Analysis of Clinical Features in Novel Coronavirus Pneumonia Convalescents

Background:To analyze the clinical features of convalescent individuals with novel coronavirus-infected pneumonia(novel coronavirus pneumonia)at rehabilitation station in Wuhan.Methods:712 patients in the convalescence period of novel coronavirus pneumonia isolated and observed at the rehabilitation station were investigated by collecting their basic data,clinical syndrome features,and tongue manifestations.The clinical syndrome features were analyzed based on guidelines of Diagnosis and Treatment Plan for Novel Coronavirus-infected Pneumonia(National Health Commission of the People’s Republic of China,7th Trial Edition).Results:Cough(24.86%),chest tightness and shortness of breath(23.17%),and fatigue(16.57%)were the main symptoms of patients in the convalescence period of novel coronavirus pneumonia.Their tongue appearance was mostly characterized by redness(88.65%),thick coating(67.25%),greasy coating(49.78%)and white coating(76.86%).Conclusion:Compared with the ordinary/mild patients,cough and anorexia symptoms were more common in the severe/critical patients.In convalescent patients,red and fat tongue with thick greasy fur were common.

Analysis on the Clinical Characteristics of 10 Cases of Asymptomatic SARS-CoV-2 Novel Coronavirus Infection

Objective:To analyze the clinical features of asymptomatic patients infected with the SARS-CoV-2 novel coronavirus.Methods:The clinical data of 10 asymptomatic cases and 12 symptomatic cases of COVID-19 diagnosed during February 2020 to April 2020 was collected and the clinical features of the two groups of patients were compared.Results:10 cases of asymptomatic infection and 12 cases of symptomatic patients were tested positive for the novel coronavirus nucleic acid test.There was no significant difference in gender distribution between the two groups(P>0.05);the average age of patients in the asymptomatic group was lower than that of the symptomatic group(P<0.05),the difference in clinical classification between the two groups was statistically significant(P<0.05);there was no statistically significant difference in the results of chest CT examination involving lung lobes between the two groups(P>0.05),and there was no statistically significant difference in mortality between the two groups(P>0.05).Conclusion:The average age of asymptomatic novel coronavirus infections was lower than that of confirmed cases of COVID-19,mainly among young people.There was no significant difference in clinical classification,mortality and chest CT examination results between symptomatic and asymptomatic cases.

Clinical features and outcomes of 2019 novel coronavirus-infected patients with high plasma brain natriuretic peptide levels

Background As shown in previous studies,high brain natriuretic peptide(BNP)is one of common abnormal laboratory test results in some critical patients infected with 2019 novel coronavirus(2019-nCoV),while the role of BNP in the prognosis of coronavirus disease 2019(COVID-19)is still unknown.This study aims to investigate the effects of the increased BNP value on the outcomes of 2019-nCoV infected patients.Methods Our study initially included patients diagnosed with COVID-19 in Guangzhou Eighth People’s Hospital from January 20 th,2020 to February 24 th.After screening out the participants based on the exclusion criteria,a total of 34 participants were finally enrolled in our research for retrospective analysis.The primary outcome was severe pneumonia defined according to the international guidelines for community-acquired pneumonia.Clinical characteristics and laboratory data were collected from their medical records.Results The best cut-off value of BNP for predicting severe pneumonia was 97.5 pg/mL with the sensitivity for 80%and the specificity for 91.7%.The median age for high BNP level group(>97.5 pg/mL)was 60.5 years(interquartile range:40-80 years).The ratio of males in those patients was 60.0%.Compared with the normal BNP level group,higher temperature(P=0.09),higher values of aspartate aminotransferase(P=0.02),troponin I(P<0.001),C-reactive protein(P<0.001)and myoglobin(P=0.001)as well as lower levels of hemoglobin(P=0.04)and platelet count(P=0.001)were observed in the high BNP group.Multivariable logistic regression demonstrated that 2019-nCoV infected patients with high BNP were more likely to develop severe pneumonia(OR:17.368,P=0.025)and be admitted to the intensive care unit(OR:27.093,P=0.048).Conclusions The increased level of BNP is associated with the undesirable condition and disease aggravation of patients with COVID-19.BNP is expected to be an independent prognostic predictor of clinical outcomes for patients with COVID-19.

