Nyob rau hauv lub ntsej muag ntawm Covid 19 cov neeg mob, Nephrologists yuav tsum paub cov ntsiab lus tseem ceeb ntawm kev kho mob!
Dec 27, 2022
Ua ntej ntawm tag nrho cov, nyob rau hauv lub hauv paus ntsiab lus, kev kho mob ntawm mob me me ntawm cov kab mob tshiab coronary pneumonia yog txawv kiag li los ntawm kev kho mob ntawm cov mob hnyav. Tam sim no, kev kho mob me me feem ntau txhawb kev kho tus kheej hauv tsev, thaum lub hauv paus ntawm kev kho mob hnyav yog kev txhawb nqa kev kho mob, uas yog, kho cov pa oxygen raws li tus neeg mob ua pa, kho cov kua dej hloov raws li tus neeg mob lub ntim mob, thiab ib txhij nqa tawm cov kab mob antiviral, anticoagulation, thiab lwm yam kev kho mob. Cov kev kho mob tshwj xeeb yog raws li hauv qab no.
Nyem rau Rou cong rong Cistanche rau mob raum
Kev kho mob
1. Kev kho pa
Cov kab mob ua pa yog lub hom phiaj tseem ceeb ntawm lub cev raug tawm tsam los ntawm tus kab mob coronary pneumonia tshiab. Hypoxemia yog qhov txuas tseem ceeb hauv kev kho cov kab mob tshiab coronary pneumonia. Clinically, nws yog ib qho tsim nyog yuav tsum tau siv ntau txoj hauv kev kho cov pa oxygen rau cov neeg mob hypoxemia raws li kev soj ntsuam nruj thiab kev soj ntsuam zoo. Txhim kho sai sai rau tus neeg mob lub xeev hypoxic thiab muab lub hauv paus rau lwm yam kev kho mob. Rau cov neeg mob hypoxemic nrog oxygen saturation<93% or Pa0/FiO2 between 200 and 300 mmHg, the following treatments can be selected.
(1) Kev nqus pa oxygen los ntawm qhov ntswg cannula: Cov pa oxygen feem ntau tsis tshaj 5 L / min; kev saib xyuas yog hais txog oxygen saturation> 93 feem pua.
(2) Ordinary face mask oxygen therapy: If nasal cannula oxygen inhalation cannot maintain finger oxygen saturation >93 feem pua , kev kho lub ntsej muag lub ntsej muag oxygen tuaj yeem txiav txim siab, thiab cov pa oxygen txaus raug pom zoo kom tswj tau ntawm 5-10 L / min.
(3) Kev kho qhov ntswg qhov ntswg siab: Thaum tus neeg mob qhov ua pa nyuaj thiab / lossis hypoxemia tsis zoo tom qab tau txais lub qhov ntswg cannula lossis daim npog qhov ntswg nqus pa, yuav tsum siv qhov ntswg qhov ntswg los kho oxygen. Cov neeg mob uas muaj tus mob hnyav / tseem ceeb rau COVID-19 mob ntsws uas nws qhov kev mob hnyav tsawg dua 93 feem pua kuj tuaj yeem siv ncaj qha rau kev kho qhov ntswg qhov ntswg. Thaum lub sij hawm kho mob, tus neeg mob txoj kev ua pa tsis ua pa yuav tsum tau saib xyuas kom zoo. Oxygen therapy thiab lwm yam kev kho mob kho.
(4) Mechanical ventilation: Rau cov neeg mob uas muaj hypoxemia uas nws Pa0/Fi02 yog 150-200 mmHg, qhov tsis muaj qhov cua tshuab tuaj yeem sim los txhawb kev kho mob. Yog tias qhov hypoxia tseem tsis txhim kho lossis tseem hnyav dua, Pa0 / FiO<150 mmHg, invasive mechanical ventilation should be given in time. The setting principles of invasive mechanical ventilation modes and parameters should follow the lung-protective mechanical ventilation strategy. The setting principles of the dry number should follow the lung-protective mechanical ventilation strategy. For patients with moderate to severe acute respiratory distress syndrome, or when Fi02 continues to be higher than 50%, lung recruitment therapy can be tried, and according to the responsiveness of the patient's lung recruitment, it is decided whether to perform repeated lung recruitment maneuvers.
2. tshuaj tiv thaiv kab mob
Rau cov neeg mob uas muaj COVID-19 nucleic acid zoo rau tsawg dua 5 hnub thiab tsis muaj contraindications xws li daim siab thiab lub raum ua haujlwm tsis zoo, nematevir / ritonavir tuaj yeem siv los kho cov tshuaj tiv thaiv IgM thiab IgG tshwj xeeb, tshwj xeeb tshaj yog cov tshuaj tiv thaiv IgG yuav muaj kev cuam tshuam tsis zoo, Nws yog qhov zoo los tshem tawm tus kab mob thiab txhawb kev rov zoo. Rau cov neeg mob uas muaj IgG qis dua 10 mg / L, neutralizing antibodies thiab cov immunoglobulins tshwj xeeb tuaj yeem siv rau kev kho mob. Rau cov neeg mob uas muaj kev pheej hmoo siab, muaj kab mob hnyav, thiab kis tau tus kab mob sai, cov ntshav plasma tuaj yeem siv tau thaum ntxov ntawm cov kab mob, thiab cov koob tshuaj infusion yog 200-500 mL (4-5} mL / kg). Cov xwm txheej ntawm tus kheej thiab kis kab mob, thiab lwm yam, txiav txim siab seb puas yuav rov ua dua.
