Kev kho mob raum tsis ua haujlwm los ntawm tus kab mob Coronavirus 2019 (COVID-19)
Mar 15, 2022
Yog xav paub ntxiv:ali.ma@wecistanche.com
COVID-19: Lub raum Qhia Ib Zaj Dab Neeg
Lii Chan, Judy Hindi, thiab Girish N. Nadkarni
Kab mob khaus laus nas vais lav 2019(COVID-19), tshwm sim los ntawm tus mob hnyav ua pa nyuaj rau tus mob coronavirus 2 (SARS-CoV-2), yog xwm txheej ceev rau pej xeem kev noj qab haus huv. Txawm hais tias thaum xub thawj tau piav qhia tias yog tus kab mob ua pa, SARS-CoV-2 muaj Cov Ntawv Tshaj Lij, p.190 thiab p.204 tam sim no tau pom tias muaj ntau lub cev koom nrog.Mob raum mob(CKD) tau tshwm sim los ua ib qho kev pheej hmoo rau qhov tshwm sim tsis zoo. Hauv qhov teeb meem no ntawm AJKD, Ng et al² thiab Flythe et al tshawb nrhiav kev koom tes ntawm cov kab mob raum nrog cov txiaj ntsig ntawm cov neeg mob pw hauv tsev kho mob nrog COVID-19 (Kab mob khaus laus nas vais lav 2019).
Nyem rau Cistanche DHT rau mob raum
Txawm hais tias thawj zaug kev tshaj tawm los ntawm Tuam Tshoj tau qhia tias muaj qhov tshwm sim tsawg (5 feem pua -10 feem pua) ntawmmob raum raug mob(AKI), cov ntawv tom ntej tau sau tseg qhov tshwm sim ntau dua ntawm AKI (mob raum raug mob) hauv tsev kho mob cov neeg mob nrog COVID-19 (Kab mob khaus laus nas vais lav 2019)' (Daim duab 1).Nyob rau hauv kev tshawb nrhiav cov neeg mob hauv tsev kho mob nrog COVID-19 (Kab mob khaus laus nas vais lav 2019)los ntawm Northwell Health system, Ng et al pom tias 40 feem pua ntawm cov neeg mob hauv tsev kho mob tau txais nrog COVID-19 (Kab mob khaus laus nas vais lav 2019)tsim AKII (mob raum raug mob). Txawm hais tias tsis tau tham hauv tsab xov xwm no, urinalysis tau pom tias ua rau lwm qhov tsis yog mob tubular raug mob. Feem ntau,raumbiopsies tau qhia ntau yam histopathology, nrog rau mob glomerulonephritis thiab mob tubular raug mob.
Tsis hais txog pathophysiology, COVID-19 (Kab mob khaus laus nas vais lav 2019)- koom nrog AKII (mob raum raug mob)yog txuam nrog kev tuag ntau ntxiv. Ng et al pom cov nqi no yog 46.4 feem pua ntawm cov tsis xav tauraumhloovKev kho mob (KRT) thiab siab li 79.3 feem pua ntawm cov uas xav tau KRT. Thaum tso tawm, 69 feem pua ntawm cov neeg mob uas xav tau KRT thiab 74 feem pua ntawm cov neeg mob AKII (mob raum raug mob)tsis xav tau KRT muajraumrov qab los. Dab tsi tseem yuav tau piav qhia yog qhov tshwm sim mus sij hawm ntev ntawm COVID-19 (Kab mob khaus laus nas vais lav 2019)- koom nrog AKI (mob raum raug mob). Ntawm cov uas tsis tau rov qab losraummuaj nuj nqilossis cov uas raug tso tawm nrog qhov yuav tsum tau ua ntxiv rau KRT, pes tsawg tus neeg mob thaum kawg rov zoo? Hloov pauv, rau cov neeg uas rov zoo, qhov feem pua ntawm cov neeg mob yuav muaj xwm txheej CKD (Mob raum mob)?