“An integrated system,three separated responsibilities”,a new fever clinic management model,in prevention and control of novel coronavirus pneumonia

BACKGROUND Since December 2019,there have been many new cases of coronavirus pneumonia in Wuhan,Hubei Province,which has gradually spread throughout the country.AIM To explore our hospital’s innovative management system to ensure the efficient operation of fever clinics during the epidemic,since controlling the spread of disease is an important way to prevent and control the epidemic.METHODS In total,200 outpatients with fever at our hospital between November 2019 and July 2020 were selected and allocated into two groups.RESULTS The fever clinic in our hospital operated smoothly,and infection with the novel coronavirus disease(COVID-19)has not been reported in our hospital.Additionally,we did not have any cases of missed diagnosis.The awareness regarding COVID-19 infection sources,transmission routes,early symptoms,and preventive measures was significantly higher in our fever clinic than in those of the pre-management group.CONCLUSION"An integrated system,three separate responsibilities"ensured the efficient functioning of our fever outpatient clinic and early screening of COVID-19 cases,which effectively curbed the transmission of COVID-19 and hence prevented COVID-19 pneumonia epidemic in our hospital,ultimately achieving the maximum effect of epidemic prevention and control.

A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV) infected pneumonia(standard version)

In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.

Clinical features and radiological manifestations of COVID-19 disease

Coronavirus disease 2019(COVID-19)was discovered after unusual cases of severe pneumonia emerged in December 2019 in Wuhan Province(China).Coronavirus is a family of single-stranded RNA viruses.Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is transmitted from person to person.Although asymptomatic individuals can transmit the virus,symptomatic patients are more contagious.The incubation period ranges from 3-7 d and symptoms are mainly respiratory,including pneumonia or pulmonary embolism in severe cases.Elevated serum levels of interleukins(IL)-2,IL-6,IL-7 indicate the presence of cytokine release syndrome,which is associated with disease severity.The disease has three main phases:Viral infection,pulmonary involvement,and hyperinflammation.To date,no treatment has proved to be safe or effective.Chest X-ray and computed tomography(CT)are the primary imaging tests for diagnosis of SARS-CoV-2 pneumonia,follow-up,and detection of complications.The main radiological findings are ground-glass opacification and areas of consolidation.The long-term clinical course is unknown,although some patients may develop pulmonary fibrosis.Positron emission tomography-computed tomography(PETCT)is useful to assess pulmonary involvement,to define the affected areas,and to assess treatment response.The pathophysiology and clinical course of COVID-19 infection remain poorly understood.However,patterns detected on CT and PETCT may help to diagnose and guide treatment.In this mini review,we analyze the clinical manifestations and radiological findings of COVID-19 infection.

A summary of diagnosis and treatment experience of novel coronavirus pneumonia

The current epidemic situation of the COVID-19 is still serious.As a designated unit for the diagnosis of COVID-19 in Hainan Province,We,The Second Affiliated Hospital of Hainan Medical University,established a multidisciplinary integrated individualized treatment team.We emphasized early improvement of relevant examinations,early antiviral treatment,dynamic monitoring of inflammatory markers and imaging changes.In addition,nutritional support,psychological intervention,and Chinese medicine treatment also play an important role.We summarized the experience in the diagnosis and treatment process for the reference of clinicians.