3. Kev kho mob immunomodulatory
Raws li cov txiaj ntsig ntawm kev sim loj randomized tswj xws li RECOVERY, ib koob me me (5 mg ntawm dexamethasone lossis sib npaug ntawm lwm cov glucocorticoids), thiab kev kho luv luv (hauv 10 hnub) glucocorticoid kho. Thymofasin (thymosin 1) yog ib qho kev siv tshuaj tiv thaiv kab mob. Rau cov neeg mob uas tsis tshua muaj lymphocyte suav, thymosin tuaj yeem siv rau kev kho mob. Rau cov neeg mob hnyav / tseem ceeb ntawm COVID-19, cov neeg mob immunoglobulin 5-20 g/d tuaj yeem muab tso rau hauv. Txawm li cas los xij, kev siv tib neeg immunoglobulin tuaj yeem ua rau lub raum tsis ua haujlwm thiab cov xwm txheej thrombotic hauv cov neeg mob, yog li nws yuav tsum tau siv nrog kev ceev faj hauv cov neeg mob uas muaj lub xeev hypercoagulable, thiab lub cev ua haujlwm ntawm cov neeg mob yuav tsum tau saib xyuas zoo thaum siv.
4. Anticoagulant kho
Cov kev tshawb fawb cuam tshuam tau pom tias qhov tshwm sim ntawm venous thromboembolism hauv cov neeg mob uas muaj mob ntsws tshiab thaum mus pw hauv tsev kho mob tuaj yeem siab txog 26 feem pua. Raws li cov txheej txheem pathogenic ntawm COVID-19, kev kho tshuaj anticoagulant yuav tsum tau muab rau cov neeg mob uas muaj tus kab mob COVID-19 yam tsis muaj kev xav los ntshav, thiab kev saib xyuas kev ua haujlwm coagulation thiab kev soj ntsuam cov hlab ntsha sib sib zog nqus yuav tsum tau ua niaj hnub rau cov neeg mob uas muaj kev pheej hmoo siab. . Tsawg molecular hnyav heparin yog thawj qhov kev xaiv rau kev kho mob anticoagulant. Cov neeg mob tuaj yeem kho nrog cov tshuaj heparin uas tsis muaj kev cuam tshuam. Thaum muaj qhov tshwm sim thromboembolic tshwm sim hauv tus neeg mob, kev kho mob xws li thrombolysis yuav tsum tau ua raws li cov lus qhia sib xws.
Kev tiv thaiv thiab kho cov kab mob raum thiab cov neeg mob hemodialysis
Rau COVID-19 cov neeg mob uas muaj kab mob hauv lub raum lossis lub raum ua haujlwm tsis zoo, nws yuav tsum nco ntsoov lub hauv paus ntsiab lus ntawm "ob qhov kev ntsuam xyuas, ib qho qhia, thiab ob txoj kev kho mob" raws li kev tswj hwm niaj hnub, uas yog, muab qhov tseem ceeb rau Kev soj ntsuam seb lub raum ua haujlwm zoo li cas thiab seb puas muaj cov tsos mob raum tsis ua haujlwm, xav tau kev lim ntshav tam sim, thiab kev kho mob thaum lub raum lim ntshav thiab tswj cov teeb meem, raws li hauv qab no:
1. Kev ntsuam xyuas lub raum ua haujlwm: Lub raum ua haujlwm ntawm cov neeg mob uas muaj kab mob ntsws tshiab yuav tsum tau soj ntsuam tom qab nkag mus. Yog tias tus neeg mob tau ncua kev lim ntshav, ntshav urea nitrogen thiab ntshav creatinine nce ntxiv, thiab kev kho mob ntshav qab zib yuav tsum tau teem sijhawm.
2. Kev ntsuam xyuas cov teeb meem rau lub raum tsis ua haujlwm: Kev ntsuam xyuas cov teeb meem rau lub raum tsis ua haujlwm suav nrog kev ua haujlwm ntawm lub plawv, electrolytes (tshwj xeeb tshaj yog cov ntshav poov tshuaj), dej thiab acid-base tshuav nyiaj li cas, ntshav siab, gastrointestinal function, anemia, khoom noj khoom haus, thiab lwm yam.
3. Cov lus qhia rau kev lim ntshav thaum muaj xwm txheej ceev: Hauv cov neeg mob uas kho hemodialysis uas tsis tau lim ntshav rau lub sijhawm ntev, lawv cov ntshav creatinine nce ntau, thiab lawv ua rau mob plawv sab laug, hyperkalemia, acidosis hnyav, ua ke nrog plab hnyuv los ntshav los ntawm uremia, mob hnyav. Cov teeb meem xws li uremic encephalopathy xav tau kev lim ntshav sai sai.
