切换至 "中华医学电子期刊资源库"

第五届中国出版政府奖音像电子网络出版物奖提名奖

中国科技核心期刊

中国科学引文数据库(CSCD)来源期刊

中华重症医学电子杂志 ›› 2020, Vol. 06 ›› Issue (03) : 329 -334. doi: 10.3877/cma.j.issn.2096-1537.2020.03.017

所属专题: 文献

新型冠状病毒肺炎

重型新型冠状病毒肺炎的临床决策与思考
刘宇鹏1, 杨荣利2, 万献尧3,()   
  1. 1. 116011 大连,中国人民解放军联勤保障部队第九六七医院重症医学科
    2. 116021 大连市中心医院重症医学科
    3. 116011 大连医科大学附属第一医院重症医学科
  • 收稿日期:2020-05-27 出版日期:2020-08-28
  • 通信作者: 万献尧

Severe novel coronavirus pneumonia: clinical decision-making and consideration

Yupeng Liu1, Rongli Yang2, Xianyao Wan3,()   

  1. 1. Department of Critical Care Medicine, the 967th Hospital of Joint Logistic Support Forces of Chinese PLA, Dalian 116011, China
    2. Department of Critical Care Medicine, Dalian Central Hospital, Dalian 116021, China
    3. Department of Critical Care Medicine, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
  • Received:2020-05-27 Published:2020-08-28
  • Corresponding author: Xianyao Wan
  • About author:
    Corresponding author: Wan Xianyao, Email:
引用本文:

刘宇鹏, 杨荣利, 万献尧. 重型新型冠状病毒肺炎的临床决策与思考[J]. 中华重症医学电子杂志, 2020, 06(03): 329-334.

Yupeng Liu, Rongli Yang, Xianyao Wan. Severe novel coronavirus pneumonia: clinical decision-making and consideration[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2020, 06(03): 329-334.

目前新型冠状病毒肺炎正在世界范围内蔓延,我国疫情暂时得到了有效控制,但仍需密切关注及防范输入性病例和无症状感染者引发疫情的可能。当前新型冠状病毒肺炎的诊疗方案与指南为临床实践提供了依据,但是仍有很多问题亟待解决。临床决策需结合医疗资源配置及患者情况制定个体化治疗方案,根据病情变化及时调整,多部门沟通协调以保证方案实施。辽宁省新冠肺炎集中救治中心大连中心自2020年1月以来共成功救治35例新型冠状病毒肺炎患者,其中重型5例。本文旨在总结新型冠状病毒肺炎的救治经验,以期进一步优化临床决策。

The novel coronavirus pneumonia is spreading worldwide, but the epidemic situation in China has been effectively controlled. However, we still need to pay close attention to and prevent the possibility of epidemic caused by imported cases and asymptomatic infected persons. The current diagnosis and treatment plan and guidelines provide a basis for our clinical practice, but there are still many problems to be solved. Clinical decision-making should be based on the allocation of medical resources and patients' situation to develop individualized treatment plan, timely adjustment according to the change of the condition, and multi-disciplinary communication and coordination to ensure the implementation of the plan. Thirty-five novel coronavirus pneumonia patients, including five severe cases, have been successfully treated in Dalian Center since January. This article aims to summarize the experience of treatment in order to further optimize the clinical decision-making.

1
He F, Deng Y, Li W. Coronavirus disease 2019: What we know? [J]. J Med Virol, 2020, 92(7): 719-725.
2
Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study [J]. Lancet, 2020, 395(10223): 507-513.
3
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [J]. Lancet, 2020, 395(10223): 497-506.
4
Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China [J]. JAMA, 2020, 323(11): 1061-1069.
5
Wu Z, McGoogan JM. Characteristics of and important lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention [J]. JAMA, 2020 Feb 24. [Epub ahead of print].
6
国家卫生健康委办公厅, 国家中医药管理局办公室. 新型冠状病毒肺炎诊疗方案(试行第七版) [EB/OL].