CT Imaging Evolution of Novel Coronavirus Pneumonia during Hospitalization

Object: To evaluate CT Features on serial thin-section computed tomographic (CT) scans in patients with conventional Novel Coronavirus Pneumonia (COVID-19) for the period during which they remained hospitalized. Methods: In this Retrospective study, we collected clinical information including Laboratory investigations and more importantly we focused on collecting imaging data of these 15 selected patients (8 men and 7 women, 22 - 70 years old, average age (45 ± 15)) with COVID-19 disease. The mean time between the initial and repeat thin-section CT scans was 3.3 ± 2.1 days, 7.9 ± 2.1 days, 14.2 ± 1.3 days after onset of symptoms in these 15 patients. Three experienced Radiologists reviewed the CT images independently and also in collaboration with each other for complicated or unique cases, for the Imaging characteristics like number and site of lesions, distribution of lesions whether it is lobular, lobar, unilateral or bilateral, and comparing the severity of disease in relation to the CT findings. The CT features were compared using the χ2 test and Fisher’s exact probability. Results: All of 15 patients had a history of visit to the endemic center i.e. Wuhan city or came in direct contact with an infected individual. Fever (93.3%) was the most common symptom. Majority of patients had a normal white blood cell count, and normal lymphocyte count although there were patients with leucopenia and lymphocytopenia. CT images showed predominate Ground-Glass opacities in the initial and repeat CT scans with a percentage of 90.6%, 53.9%, 44.2% respectively during the three spaced CT examinations;most patients had bilateral lung involvement (60%, 93.3%, 93.3%), the lesions predominantly involved the posterior (87.5%, 71.9%, 76.6%) and peripheral (90.6%, 84.3%, 85.7%) part of the lungs. There were more consolidation and mixed patterns in repeat CT scan Versus initial CT scan, the difference was statistically significant (P-values were < 0.001). The total lung severity score in the three aforementioned timely spaced CT scans were 36 (3.3 ± 2.1 days) 63 (7.9 ± 2.1 days), and 57 (14.2 ± 1.3 days) respectively. The median percentage of pneumonia lesions of the whole lung volume in three times CT scan was 1.69% (4.59), 3.47% (5.46), 2.33% (4.75) respectively. Besides, “Tree-in-bud” sign, lung cavitation, and lymphadenopathy were absent. Conclusion: The Thin-slice Section CT Imaging features show uniquely different characteristics, each time the scans are taken. The most common findings in our study were bilateral multiple peripheral and mostly posterior ground-glass opacities (GGO), however the CT scan images that were taken in a timely manner to follow up demonstrated some remarkable changes, which undoubtedly play an important role in the diagnosis and management of the patient with COVID-19 disease.

Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province

Background:The 2019 novel coronavirus(2019-nCoV)causing an outbreak of pneumonia in Wuhan,Hubei province of China was isolated in January 2020.This study aims to investigate its epidemiologic history,and analyze the clinical characteristics,treatment regimens,and prognosis of patients infected with 2019-nCoV during this outbreak.Methods:Clinical data from 1372019-nCoV-infected patients admitted to the respiratory departments of nine tertiary hospitals in Hubei province from December 30,2019 to January 24,2020 were retrospectively collected,including general status,clinical manifestations,laboratory test results,imaging characteristics,and treatment regimens.Results:None of the 137 patients(61 males,76 females,aged 20-83 years,median age 57 years)had a definite history of exposure to Huanan Seafood Wholesale Market.Major initial symptoms included fever(112/137,81.8%),coughing(66/137,48.2%),and muscle pain or fatigue(44/137,32.1%),with other,less typical initial symptoms observed at low frequency,including heart palpitations,diarrhea,and headache.Nearly 80%of the patients had normal or decreased white blood cell counts,and 72.3%(99/137)had lymphocytopenia.Lung involvement was present in all cases,with most chest computed tomography scans showing lesions in multiple lung lobes,some of which were dense;ground-glass opacity co-existed with consolidation shadows or cord-like shadows.Given the lack of effective drugs,treatment focused on symptomatic and respiratory support.Immunoglobulin G was delivered to some critically ill patients according to their conditions.Systemic corticosteroid treatment did not show significant benefits.Notably,early respiratory support facilitated disease recovery and improved prognosis.The risk of death was primarily associated with age,underlying chronic diseases,and median interval from the appearance of initial symptoms to dyspnea.Conclusions:The majority of patients with 2019-nCoV pneumonia present with fever as the first symptom,and most of them still showed typical manifestations of viral pneumonia on chest imaging.Middle-aged and elderly patients with underlying comorbidities are susceptible to respiratory failure and may have a poorer prognosis.