4. Kev kho mob hemodialysis: Rau cov neeg mob uremia uas tuaj rau hauv tsev kho mob thawj zaug, kev kho lub raum tsis tu ncua yuav tsum tau ua tam sim ntawd, thiab thawj lub tsev kho mob lim ntshav yuav tsum tau nug txog cov ntaub ntawv tseem ceeb ntawm cov neeg mob lim ntshav (tshwj xeeb tshaj yog hais txog kab mob siab B, kab mob siab C, tib neeg kis HIV, syphilis, thiab lwm yam). Tom qab tus neeg mob cov ntaub ntawv tus kab mob tau qhia meej, kev kho hemodialysis tsis tu ncua lossis kev kho lub raum tsis tu ncua tuaj yeem raug xaiv raws li qhov xwm txheej tshwj xeeb ntawm tus neeg mob.
5. Kev kho mob ntev ntawm kev tu cov neeg mob dialysis: (1) Rau cov teeb meem ntawm kev tu cov neeg mob dialysis, xws li kub siab, kab mob plawv, anemia, dej, thiab electrolyte acid-base imbalance, kev kis kab mob, thiab lwm yam. Qhia txog kev kho mob. (2) Rau cov neeg mob uas tsis tau lim ntshav ntev ntev, yuav tsum tau them nyiaj tshwj xeeb. Nws raug nquahu kom siv cov tshuaj proton twj tso kua mis thiab cov tshuaj tiv thaiv kab mob hauv plab los tiv thaiv lub plab thiab tiv thaiv plab hnyuv los ntshav. (3) Rau cov neeg mob uas muaj teeb meem uremia (xws li hyperkalemia, metabolic acidosis, plawv tsis ua hauj lwm, plab hnyuv tawm, thiab lwm yam), xa mus rau cov lus qhia txog kev kho mob.
Kev kho tus kab mob coronary pneumonia tshiab hauv cov neeg mob lub raum tsis txaus
Rau kev saib xyuas cov neeg mob hemodialysis kis nrog COVID-19, nws yog qhov tseem ceeb tshaj plaws kom tswj xyuas kev lim ntshav tsis tu ncua, thiab cov neeg mob yuav tsum tau kho los ntawm "Kev kuaj mob thiab kev kho raws cai rau Novel Coronavirus Pneumonia (Tsim Ninth Edition)". Kev tu cov neeg mob hemodialysis tsis tau txhaj tshuaj tiv thaiv kab mob khaub thuas tshiab, thiab lawv yog pab pawg muaj kev pheej hmoo siab rau mob ntsws tshiab mob ntsws. Hauv kev tswj xyuas kev kho mob, ntxiv rau cov tswv yim kho mob xws li kev kho cov pa oxygen, kho qhov ntswg ua pa oxygen, recombinant human granulocyte-macrophage stimulating factor, thymosin, gamma globulin, thiab lwm yam kev kho mob txhawb nqa, nws yog ib qho tsim nyog yuav tsum ua tib zoo saib xyuas cov kev hloov pauv hauv cov tshuaj. tus neeg mob tus mob, nrog rau cov hauv qab no:
(1) Ua tib zoo saib xyuas cov kab mob coronavirus tshiab nucleic acid ncig qhov pib, oxygenation Performance index, lymphocyte suav, D-dimer, hauv siab CT duab, thiab lwm yam.
(2) Rau cov neeg mob uas tsis muaj pulmonary infiltration pom nyob rau hauv kev nkag, lub hauv siab imitation yuav tsum tau rov kuaj dua tom qab 3 mus rau 5 hnub.
(3) If the patient's chest imaging features support the manifestation of new coronary pneumonia at the time of admission, the patient should be treated in the prone position immediately (>16 h / d), thiab lub hauv siab CT yuav tsum tau rov kuaj dua hauv 72 teev los txiav txim seb lub ntsws effusion puas lawm. Yog tias muaj kev vam meej, luv luv glucocorticoids, convalescent plasma, thiab tshiab crown-specific human immunoglobulin tuaj yeem muab tau raws li tus mob.
(4) Ua tib zoo saib xyuas kev noj zaub mov ntawm cov neeg mob, xyuas kom muaj lub zog txhua hnub ntawm cov neeg mob, tiv thaiv thiab kho cov teeb meem nyuaj, thiab tiv thaiv kab mob thib ob lossis kab mob fungal. Yog tias tus neeg mob tus mob muaj zog, nws yuav tsum tau pauv sai rau ICU rau kev kho ua haujlwm ntxiv.
(5) Vim tias cov neeg mob nquag ua rau hypercoagulation tom qab kis tus kab mob tshiab, nws raug pom zoo tias raws li niaj hnub hemodialysis anticoagulation, cov tshuaj qis qis molecular hnyav heparin anticoagulation yuav tsum tau ntxiv rau cov hnub tsis lim ntshav, thiab los ntshav yuav tsum nyob ze. pom.
Yog xav paub ntxiv:ali.ma@wecistanche.com
