex, and fracture types of patients were recorded.The number of patients in the pre-covid period was 629 (38.1%), those were 334 (20.2%) in the restriction period, and 688 (41.7%) patients were admitted in the permitted period. A total of 1203 (72.9%) patients with upper extremity fractures, 383 (23.2%) patients with lower extremity fractures, and 65 (3.9%) patients with axial skeleton and pelvic ring fractures were included in the study. The lowest rates were found in the restriction period when all fractures were evaluated according to the admission periods. There were significant differences between admission dates and the fractures (P < .001).In this study, a decrease in orthopedic trauma rates was observed by half in the restriction period compared with the other 2 periods. Public health precautions had led to a reduction in the incidence of orthopedic trauma in all age groups.     

他汀类药物仍是心血管病患者合并新型冠状病毒病的一线用药

他汀类药物是心血管病患者药物治疗的基石,除降低胆固醇外,还有改善内皮功能、抑制炎症反应、抗氧化应激及血栓形成等多种作用。这些降脂以外的作用使得他汀类药物在呼吸系统疾病的治疗中也有一定的作用。在新型冠状病毒病（COVID-19）流行期间,心血管病患者易感染新型冠状病毒（SARS-CoV-2）,SARS-CoV-2与肺泡上皮细胞血管紧张素转换酶2（ACE2）结合,导致ACE/AngII/AT1R通路活性增强,促进肺部炎症、肺血管平滑肌细胞增生、肺组织纤维性,引起肺动脉高压,严重导致急性心肺功能衰竭,增加心血管病患者病死率。鉴于他汀类药物对心肺功能的保护作用,本文通过文献分析,阐释他汀类药物在心血管及呼吸系统中的获益,探讨疫情期间合并COVID-19的心血管病患者如何合理使用他汀类药物。