Clinical features of 162 fatal cases of COVID-19:a multi-center retrospective study

Background:The coronavirus disease 2019(COVID-19)has affected approximately 2 million individuals worldwide;however,data regarding fatal cases have been limited.Objective:To report the clinical features of 162 fatal cases of COVID-19 from 5 hospitals in Wuhan between December 30,2019 and March 12,2020.Methods:The demographic data,signs and symptoms,clinical course,comorbidities,laboratory findings,computed tomographic(CT)scans,treatments,and complications of the patients with fatal cases were retrieved from electronic medical records.Results:The median patient age was 69.5(interquartile range:63.0–77.25)years,and 80%of the patients were over 61 years.A total of 112(69.1%)patients were men.Hypertension(45.1%)was the most common comorbidity,while 59(36.4%)patients had no comorbidity.At admission,131(81.9%)patients had severe or critical COVID-19,whereas 39(18.1%)patients with hypertension or chronic lung disease had moderate COVID-19.In total,126(77.8%)patients received antiviral treatment,while 132(81.5%)patients received glucocorticoid treatment.A total of 116(71.6%)patients were admitted to the intensive care unit(ICU),and 137(85.1%)patients received mechanical ventilation.Most patients received mechanical ventilation before ICU admission.Approximately 93.2%of the patients developed respiratory failure or acute respiratory distress syndrome.There were no significant differences in the inhospital survival time among the hospitals(P=0.14).Conclusion:Young patients with moderate COVID-19 without comorbidity at admission could also develop fatal outcomes.The in-hospital survival time of the fatal cases was similar among the hospitals of different levels in Wuhan.

Pathogen evolution, prevention/control strategy and clinical features of COVID-19: experiences from China

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)was reported at the end of 2019 as a worldwide health concern causing a pandemic of unusual viral pneumonia and many other organ damages,which was defined by the World Health Organization as coronavirus disease 2019(COVID-19).The pandemic is considered a significant threat to global public health till now.In this review,we have summarized the lessons learnt during the emergence and spread of SARS-CoV-2,including its prototype and variants.The overall clinical features of variants of concern(VOC),heterogeneity in the clinical manifestations,radiology and pathology of COVID-19 patients are also discussed,along with advances in therapeutic agents.

Clinical features and risk factors associated with severe COVID-19 patients in China

Background::Coronavirus disease 2019(COVID-19),which is caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has rapidly spread throughout the world.In this study,we aimed to identify the risk factors for severe COVID-19 to improve treatment guidelines.Methods::A multicenter,cross-sectional study was conducted on 313 patients hospitalized with COVID-19.Patients were classified into two groups based on disease severity(nonsevere and severe)according to initial clinical presentation.Laboratory test results and epidemiological and clinical characteristics were analyzed using descriptive statistics.Univariate and multivariate logistic regression models were used to detect potential risk factors associated with severe COVID-19.Results::A total of 289 patients(197 nonsevere and 92 severe cases)with a median age of 45.0(33.0,61.0)years were included in this study,and 53.3%(154/289)were male.Fever(192/286,67.1%)and cough(170/289,58.8%)were commonly observed,followed by sore throat(49/289,17.0%).Multivariate logistic regression analysis suggested that patients who were aged≥65 years(OR:2.725,95%confidence interval[CI]:1.317-5.636;P=0.007),were male(OR:1.878,95%CI:1.002-3.520,P=0.049),had comorbid diabetes(OR:3.314,95%CI:1.126-9.758,P=0.030),cough(OR:3.427,95%CI:1.752-6.706,P<0.001),and/or diarrhea(OR:2.629,95%CI:1.109-6.231,P=0.028)on admission had a higher risk of severe disease.Moreover,stratification analysis indicated that male patients with diabetes were more likely to have severe COVID-19(71.4%vs.28.6%,χ2=8.183,P=0.004).Conclusions::The clinical characteristics of those with severe and nonsevere COVID-19 were significantly different.The elderly,male patients with COVID-19,diabetes,and presenting with cough and/or diarrhea on admission may require close monitoring to prevent deterioration.

