新型冠状病毒肺炎后时代：基础疾病带来的巨大挑战

doi:10.3877/cma.j.issn.2096-1537.2022.03.004

中华重症医学电子杂志 ›› 2022, Vol. 08 ›› Issue (03) : 207 -210. doi: 10.3877/cma.j.issn.2096-1537.2022.03.004

专家论坛

新型冠状病毒肺炎后时代：基础疾病带来的巨大挑战

刘松桥¹, 王胜云², 吴志雄³, 马璐⁴, 马晓春⁵^,^†(

), 管向东⁶^,^†(

), 杨毅⁴^,^†(

)

^1. 210009　南京，江苏省重症医学重点实验室　东南大学附属中大医院重症医学科；211200　南京，南京市溧水区人民医院　东南大学附属中大医院溧水分院重症医学科
^2. 200003　上海，上海长征医院重症医学科
^3. 200040　上海，复旦大学附属华东医院重症医学科
^4. 210009　南京，江苏省重症医学重点实验室　东南大学附属中大医院重症医学科
^5. 110001　沈阳，中国医科大学附属第一医院重症医学科
^6. 510080　广州，中山大学附属第一医院重症医学科

收稿日期:2022-07-27 出版日期:2022-08-28
通信作者: 马晓春, 管向东, 杨毅
基金资助:
国家自然科学基金项目(81971888，81971885); 江苏省重点研发计划（社会发展）重点项目(BE2019749)

The post-COVID-19 era: tremendous challenges of underlying comorbidities

Songqiao Liu¹, Shengyun Wang², Zhixiong Wu³, Lu Ma⁴, Xiaochun Ma⁵^,^†(), Xiangdong Guan⁶^,^†(), Yi Yang⁴^,^†()

^1. Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China; Department of Critical Care Medicine, Lishui District People's Hospital, Lishui Branch of Zhongda Hospital, School of Medicine, Southeast University, Nanjing 211200, China
^2. Department of Critical Care Medicine, Shanghai Changzheng Hospital, Shanghai 200003, China
^3. Department of Critical Care Medicine, Huadong Hospital, Fudan University, Shanghai 200040, China
^4. Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
^5. Department of Critical Care Medicine, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
^6. Department of Critical Care Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China

Received:2022-07-27 Published:2022-08-28
Corresponding author: Xiaochun Ma, Xiangdong Guan, Yi Yang

全文 ( ) 下载PDF ( ) 导出引用

引用本文：

刘松桥, 王胜云, 吴志雄, 马璐, 马晓春, 管向东, 杨毅. 新型冠状病毒肺炎后时代：基础疾病带来的巨大挑战[J]. 中华重症医学电子杂志, 2022, 08(03): 207-210.

Songqiao Liu, Shengyun Wang, Zhixiong Wu, Lu Ma, Xiaochun Ma, Xiangdong Guan, Yi Yang. The post-COVID-19 era: tremendous challenges of underlying comorbidities[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2022, 08(03): 207-210.

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。

关键词: 新型冠状病毒肺炎, 高危因素, 老年, 基础疾病

SARS-CoV-2 infections have caused more than 500 million cases worldwide. Due to virus variation and vaccination, the number of critically ill patients caused by underlying comorbidities has increased significantly, posing a tremendous challenge to the clinical practice. Elderly patients with underlying diseases are more likely to progress to severe COVID-19 illness and poor outcome in China. Early screening and intervention of high-risk patients; standardized management of critically ill patients, specialized diagnosis and treatment of underlying comorbidities; pay more attention to the protection of lung and extra-pulmonary organs function; nutritional support and rehabilitation and early mobilization are also the key points to the elderly COVID-19 patients with comorbidities. The lessons shared here should be instructive and useful to reduce the rate of severe COVID-19 illness and mortality.

