关于重型和危重型新型冠状病毒肺炎救治的思考和实践  

Thoughts and practice on the treatment of severe and critical new coronavirus pneumonia

作　　者：李海潮[1] 马靖[1] 张红[1] 程渊[1] 王玺[1] 胡展维 李楠[2] 邓雪蓉[3] 张杨[4] 郑茜子[5] 杨帆[6] 翁浩宇[6] 董锦沛 刘敬伟[8] 王玉英[8] 刘新民[9] Li Haichao;Ma Jing;Zhang Hong;Cheng Yuan;Wang Xi;Hu Zhanwei;Li Nan;Deng Xuerong;Zhang Yang;Zheng Qianizi;Yang Fan;Weng Haoyu;Dong Jinpei;Liu Jingwei;Wang Yuying;Liu Xinmin(Division of Respiratory and Critical Care Medicine,Peking University First Hospital,Beijing 100034,China;Division of Critical Care Medicine,Peking University First Hospital,Beijing 100034,China;Division of Rheumatology,Peking University First Hospital,Beijing 100034,China;Division of Endocrinology,Peking University First Hospital,Beijing 100034,China;Division of Nephrology,Peking University First Hospital,Beijing 100034,China;Division of Cardiology,Peking University First Hospital,Beijing 100034,China;Division of Digestive Disease,Peking University First Hospital,Beijing 100034,China;Division of Thoracic Surgery,Peking University First Hospital,Beijing 100034,China;Division of Geriatrics,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院呼吸和危重症医学科,100034 [2]北京大学第一医院重症医学科,100034 [3]北京大学第一医院风湿免疫科,100034 [4]北京大学第一医院内分泌科,100034 [5]北京大学第一医院肾脏内科,100034 [6]北京大学第一医院心内科,100034 [7]北京大学第一医院消化内科,100034 [8]北京大学第一医院胸外科,100034 [9]北京大学第一医院老年科,100034

出　　处：《中华结核和呼吸杂志》2020年第5期396-400,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：重型和危重型新型冠状病毒肺炎常常发生于高龄及多合并疾病患者,严重低氧事件是造成部分病例病情恶化的重要因素。危重型可进展为急性呼吸窘迫综合征及多器官功能障碍,是造成死亡的重要原因。针对可能的病生理异常,及早开始无创通气治疗有助于改善预后。严密监护氧合情况、降低患者氧耗量、积极心理干预、迅速处理低氧事件是无创通气成功治疗的关键因素。积极纠正凝血功能紊乱、合理的营养支持、准确的容量控制和安全个体化的血糖监控等治疗具有重要意义。Severe and critical coronavirus pneumonia 2019(COVID-19)often occurs in elder patients with multiple comorbidities,and severe hypoxemia events constitute a key factor for the deterioration of some cases.The critical type of COVID-19 could progress into acute respiratory distress syndrome and multi-organ dysfunction,which are the major causes of death.Early non-invasive ventilation(NIV)treatment of possible pathophysiological abnormalities is helpful to improve prognosis.Close monitoring of oxygenation,reducing patients′oxygen consumption,active psychological intervention,and rapid handling of severe hypoxemia events are the key factors for successful NIV treatment.In addition,active adjuvant therapies such as correcting coagulation dysfunction,providing proper nutritional support,accurate volume control,and safe individualized blood glucose monitoring are of great significance.

关 键 词：新型冠状病毒肺炎 急性呼吸窘迫综合征 无创通气 严重低氧事件 早期干预 

分 类 号：R563[医药卫生—呼吸系统]