Comparison and Analysis of Clinical Characteristics of Common COVID-19 and NSIP Patients

Objective:To investigate the relationship between coronavirus disease 2019(COVID-19)and non-specific interstitial pneumonia(NSIP),with a focus on the clinical features of COVID-19 and NSIP,and the key points of differential diagnosis.Methods:The clinical data of 20 patients with common-type COVID-19 and NSIP admitted to Linyi People’s Hospital from January 21,2020,to June 21,2022,were retrospectively analyzed.Gender,age,history of residence in Hubei province,underlying diseases,clinical manifestations,laboratory test results(including blood routine indexes,inflammatory markers,liver function indexes,and coagulation indexes),and computed tomography(CT)scan images were compared between the two groups.Results:COVID-19 patients were younger than NSIP patients(P<0.05).Nine COVID-19 patients had a travel history to Hubei province,while none of the NSIP patients did(P<0.05).Eight COVID-19 patients had underlying chronic conditions,fewer than the NSIP group(12 patients;P<0.05).Both groups experienced symptoms such as shortness of breath,expectoration,fatigue,and runny nose,but fever and cough were more severe and more frequent in the COVID-19 group.Compared to normal reference ranges,both groups exhibited normal white blood cell counts(WBC)and liver function indexes,but elevated lymphocyte counts(LYMP),inflammatory markers,and coagulation indexes,with reduced neutrophil counts(NE).WBC and LYMP were higher in the COVID-19 group compared to the NSIP group.Male patients in the COVID-19 group had higher erythrocyte sedimentation rates and C-reactive protein values than those in the NSIP group,while procalcitonin levels were lower in the COVID-19 group,although the differences were not statistically significant(all P>0.05).The NE count in the COVID-19 group was significantly lower than in the NSIP group(P<0.05).Alanine aminotransferase,total bilirubin,and indirect bilirubin were significantly higher in the COVID-19 group compared to the NSIP group(P<0.05).Chest CT scans of both groups showed bilateral patchy ground-glass opacities,but the lesions in COVID-19 patients were scattered.NSIP patients’chest CTs showed diffuse lesions centered around the hilum or multiple lesions in both lungs,with pleural involvement being rare.Conclusion:While there are certain specific clinical,laboratory,and imaging findings in both COVID-19 and NSIP,the specificity of these features is not high.Differentiating the two requires careful consideration of epidemiological history,nucleic acid testing,and antigen-antibody levels.

Compare the epidemiological and clinical features of imported and local COVID-19 cases in Hainan, China

