新型冠状病毒肺炎重症患者的救治及随访体会

Experiences in treatment and follow-up of critically ill patients with coronavirus disease 2019

目的了解新型冠状病毒肺炎(新冠肺炎)患者的流行病学和临床特征以及预后.方法收集2020年1月至2月收治于贵州医科大学附属医院重症监护病房(ICU)的新冠肺炎患者的临床资料,包括流行病学特征、症状体征、治疗措施及6个月随访情况,分析疾病发展动态并总结救治经验.结果共纳入6例新冠肺炎患者,年龄33~83岁,均有明确的流行病学史;在入ICU前经实时荧光反转录-聚合酶链反应(RT-PCR)检测新型冠状病毒(2019-nCoV)核酸阳性,胸部CT或X线显示有肺炎影像学特征.患者入ICU时急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)为13~23分.由以ICU医生为基础的多学科团队制定治疗策略,所有患者均给予氧疗和抗病毒治疗,其中4例接受了机械通气,5例接受了抗菌药物,5例接受了血必净注射液,4例接受了糖皮质激素.患者ICU住院时间为5~17 d,除1例在住ICU第5天死亡外,其余患者均顺利转出ICU.以转入ICU当日为起点,1个月、3个月和6个月随访时均未再报告2019-nCoV核酸检测阳性;但6个月随访时,有2例患者(分别为64岁和83岁)心肺功能仍未恢复至患病前.结论多学科团队指导的器官功能支持和抗炎在ICU新冠肺炎的救治中具有重要地位,危重型新冠肺炎可能对老年患者心肺功能存在较长期影响.

Objective To understand the epidemiology,clinical characteristics and outcomes of patients with coronavirus disease 2019(COVID-19).Methods The clinical data of patients with COVID-19 admitted to the Intensive Care Unit(ICU)of the Affiliated Hospital of Guizhou Medical University from January to February 2020 were collected,including epidemiological characteristics,symptoms and signs,treatment measures and 6-month follow-up situations.The disease development trends were analyzed and the rescue and therapeutic experiences were summarized.Results A total of 6 patients aged 33-83 years old had clear epidemiological history,their positive results of 2019 novel coronavirus(2019-nCoV)were confirmed by real-time fluorescent reverse transcription-polymerase chain reaction(RT-PGR)and their imaging features of pneumonia were found in chest CT or X-ray images before entering the ICU.The acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)scores of the patients ranged from 13 to 23 at ICU admission.The intensivist-led multidisciplinary team formulated the treatment strategies.All patients were treated with oxygen and antiviral therapies.Four patients used mechanical ventilation,five adopted antibiotics,five got Xuebijing injection and four received glucocorticoids.The patients'length of ICU stay was 5-17 days,except one patient died on day 5 after ICU admission.The rest of the patients were successfully transferred out of ICU,and did not report any positive RT-PCR results of 2019-nCoV at 1 month,3 months and 6 months in the follow-up;but two patients(64 and 83 years old respectively)complained of that compared with that before ICU admission,their cardiopulmonary function at 6 months of follow-up had not yet recovered to their former level.Conclusion The organ function support and anti-inflammatory therapies guided by intensivist-led multidisciplinary team play an important role in the rescue and treatment of COVID-19 in ICU,and critical COVID-19 may have long influence on the cardiopulmonary function in elder patients.