After the new coronavirus enters the human body, due to the different immune response of each human body, the clinical symptoms shown are also different. How to treat patients with mild, severe and critical illness? What should be paid attention to in the recovery period of patients with the new coronavirus pneumonia? … Recently, Xinhua launched the special topic “Experts in
Anti-Coronavirus”, interviewing Jiang Ronglin, director of the Department of Intensive Medicine of the First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, in the sixth issue to answer questions about the treatment of patients with
the new coronavirus pneumonia.
Q: What treatments are needed for patients with mild coronavirus pneumonia?
Jiang Ronglin: New coronavirus pneumonia is pneumonia caused by new coronavirus infection, which is more infectious. For the infection of
the new coronavirus, there is currently no so-called special effect medicine, and more rely on antibodies produced by autoimmune function to kill Virus, so we call the new coronavirus pneumonia a self-limiting disease.
The medical treatment of mild patients is actually a symptomatic and supportive treatment. If the patient has fever, cough and other uncomfortable symptoms, it can be relieved by taking appropriate antipyretics and cough medicines, and then self-healing through antibodies produced by itself. In this process, as a mild patient, it is recommended: first, maintain an optimistic attitude and not have too much mental pressure; second, take a proper rest, do not fatigue and stay up late; third, drink plenty of hot water and maintain An overall stable state of the body; fourth, you can eat more vegetables and easily digestible foods in your diet. In this way, mild patients generally recover faster.
Q: For severe and critically ill patients, what treatment measures will be taken clinically?
Jiang Ronglin: For severe and critical illnesses, we must first attach great importance to them. We must deal with severe illnesses as soon as possible to avoid becoming critically ill. For critical illness, we must strengthen treatment to avoid becoming a more serious or irreversible state. With the development of intensive medicine, there are multiple rescue and treatment methods for these patients, such as artificial liver, artificial kidney, blood purification treatment, powerful drugs, and even the use of extracorporeal membrane oxygenation (ECMO) to maintain cardiopulmonary function .
The new coronavirus infection, the largest loss of organs is lung tissue, resulting in human hypoxia. So I think the first, the most critical treatment is to avoid the patient from excessive hypoxia. There are many treatment methods that can be used, such as nasal cannula inhalation, mask inhalation, high-flow inhalation, non-invasive mechanical ventilation, and invasive trachea Intubation mechanical ventilation, etc. Among them, non-invasive mechanical ventilation and the final extracorporeal membrane lung oxygenation (ECMO) are to allow patients to temporarily get sufficient oxygen supply to avoid the deterioration of the disease. Second, during the process of viral infection, it will induce a certain inflammatory response in the human body. In general, the inflammatory response is helpful to the patient, but the excessive inflammatory response will damage other organs, such as kidney and liver. , Heart, blood coagulation, gastrointestinal tract, etc. Therefore, effective measures must be taken to stop the excessive inflammatory reaction, and some drugs such as hormones can be used to suppress the inflammatory reaction. In addition, other measures can also be used. For example, some patients have poor gastrointestinal function, which can be properly adjusted by traditional Chinese medicine methods, and can also give patients nourishing nutrition to maintain the gastrointestinal mucosal barrier. Then, for some patients with high fever and patients with unconsciousness, the country also highly recommends the method of using traditional Chinese medicine. On February 19, the National Health and Health Commission and the State Administration of Traditional Chinese Medicine released the "
The New Coronavirus Pneumonia Diagnosis and Treatment Program (Trial) "Sixth Edition" "and interpretation," plan "also recommended for severe and critically ill patients with traditional Chinese medicine treatment plan, such as patients with high fever and consciousness disorder recommend Xingnaojing injection.
In the treatment of severe and critical illness, various clinical methods are still relatively powerful. Of course, it will also bring some pain to the patient, such as tracheal intubation, the indwelling of various catheters will make the patient feel some pain, so at this time, we need to give the patient appropriate analgesia and sedation to avoid the patient from having too much The bad feeling is to avoid the excessive sympathetic excitement caused by these bad stimuli. The sympathetic excitement will cause damage to the organs, such as very rapid breathing, fast heartbeat, and increased blood pressure. Therefore, through analgesia and sedation, the patient's excessive sympathetic response is suppressed, and the patient is better repaired.
In addition, when rescuing critically ill patients, special attention should be paid to the stability of the internal environment, such as electrolyte acid-base balance and volume management. At this time, restrictive fluid resuscitation strategies are needed, because fluid replacement may make the circulation more stable However, excessive fluid replenishment will not only cause excessive load on the heart, but also cause lung tissue edema, gastrointestinal edema and other tissue damage. Therefore, proper restriction of fluid replacement is also beneficial to patients. At the same time, issues such as preventing secondary infections should also be taken seriously.