Background:Effective management of imported cases is an important part of epidemic prevention and control.Hainan Province,China reported 168 coronavirus disease 2019(COVID-19),including 112 imported cases on February 19,2020,but successfully contained the epidemic within 1 month.We described the epidemiological and clinical characteristics of COVID-19 in Hainan and compared these features between imported and local cases to provide information for other international epidemic areas.Methods:We included 91 patients(56 imported and 35 local cases)from two designated hospitals for COVID-19 in Haikou,China,from January 20 to February 19,2020.Data on the demographic,epidemiological,clinical and laboratory characteristics were extracted from medical records.Patients were followed until April 21,2020,and the levels of antibodies at the follow-ups were also analysed by the Wilcoxon matched-pairs signed ranks test.Results:Of the 91 patients,78(85.7%)patients were diagnosed within the first three weeks after the first case was identified(Day 1:Jan 22,2020),while the number of local cases started to increase during the third week No new cases occurred after Day 29.Fever and cough were two main clinical manifestations.In total,15(16.5%)patients were severe,14(15.4%)had complicated infections,nine(9.9%)were admitted to the intensive care unit,and three died.The median duration of viral shedding in feces was longer than that in nasopharyngeal swabs(19 days vs 16 days,P=0.007).Compared with local cases,imported cases were older and had a higher incidence of fever and concurrent infections.There was no difference in outcomes between the two groups.IgG was positive in 92.8%patients(77/83)in the follow-up at week 2 after discharge,while 88.4%patients(38/43)had a reduction in IgG levels in the follow-up at week 4 after discharge,and the median level was lower than that in the follow-up at week 2(10.95 S/Cut Off(S/CO)vs 15.02 S/CO,P<0.001).Conclusion:Imported cases were more severe than local cases but had similar prognoses.The level of IgG antibodies declined from week 6 to week 8 after onset.The short epidemic period in Hainan suggests that the epidemic could be quickly brought under control if proper timely measures were taken.

Analysis of status quo and research progress in nursing care for different typed coronavirus disease 2019: A literature review

At present,patients with coronavirus disease 2019(COVID‑19)are showing a surge in the world,to explore the clinical characteristics,treatment,and care of different types of COVID‑19.The authors reviewed the existing literature,selected,and analyzed the diagnosis and treatment records of 11 patients with COVID‑19 who were initially cured,including patient information,clinical manifestations,auxiliary examination results,treatment principles,nursing evaluation,nursing goals,nursing diagnosis,and nursing measures,and found clinical similarities and differences in the care of different types of patients.Among them,nine patients recovered and discharged after receiving treatment,and two died.As there is no specific medicine,only symptomatic treatment and supportive treatment can be given.Eleven common nursing measures and special nursing measures of different levels were carried out for patients diagnosed with mild,common,severe,and critical illnesses,and different treatment methods were given according to the severity of signs and symptoms.By summarizing the similarities and differences of clinical nursing interventions,we hope to help improve the quality of care for patients diagnosed with COVID‑19.

Analysis of clinical characteristics and risk factors between elderly patients with severe and nonsevere Omicron variant infection

BACKGROUND Coronavirus disease 2019(COVID-19),caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has led to millions of confirmed cases and deaths worldwide.Elderly patients are at high risk of developing and dying from COVID-19 due to advanced age,decreased immune function,intense inflammatory response,and comorbidities.Shanghai has experienced a wave of infection with Omicron,a new variant of SARS-CoV-2,since March 2022.There is a pressing need to identify clinical features and risk factors for disease progression among elderly patients with Omicron infection to provide solid evidence for clinical policy-makers,public health officials,researchers,and the general public.AIM To investigate clinical characteristic differences and risk factors between elderly patients with severe and nonsevere Omicron SARS-CoV-2 variant infection.METHODS A total of 328 elderly patients with COVID-19 admitted to the Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from April 2022 to June 2022 were enrolled and divided into a severe group(82 patients)and a nonsevere group(246 patients)according to the diagnosis and treatment protocol of COVID-19(version 7).The clinical data and laboratory results of both groups were collected and compared.A chi-square test,t test,Mann-Whitney U test,hierarchical log-rank test,univariate and multivariate logistic regression,and hierarchical analyses were used to determine significant differences.RESULTS The severe group was older(84 vs 74 years,P<0.001),included more males(57.3%vs 43.9%,P=0.037),had a lower vaccination rate(P<0.001),and had a higher proportion of comorbidities,including chronic respiratory disease(P=0.001),cerebral infarction(P<0.001),chronic kidney disease(P=0.002),and neurodegenerative disease(P<0.001),than the nonsevere group.In addition,severe disease patients had a higher inflammatory index(P<0.001),greater need for symptomatic treatment(P<0.001),longer hospital stay(P=0.011),extended viral shedding time(P=0.014),and higher mortality than nonsevere disease patients(P<0.001).No difference was observed in the application of Paxlovid in the severe and nonsevere groups(P=0.817).Oxygen saturation,cerebral infarction,and D-dimer were predictive factors for developing severe disease in patients with COVID-19,with D-dimer having an excellent role(area under the curve:90.1%,95%CI:86.1-94.0%).In addition,D-dimer was a risk factor for developing severe COVID-19 according to multivariate stratified analysis.CONCLUSION The clinical course of severe COVID-19 is complex,with a higher need for symptomatic treatment.D-dimer is a suitable biomarker for identifying patients at risk for developing severe COVID-19.