URL    
7
李文雯, 万献尧. 对急性呼吸窘迫综合征柏林诊断标准中有关校正氧合指数计算公式的修正 [J]. 中华内科杂志, 2014, 58(8): 677.
8
Alhazzani W, Møller MH, Arabi YM, et al. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19) [J]. Crit Care Med, 2020, 48(6): e440-e469.
9
Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome [J]. Lancet Respir Med, 2020, 8(4):420-422.
10
国务院联防联控机制新闻发布会. 新冠肺炎疫情防控与医疗诊治有关情况(2020年3月24日)[EB/OL].

URL    
11
Frat JP, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure [J]. N Engl J Med, 2015, 372(33):2185-2196.
12
Ni YN, Luo J, Yu H, et al. The effect of high flow nasal cannula in reducing the mortality and the rate of endotracheal intubation when used before mechanical ventilation compared with conventional oxygen therapy and noninvasive positive pressure ventilation. A systematic review and meta-analysis [J]. Am J Emerg Med, 2018, 36(2): 226-233.
13
Ou X, Hua Y, Liu J, et al. Effect of high-flow nasal cannula oxygen therapy in adults with acute hypoxemic respiratory failure: a meta-analysis of randomized controlled trials [J]. CMAJ, 2017, 189(7): E260-E267.
14
Rochwerg B, Granton D, Wang DX, et al. High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and meta analysis [J]. Intensive Care Med, 2019, 45(5):563-572.
15
Cao B, Wang Y, Wen D, et al. A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19 [J]. N Engl J Med, 2020, 382(19): 1787-1799.
16
Ferner RE, Aronson JK. Chloroquine and hydroxychloroquine in COVID-19 [J]. BMJ, 2020, 369: m1432.
17
Geleris J, Sun Y, Platt J, et al. Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19 [J]. N Engl J Med, 2020, 382(25): 2411-2418.
18
Tang W, Cao Z, Han M, et al. Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial [J]. BMJ, 2020, 369: m1849.
19
Mehra MR, Desai SS, Frank Ruschitzka F, et al. RETRACTED: Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis [J]. Lancet, 2020, S0140-6736(20)31180-6.
20
Grein J, Ohmagari N, Shin D, et al. Compassionate Use of Remdesivir for patients with severe COVID-19 [J]. N Engl J Med, 2020, 382(24): 2327-2336.
21
Wang Y, Zhang D, Du G, et al. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial [J]. Lancet, 2020, 395(10236): 1569-1578.
22
Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the Treatment of Covid-19-Preliminary Report [J]. N Engl J Med, 2020, 173(2): JC4.