Kab mob khaus laus nas vais lav 2019(COVID-19) cuam tshuamcov neeg mob nrogmob raum
Kev ntsuam xyuas thiab kev kho mob ntawm AKII (mob raum raug mob)hauv COVID-19 (Kab mob khaus laus nas vais lav 2019)cov neeg mob zoo ib yam li AKII (mob raum raug mob)hauv non-COVID-19 (Kab mob khaus laus nas vais lav 2019)cov neeg mob, nrog kev txhawb nqa yog lub hauv paus ntawm kev tswj hwm. Hyperkalemia yog tshwm sim hauv cov neeg mob pw hauv tsev kho mob nrog COVID-19 (Kab mob khaus laus nas vais lav 2019), tej zaum vim yog cov cell hloov pauv siab zoo ib yam li lub xeev hypercatabolic thiab txo qisraummuaj nuj nqi. Muab qhov muaj peev xwm ntawm kev lim ntshav tsawg thaum muaj kev sib kis thoob qhov txhia chaw,' kev siv cov tshuaj potassium ntxiv rau lwm qhov kev ntsuas yuav pab ncua KRT qhov tsim nyog.
Kwv yees li 19 feem pua ntawm cov neeg mob pw hauv tsev kho mob nrog COVID-19 (Kab mob khaus laus nas vais lav 2019)- koom nrog AKII (mob raum raug mob)yuav xav tau KRT." Thaum lub sijhawm muaj kev sib kis thiab qhov tshwm sim ntawm cov neeg mob uas xav tau KRT, ntau qhov kev sib tw tau ua rau txo qis lub peev xwm lim ntshav, suav nrog cov neeg ua haujlwm tu neeg mob tsis txaus, cov khoom siv tiv thaiv tus kheej tsis txaus thaum lub sijhawm pib, thiab kev tsis txaus ntawm lub tshuab lim ntshav thiab cov khoom siv.
Intermittent hemodialysis (HD) tseem yog qhov kev xaiv zoo tshaj plaws hauv cov neeg mob hemodynamically ruaj khov, qhov txuas ntxiv KRT (CKRT) yog qhov kev xaiv rau cov neeg mob hemodynamically tsis ruaj khov. degree Kom haum raws li tus neeg mob qhov ntim ntau ntxiv, kev kho HD tsis tu ncua feem ntau tau luv luv, nrog rau kev siv cov khoom siv qeeb qeeb ultrafiltration thiab potassium binders ntawm kev sib tham. Yog tias muaj CKRT, cov kev kho mob uas muaj tus nqi siab dua yuav raug siv los muab kev tshem tawm kom txaus thaum tso cai rau cov tshuab siv rau ntau tus neeg mob ib hnub.'KRT ntev ntev tau siv rau cov neeg mob hemodynamically tsis ruaj khov hauv cov chaw tsis muaj peev xwm CKRT lossis yog tias xav tau. outstripped khoom. Nws tseem yuav tau txiav txim siab seb ib qho ntawm cov kev ntsuas no puas muaj feem cuam tshuam rau tus neeg mob.
Nrog rau cov neeg ua haujlwm tsawg thiab cov khoom siv lim ntshav thaum muaj kev kub ntxhov, mob peritoneal dialysis (PD) pom qhov rov tshwm sim vim tias nws tau pab hla lub tshuab tsis txaus thiab cov teeb meem coagulopathy / vascular nkag, nrog rau txo cov neeg mob / lub sijhawm sib cuag. PD catheters tso los ntawm cov neeg ua haujlwm paub txog yuav siv tau li ntawm 24 txog 48 teev tom qab tso. Kev siv PD muaj cov lus nug txog kev ua tiav hauv cov neeg mob uas mob ua pa nyuaj siab kho mob nrog qhov chaw nyob. Kev tshawb fawb txog cov txiaj ntsig ntev ntawm cov neeg mob kho mob PD thiab kev sib piv ntawm cov txiaj ntsig nrog HD tam sim no tseem tab tom tos.
Nws tau pom meej sai sai tias cov neeg mob hnyav nrog COVID-19 (Kab mob khaus laus nas vais lav 2019)yog hypercoagulable, uas ua rau muaj lwm qhov kev sib tw: txhaws ntawm vascular nkag thiab dialyzers / kab. Ntau lub koom haum tau siv cov tswv yim kho mob anticoagulation; Txawm li cas los xij, tsis muaj cov txheej txheem siv thoob ntiaj teb.