新型冠状病毒感染心血管后遗症患者的临床特征分析

目的:分析新型冠状病毒感染心血管后遗症患者的临床特征。方法:纳入2022年12月至2023年8月因新型冠状病毒感染后主诉“反复胸闷、心悸、乏力”而就诊于本院心血管内科的48例患者为后遗症组,同时期住院拟行外科心脏瓣膜手术且有新型冠状病毒感染史的非冠心病患者32例作为对照组。分析两组患者的临床资料及冠状动脉造影和24小时动态心电图心率变异性资料。结果:后遗症组和对照组的性别构成比、年龄差异均无统计学意义(P均>0.05)。后遗症组肺部CT检查显示无炎症浸润,且白细胞计数、血沉、C反应蛋白、白细胞介素-6、D二聚体、B型利钠肽水平均正常。后遗症组中所有患者心肌肌钙蛋白I检测为阴性,超声心动图检查未发现局部或整体心肌收缩和舒张功能异常,同时排除心包积液。后遗症组中19例(39.6%)患者经肺动脉CT血管造影(CTA)检查排除肺栓塞。后遗症组9例(18.8%)患者接受3T心脏磁共振钆增强检查,仅2例(22.2%)钆延迟增强(LGE)阳性。后遗症组14例(29.2%)患者接受冠状动脉造影检查,其中12例(85.7%)存在冠状动脉慢血流现象,对照组32例患者接受冠状动脉造影检查,其中6例(18.8%)存在冠状动脉慢血流现象,差异有统计学意义(P<0.001)。后遗症组8例(16.7%)患者在冠状动脉造影结束时接受左肱二头肌动脉造影,其中7例(87.5%)患者存在肱二头肌动脉慢血流现象。后遗症组心率变异性指标均较对照组显著降低[全部窦性心搏RR间期标准差(SDNN):(67.20±14.41)ms vs.(93.03±22.19)ms,P<0.01;相邻RR间期差值的均方根(rMSSD):(22.33±13.69)ms vs.(41.18±17.52)ms,P<0.01;相差大于50 ms的相邻RR间期总数占RR间期总数的百分比(pNN50):(5.8±4.9)%vs.(8.8±6.8)%,P<0.05]。结论:新型冠状病毒感染心血管后遗症患者存在多组织微血管功能障碍和长期自主神经失衡,可能是后遗症的发生原因。

新型冠状病毒感染对急性冠状动脉综合征患者住院期间主要不良心血管事件的影响

目的探究新型冠状病毒感染对于急性冠状动脉综合征(ACS)患者住院期间主要不良心血管事件(MACE)的影响。方法对2022年12月至2023年1月首都医科大学附属北京安贞医院收治的因ACS入院的147例患者的临床资料进行分析。按照是否感染新型冠状病毒将患者分为合并新型冠状病毒感染组(49例)和未合并新型冠状病毒感染组(98例),比较2组的临床特征以及住院期间MACE的发生情况,采用Cox回归模型分析新型冠状病毒感染是否与患者住院期间发生MACE有独立关联。结果ACS合并新型冠状病毒感染组患者的年龄、女性比例、D-二聚体水平、住院时间大于/高于/长于未合并新型冠状病毒感染组,淋巴细胞计数和入院后行血运重建比例低于未合并新型冠状病毒感染组(均P<0.05)。合并新型冠状病毒感染组住院期间MACE的发生率显著高于未合并新型冠状病毒感染组[32.7%(16/49)比11.2%(11/98)](P=0.002)。多因素Cox回归分析显示,新型冠状病毒感染是ACS患者住院期间MACE的独立危险因素(风险比=3.217,95%置信区间:1.151~8.987,P=0.031)。结论新型冠状病毒感染可增加ACS患者住院期间MACE的发生率。

