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

所属专题：重症医学；

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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

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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/OL]. 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/OL]. 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.

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