Q: How is glucocorticoid used clinically?
Jiang Ronglin: Glucocorticoids are essentially substances needed by the human body, but they cannot be overused. For patients with
the new coronavirus pneumonia, the first benefit of using hormones is to suppress excessive inflammatory response, avoid the occurrence of multiple organ dysfunction syndrome (MODS), and then reduce lung exudation, and reduce acute respiratory distress syndrome ARDS) phenomenon. The second critically ill patient will be in a relatively inadequate state of the adrenal cortex. For young people, the adrenal cortex can be fully compensated, while for the elderly, his compensatory ability is limited. There will be a state of relatively inadequate adrenal cortex function, for which the application of glucocorticoids will play a certain role.
When
the new coronavirus is infected, it mainly depends on the specific antibodies produced by itself to kill the virus. After using glucocorticoids, it may have an inhibitory effect on the antibodies produced by the human body and prolong the time the virus stays in the body. In addition, glucocorticoids will make patients more susceptible to bacteria and fungi after suppressing immunity. And glucocorticoids can also cause gastrointestinal bleeding, osteoporosis, femoral head necrosis, increased blood sugar and other adverse consequences, so glucocorticoids are a double-edged sword. How to use it in the clinic is determined by the doctor according to the patient's condition, and the new coronavirus infection patients, if the disease progresses rapidly, the fever does not retreat, the shock is very serious, and in other critical conditions, some are available Glucocorticoids, but also advocate a short course of small doses, usually 5-7 days, because the use of too long, there may be more adverse reactions.
Q: What role do antibacterial drugs play in the treatment of the new coronavirus pneumonia?
Jiang Ronglin: As the name suggests, antibacterial drugs are antibacterial. The new coronavirus is a virus, so antibacterial drugs have no direct effect on
the new coronavirus. Mild patients do not need it in principle, but if the patient has a secondary bacterial infection, If yellow sputum, fever reappears after the body temperature has dropped, neutrophils and procalcitonin are significantly increased, and CT shows that there is a secondary bacterial infection in the lungs, antibacterial drugs should be used. Control bacterial infections. For severe and critical illnesses, you can choose to use some antibacterial drugs to prevent and prevent bacterial infections. Prophylactic antibacterial drugs generally advocate the use of relatively simple, primary, do not need to be too advanced, so as to avoid the emergence of drug-resistant bacteria.
If the patient already has an infection, such as high blood pressure, high PCT, high procalcitonin or bloodstream infection, urinary tract infection, etc., target treatment is needed, first to collect specimens, and then consider what kind of Antimicrobial drugs, empirical selection of antimicrobial drugs before the results of the culture are usually combined with the characteristics of the patient, where they are infected, the degree of infection, the drainage of the infection, the characteristics of the epidemiology of the department where the infection is located, the disease What kind of bacteria are usually combined in the district to choose a certain antibacterial drug. In addition, it is also necessary to consider whether this antibacterial drug is suitable for patients, because the liver function and kidney function of each patient are different, and the physiological status of the elderly and young people are also different, so it varies from person to person. Choose an effective antibacterial drug to control the infection.
Q: As a family member of a critically ill patient, what should I do?
Jiang Ronglin: As a family member of patients with severe and critical
the new coronavirus pneumonia, we must first understand that all new coronaviruses are easy to be infected, and there is a certain lethal rate. Especially for the elderly, there are many basic diseases, such as hypertension, diabetes, malignant tumors, chronic kidney disease, etc. These families must be more mentally prepared, because their mortality rate is higher than the average person.
Second, most of the critically ill patients can still communicate, and critically ill patients may not be able to communicate. As a family member, if the patient can communicate, they should try to comfort the patient, relax the mood, build the courage to fight the disease, but also have a The belief of victory. I think this is a very important spiritual force that supports patients to survive and overcome disease. If the patient can eat, a small amount of light, easily digestible food can be given under the guidance of medical staff.
Third, establish good communication with medical staff. Because medical staff are very hard in this epidemic, they are devoted to their work wholeheartedly, and they will use their professional knowledge to deliver professional advice to their families. Therefore, I feel that as a family member, you must fully trust the medical staff, so that the medical staff can treat the patient with all their heart and soul, and everyone can work together to overcome this disease. The medical staff advised the family that the family should fully understand him.