清肺排毒汤联合西医治疗新型冠状病毒肺炎临床疗效的Meta分析

目的:系统评价清肺排毒汤治疗新型冠状病毒肺炎(COVID-19)的临床疗效与安全性。方法:检索中国知网、万方、维普、Pubmed、Embase、Cochrane Library等数据库,检索时间截至2022年4月20日,筛选有关清肺排毒汤联合西医治疗COVID-19的临床疗效研究。采用Cochrane偏倚风险评价工具对纳入的研究进行风险评估及质量评价,提取相关数据,采用State17.0软件进行Meta分析,Begg’s检验分析发表偏倚。结果:最终纳入6篇临床疗效研究共602例患者,其中实验组采用清肺排毒汤联合西医治疗295例,对照组单纯西医治疗307例。Meta分析结果显示,实验组在提高临床有效率[RR=1.17,95%CI(1.09,1.26),P<0.0001]、CT好转情况[RR=1.20,95%CI(1.10,1.30),P<0.0001],降低不良反应[RR=0.73,95%CI(0.60,0.90),P=0.002],缩短核酸转阴时间[WMD=-6.56,95%CI(-10.37,-2.75),P=0.0007]、住院天数[WMD=-4.75,95%CI(-6.26,-3.25),P<0.00001]等方面的作用优于对照组。结论:清肺排毒汤联合西医常规疗法可有效改善COVID-19临床症状,具有一定的疗效和安全性,但仍需大量高质量研究证实疗效。

新型冠状病毒感染疫情下发热门诊医护人员身心健康的影响因素及平衡点穴的干预作用

目的:分析新型冠状病毒感染疫情下发热门诊医护人员身心健康的影响因素,观察平衡点穴按压对医护人员身心健康的干预作用。方法:将170例医护人员分为空白组60例及治疗组110例,空白组不进行任何干预,治疗组进行平衡点穴按压,根据总的治疗天数将治疗组进一步分为低频治疗组(治疗天数<20 d)及高频治疗组(治疗天数≥20d),观察平衡点穴的干预作用。统计医护人员年龄、性别、岗位等基线资料,比较3组匹兹堡睡眠质量指数(PSQI)、焦虑自评量表(SAS)、抑郁自评量表(SDS)及健康调查简表(SF-36)评分。结果:护士SAS、SDS评分均高于医师,每周运动次数<3次的医护人员PSQI评分高于每周运动次数≥3次的医护人员,差异均有统计学意义(P<0.05)。护士与医师PSQI、SF-36评分比较,以及每周运动次数≥3次的医护人员与每周运动次数<3次的医护人员SAS、SDS、SF-36评分比较,差异均无统计学意义(P>0.05)。性别、每周运动次数对PSQI评分的影响,岗位、每次运动时长对SAS评分的影响,以及岗位对SDS评分的影响,差异均有统计学意义(P<0.05)。3组PSQI、SDS、SF-36评分时间效应差异均有统计学意义(P<0.05),SAS评分时间效应差异无统计学意义(P>0.05)。3组上述4项评分组间效应差异均无统计学意义(P>0.05)。结论:新型冠状病毒感染疫情期间,发热门诊医护人员存在身心健康不良的情况,但随着时间进展,不良身心状况逐渐改善;医护人员中女性的睡眠质量优于男性,护士较医师焦虑、抑郁更明显,运动可改善睡眠质量及焦虑状态;平衡点穴按压对身心健康的影响有限,可能与干预时间过短及纳入样本量较少有关。