23
Lewis SR, Pritchard MW, Thomas CM, et al. Pharmacological agents for adults with acute respiratory distress syndrome [J]. Cochrane Database Syst Rev, 2019, 7(7): CD004477.
24
Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with Coronavirus Disease 2019 pneumonia in Wuhan [J]. JAMA Intern Med, 2020, 180(7): 1-11.
25
Ong SWX, Tan YK, Chia PY, et al. Air, surface environmental, and personal protective equipment contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) from a symptomatic patient [J]. JAMA, 2020, 323(16): 1610-1612.
[1] 武玺宁, 欧阳云淑, 孟华, 姜玉新, 张一休, 戴晴, 徐钟慧, 李建初. 新型冠状病毒肺炎疫情防控期间北京协和医院产科超声工作量的同比及环比分析[J]. 中华医学超声杂志(电子版), 2022, 19(09): 990-993.
[2] 李逸群, 王娜, 莫红楠, 兰波, 王佳妮, 温霆宇, 马飞. 早期乳腺癌患者新型冠状病毒肺炎疫苗接种情况及影响因素调查[J]. 中华乳腺病杂志(电子版), 2023, 17(01): 30-35.
[3] 李振华, 解宝江, 易为, 李丽, 卫雅娴, 周明书, 伊诺. 82例孕产妇对新型冠状病毒肺炎疫情防控认知的心理干预及常态化疫情防控应对要点[J]. 中华实验和临床感染病杂志(电子版), 2023, 17(03): 173-179.
[4] 黄毅, 董雪, 郑瑜, 赵洁, 王思翰, 郭晓茹, 于铭. 急诊床边肺部超声改良方案对新型冠状病毒肺炎患者肺部病灶的评估价值[J]. 中华实验和临床感染病杂志(电子版), 2022, 16(03): 150-157.
[5] 陈彩玲, 吉金峰, 王玉红, 徐静, 朱湘安, 李伟, 郝喜燕, 李爱琴. 新冠肺炎疫情防控期间急诊腹部多发伤一体化救治管理及对策[J]. 中华普外科手术学杂志(电子版), 2022, 16(05): 560-563.
[6] 刘扬, 左兴华, 陈志航. 新型冠状病毒肺炎疫情常态化下医院人员管理挑战及对策[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(05): 611-614.
[7] 张彬霞, 王宁, 李端芳, 刘勇, 陈珍珍. 新型冠状病毒肺炎患者分级评估及康复治疗研究进展[J]. 中华肺部疾病杂志(电子版), 2022, 15(06): 912-915.
[8] 李雪珠, 谢剑锋, 李晓青, 夏泽燕, 鲁玲, 顾晓霞, 马绍磊, 黄英姿. 循环式筛查与五色区域分类模式在方舱医院管理中的应用[J]. 中华重症医学电子杂志, 2023, 09(03): 316-320.
[9] 刘玲, 赵慧颖, 李绪言, 程渊, 罗巧侠, 俞云, 杨毅, 邱海波. 新型冠状病毒肺炎患者自主呼吸努力的床旁监测方法[J]. 中华重症医学电子杂志, 2022, 08(04): 367-370.
[10] 刘玲, 李绪言, 徐永昊, 赵慧颖, 罗巧侠, 欧晓峰, 宋雷, 程渊, 周娟, 曾以萍, 刘爱华, 边巴穷达, 张烁, 吕杰, 王玺, 鲁燕云, 陈佰绪, 达珍, 俞云, 邵佳, 中华医学会重症医学分会重症呼吸学组, 西藏医学会高原医学暨心血管专业委员会, 中国医师协会重症医学医师分会. 高原地区新型冠状病毒肺炎重症患者(重型/危重型)诊疗专家共识[J]. 中华重症医学电子杂志, 2022, 08(04): 340-346.
[11] 黄文鹏, 刘杰, 李莉明, 侯佳蒙, 高剑波. 双源双能量CT成像在新型冠状病毒肺炎中的应用价值[J]. 中华消化病与影像杂志(电子版), 2022, 12(04): 198-203.
[12] 刘广杰, 王光林, 樊少青, 王贵英. 局部新型冠状病毒感染疫情下肿瘤患者负性情绪和行为的诱因及应对措施[J]. 中华临床医师杂志(电子版), 2023, 17(01): 93-96.
[13] 孙维杰, 翁跃颂, 沈驰斌, 韩阿祥, 刘旭峰, 徐灵, 陈雪琴. 方舱医院医学检验实验室建设运行探索[J]. 中华临床实验室管理电子杂志, 2022, 10(04): 242-245.
[14] 刘敏, 彭才静, 王金能. 重庆市新型冠状病毒肺炎疫情前后儿童支气管肺炎痰培养结果分析[J]. 中华诊断学电子杂志, 2023, 11(02): 97-103.
[15] 王佳凤, 郭锐, 陈倩倩, 李惠凯, 宁波, 袁新普, 朱华, 令狐恩强. 68Ga-NC-BCH联合PET-CT淋巴结免疫示踪对于胃癌患者术前及术后临床决策影响的初步探索研究[J]. 中华胃肠内镜电子杂志, 2023, 10(04): 253-257.
阅读次数
全文


摘要