Muab lub nra hnyav rau cov neeg mob nrog CKD (Mob raum mob)thiabraumua tsis tiav, peb cia siab tias COVID-19 (Kab mob khaus laus nas vais lav 2019)kom muaj kev cuam tshuam loj heev rau cov neeg mob yooj yim no. Ntau qhov kev tshawb fawb hauv Tebchaws Meskas tau tshaj tawm tias kev tuag txog li 30 feem pua
Flythe et al tau siv STOP-COVID database, kev tshawb fawb ntau lub chaw ntawm ntau dua 4,000 cov neeg mob hnyav tau txais mus rau chav saib xyuas mob hnyav, los sib piv cov kev kho mob ntawm cov neeg mob uas muaj thiab tsis muaj ua ntej.raumkab mobthiab ntsuas qhov tshwm sim hauv cov neeg mob uas muaj ua ntejraumkab mobob qho tib si nondialysis CKD (Mob raum mob)thiabraumua tsis tiavkho nrog dialysis. Txawm hais tias 12 feem pua ntawm cov neeg mob tau muaj CKD ua ntej (Mob raum mob), tsuas yog 3 feem pua ntawm cov neeg mob tau txais kev kho mob lim ntshav. Cov qauv kab mob ua paug tsis sib haum, nrog qee qhov siab dua hauv cov neeg mob tsis lim ntshav nrog KRT, ntau qhov kev sib tw tau ua rau txo qis kev lim ntshav, suav nrog cov neeg ua haujlwm tu neeg mob tsis txaus, cov khoom siv tiv thaiv tus kheej tsis txaus thaum pib, thiab tsis txaus ntawm cov tshuab lim ntshav thiab cov khoom siv.
Intermittent hemodialysis (HD) tseem yog qhov kev xaiv zoo tshaj plaws hauv cov neeg mob hemodynamically ruaj khov, qhov txuas ntxiv KRT (CKRT) yog qhov kev xaiv rau cov neeg mob hemodynamically tsis ruaj khov. degree Kom haum raws li tus neeg mob qhov ntim ntau ntxiv, kev kho HD tsis tu ncua feem ntau tau luv luv, nrog rau kev siv cov khoom siv qeeb qeeb ultrafiltration thiab potassium binders ntawm kev sib tham. Yog tias muaj CKRT, cov kev kho mob uas muaj tus nqi siab dua yuav raug siv los muab kev tshem tawm kom txaus thaum tso cai rau cov tshuab siv rau ntau tus neeg mob ib hnub.'KRT ntev ntev tau siv rau cov neeg mob hemodynamically tsis ruaj khov hauv cov chaw tsis muaj peev xwm CKRT lossis yog tias xav tau. outstripped khoom. Nws tseem yuav tau txiav txim siab seb ib qho ntawm cov kev ntsuas no puas muaj feem cuam tshuam rau tus neeg mob.
Nrog rau cov neeg ua haujlwm tsawg thiab cov khoom siv lim ntshav thaum muaj kev kub ntxhov, mob peritoneal dialysis (PD) pom qhov rov tshwm sim vim tias nws tau pab hla lub tshuab tsis txaus thiab cov teeb meem coagulopathy / vascular nkag, nrog rau txo cov neeg mob / lub sijhawm sib cuag. PD catheters tso los ntawm cov neeg ua haujlwm paub txog yuav siv tau li ntawm 24 txog 48 teev tom qab tso. Kev siv PD muaj cov lus nug txog kev ua tiav hauv cov neeg mob uas mob ua pa nyuaj siab kho mob nrog qhov chaw nyob. Kev tshawb fawb txog cov txiaj ntsig ntev ntawm cov neeg mob kho mob PD thiab kev sib piv ntawm cov txiaj ntsig nrog HD tam sim no tseem tab tom tos.
Nws tau pom meej sai sai tias cov neeg mob hnyav nrog COVID-19 (Kab mob khaus laus nas vais lav 2019)yog hypercoagulable, uas ua rau muaj lwm qhov kev sib tw: txhaws ntawm vascular nkag thiab dialyzers / kab. Ntau lub koom haum tau siv cov tswv yim kho mob anticoagulation; Txawm li cas los xij, tsis muaj cov txheej txheem siv thoob ntiaj teb.