Key words: Coronavirus disease 2019, Risk factor, Elderly, Comorbidities

1	Zhang X, Zhang W, Chen S. Shanghai's life-saving efforts against the current omicron wave of the COVID-19 pandemic [J]. Lancet, 2022, 399(10340): 2011-2012.
2	Uraki R, Kiso M, Iida S, et al. Characterization and antiviral susceptibility of SARS-CoV-2 Omicron/BA.2 [J]. Nature, 2022, 607(7917): 119-127.
3	Yamasoba D, Kimura I, Nasser H, et al. Virological characteristics of the SARS-CoV-2 Omicron BA.2 spike [J]. Cell, 2022, 185(12): 2103-2115.e19.
4	Liu S, Luo H, Lei Z, et al. A nomogram predicting severe COVID-19 based on a large study cohort from China [J]. Am J Emerg Med, 2021, 50: 218-223.
5	Gao YD, Ding M, Dong X, et al. Risk factors for severe and critically ill COVID-19 patients: a review [J]. Allergy, 2021, 76(2): 428-455.
6	Chen Y, Klein SL, Garibaldi BT, et al. Aging in COVID-19: vulnerability, immunity and intervention [J]. Ageing Res Rev, 2021, 65: 101205.
7	Drucker DJ. Diabetes, obesity, metabolism, and SARS-CoV-2 infection: the end of the beginning [J]. Cell Metab, 2021, 33(3): 479-498.
8	Yu X, Wei D, Xu W, et al. Reduced sensitivity of SARS-CoV-2 Omicron variant to antibody neutralization elicited by booster vaccination [J]. Cell Discov, 2022, 8(1): 4.
9	国家卫生健康委员会. 《新型冠状病毒肺炎诊疗方案》第九版[EB/OL]. (2022-03-15)[2022-06-27]. URL
10	Sun Q, Qiu H, Huang M, et al. Lower mortality of COVID-19 by early recognition and intervention: experience from Jiangsu Province [J]. Ann Intensive Care, 2020, 10(1): 33.
11	Hammond J, Leister-Tebbe H, Gardner A, et al. Oral Nirmatrelvir for high-risk, nonhospitalized adults with Covid-19 [J]. New Engl J Med, 2022, 386(15): 1397-1408.
12	Investigators A, Investigators AC, Investigators RC, et al. Therapeutic anticoagulation with heparin in noncritically ill patients with Covid-19 [J]. New Engl J Med, 2021, 385(9): 790-802.
13	Sholzberg M, Tang GH, Rahhal H, et al. Effectiveness of therapeutic heparin versus prophylactic heparin on death, mechanical ventilation, or intensive care unit admission in moderately ill patients with covid-19 admitted to hospital: RAPID randomised clinical trial [J]. BMJ, 2021, 375: n2400.
14	Chen H, Xie J, Su N, et al. Corticosteroid therapy is associated with improved outcome in critically ill patients with COVID-19 with hyperinflammatory phenotype [J]. Chest, 2021, 159(5): 1793-1802.
15	Li J, Luo J, Pavlov I, et al; Awake Prone Positioning Meta-Analysis Group. Awake prone positioning for non-intubated patients with COVID-19-related acute hypoxaemic respiratory failure: a systematic review and meta-analysis [J]. Lancet Respir Med, 2022, 10(6): 573-583.
16	Ehrmann S, Li J, Ibarra-Estrada M, et al. Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial [J]. Lancet Respir Med, 2021, 9(12): 1387-1395.
17	Coppo A, Bellani G, Winterton D, et al. Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study [J]. Lancet Respir Med, 2020, 8(8): 765-774.
18	Fralick M, Colacci M, Munshi L, et al. Prone positioning of patients with moderate hypoxaemia due to covid-19: multicentre pragmatic randomised trial (COVID-PRONE) [J]. BMJ, 2022, 376: e068585.
19	Attaway AH, Scheraga RG, Bhimraj A, et al. Severe covid-19 pneumonia: pathogenesis and clinical management [J]. BMJ, 2021, 372: n436.
20	Marini JJ, Gattinoni L. Management of COVID-19 respiratory distress [J]. JAMA, 2020, 323(22): 2329-2330.
21	Liu L, Xie J, Wu W, et al. A simple nomogram for predicting failure of non-invasive respiratory strategies in adults with COVID-19: a retrospective multicentre study [J]. Lancet Digit Health, 2021, 3(3): e166-e174.
22	Fujita K, Kashihara E, Kanai O, et al. Increasing burden of nursing care on the treatment of COVID-19 patients in the aging society: analyses during the first to the third wave of pandemic in Kyoto City, Japan [J]. Front Med (Lausanne), 2021, 8: 767110.
23	Cereda E, Clavé P, Collins PF, et al. Recovery focused nutritional therapy across the continuum of care: learning from COVID-19 [J]. Nutrients, 2021, 13(9): 3293.
24	Van Aerde N, Van den Berghe G, Wilmer A, et al. Intensive care unit acquired muscle weakness in COVID-19 patients [J]. Intensive Care Med, 2020, 46(11): 2083-2085.
25	Valenzuela PL, Joyner M, Lucia A. Early mobilization in hospitalized patients with COVID-19 [J]. Ann Phys Rehabil Med, 2020, 63(4): 384-385.
26	Felten-Barentsz KM, van Oorsouw R, Klooster E, et al. Recommendations for hospital-based physical therapists managing patients with COVID-19 [J]. Phys Ther, 2020, 100(9): 1444-1457.

