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

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.