[1]	吴香敏, 吴鹏. 超声引导下收肌管阻滞联合腘动脉与膝关节后囊间隙阻滞在老年患者全膝关节置换术中的应用效果[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 516-522.
[2]	李凤仪, 李若凡, 高旭, 张超凡. 目标导向液体干预对老年胃肠道肿瘤患者术后血流动力学、胃肠功能恢复的影响[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 29-32.
[3]	晏晴艳, 雍晓梅, 罗洪, 杜敏. 成都地区老年转移性乳腺癌的预后及生存因素研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 636-638.
[4]	王晓丹, 王媛, 崔向宇, 任晓磊. 上尿路结石内镜手术后尿源性脓毒血症病原菌耐药及死亡高危因素分析[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 611-615.
[5]	刘跃刚, 薛振峰. 腹腔镜腹股沟疝日间手术在老年患者中的安全性分析[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 711-714.
[6]	代格格, 杨丽, 胡媛媛, 周文婷. 手术室综合干预在老年腹股沟疝患者中的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 759-763.
[7]	张汪, 徐淑英, 张爱华, 夏芬荣, 汪露. 手术室体温护理结合细节护理干预在老年腹股沟疝围手术期的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 635-638.
[8]	刘政委, 仪立志, 尹夕龙, 孔文龙, 纠智松, 张文源. 锥颅血肿外引流与神经内镜手术治疗老年基底节区高血压性脑出血的疗效分析[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(05): 299-303.
[9]	单秋洁, 孙立柱, 徐宜全, 王之霞, 徐妍, 马浩, 刘田田. 中老年食管癌患者调强放射治疗期间放射性肺损伤风险模型构建及应用[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 388-393.
[10]	姜里蛟, 张峰, 周玉萍. 多学科诊疗模式救治老年急性非静脉曲张性上消化道大出血患者的临床观察[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 520-524.
[11]	毛树文, 袁方, 唐昊, 王建民. 针刀调节交感神经对老年胃溃疡患者胃功能和溃疡愈合的影响[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 326-330.
[12]	郭震天, 张宗明, 赵月, 刘立民, 张翀, 刘卓, 齐晖, 田坤. 机器学习算法预测老年急性胆囊炎术后住院时间探索[J]. 中华临床医师杂志(电子版), 2023, 17(9): 955-961.
[13]	李永胜, 孙家和, 郭书伟, 卢义康, 刘洪洲. 高龄结直肠癌患者根治术后短期并发症及其影响因素[J]. 中华临床医师杂志(电子版), 2023, 17(9): 962-967.
[14]	卓徐鹏, 刘颖, 任菁菁. 感染性疾病与老年人低蛋白血症的相关性研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 896-899.
[15]	晏美娟, 邵礼晖. 高水平脂蛋白（a）与无“三高”老年人群小动脉硬化型脑小血管病的相关性研究[J]. 中华脑血管病杂志(电子版), 2023, 17(05): 458-463.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

The post-COVID-19 era: tremendous challenges of underlying comorbidities

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

The post-COVID-19 era: tremendous challenges of underlying comorbidities