Muab lub nra hnyav rau cov neeg mob nrog CKD (Mob raum mob)thiabraumua tsis tiav, peb cia siab tias COVID-19 (Kab mob khaus laus nas vais lav 2019)kom muaj kev cuam tshuam loj heev rau cov neeg mob yooj yim no. Ntau qhov kev tshawb fawb hauv Tebchaws Meskas tau tshaj tawm tias kev tuag txog li 30 feem pua
Kev kho mob ntawmraumua tsis tiav los ntawmCOVID-19 (Kab mob khaus laus nas vais lav 2019)
Flythe et al tau siv STOP-COVID database, kev tshawb fawb ntau lub chaw ntawm ntau dua 4,000 cov neeg mob hnyav tau txais mus rau chav saib xyuas mob hnyav, los sib piv cov kev kho mob ntawm cov neeg mob uas muaj thiab tsis muaj ua ntej.raumkab mobthiab ntsuas qhov tshwm sim hauv cov neeg mob uas muaj ua ntejraumkab mobob qho tib si nondialysis CKD (Mob raum mob) thiablub raum B khonrog kev lim ntshav. Txawm hais tias 12 feem pua ntawm cov neeg mob muaj CKD ua ntej (Mob raum mob), tsuas yog 3 feem pua ntawm cov neeg mob tau txais kev kho mob lim ntshav. Cov qauv kab mob ua paug tsis sib haum, nrog qee qhov siab dua hauv cov neeg mob uas tsis tau lim ntshav nrog CKD thiab cov neeg mob nrograumua tsis tiav, thiab lwm yam qis. Kab mob raum tseem yog ib qho kev pheej hmoo ntawm kev tuag hauv tsev kho mob, nrog rau 28-hnub hauv tsev kho mob tuag ntawm 51 feem pua ntawm cov neeg muaj lub raum tsis ua haujlwm tau txais kev lim ntshav, 49 feem pua hauv nondialysis CKD (Mob raum mob), thiab 35 feem pua ntawm cov uas tsis muaj ua ntejraumkab mob.
Tu siab heev, txoj kev tshawb no qhia txog "renalism,"10 qhia tias cov neeg mob CKD (Mob raum mob)(nrog rau cov nrograumua tsis tiav) tau txais kev sim kev kho mob ib nrab feem ntau raws li cov neeg mob uas tsis muaj kab mob raum. Muab qhov kev tuag siab heev, kev sim tshuaj ntsuam xyuas yuav tsum tso npe rau pawg neeg muaj kev pheej hmoo.
Cov neeg mob uas tau txais HD nyob hauv nruab nrab yog qhov tshwj xeeb tshaj plaws rau kev cog lus SARS-CoV-2 kev kis kab mob vim muaj kev sib ntsib ntau zaus. Cov neeg mob nrograumTsis tshua muaj feem yuav muaj COVID classic-19 (Kab mob khaus laus nas vais lav 2019)Cov tsos mob piv nrog cov neeg mob uas muaj thiab tsis muaj CKD (Mob raum mob). Interestingly, lawv muaj feem ntau yuav nthuav tawm nrog kev hloov pauv ntawm lub hlwb, qhia txog qhov xav tau kev soj ntsuam ceev faj muab qhov kev txhawj xeeb rau "kev sib kis ntsiag to." Kev tshawb fawb tsis ntev los no kwv yees tias 10 feem pua ntawm cov neeg mob lim ntshav tau muaj COVID-19 (Kab mob khaus laus nas vais lav 2019), txawm tias lawv sawv cev tsuas yog 3 feem pua ntawm cov neeg saib xyuas tseem ceeb hauv txoj kev tshawb no.
Ntau lub koom haum kws tshaj lij tau tshaj tawm cov lus qhia txhawm rau txwv kev kis mob hauv cov chav lim ntshav. Txawm li cas los xij, cov lus qhia tshwj xeeb txawv raws li kev thauj mus los, cov neeg ua haujlwm raug cob qhia, thiab cov cuab yeej tiv thaiv tus kheej.
Kev tshuaj ntsuam xyuas tam sim thiab kev cais cov neeg mob lossis cov neeg ua haujlwm uas tau txais koob tshuaj tiv thaiv nrog cov neeg mob muaj txiaj ntsig zoo los tiv thaiv kev kis tus kabmob ntxiv. Txawm hais tias nyuaj rau kev ua tiav nyob rau hauv nruab nrab ntawm kev sib kis, kev hloov hauv tsev, uas tuaj yeem siv lub platforms telemedicine thiab txo qhov raug, yuav tsum tau txhawb nqa.
Txij li thaum SARS-CoV-2 tau tshwm sim ze li ntawm 1 xyoo dhau los, cov zej zog kev tshawb fawb tau sib sau ua ke los xyuas kom muaj kev tshaj tawm txog kev paub txog COVID-19 (Kab mob khaus laus nas vais lav 2019). Txawm hais tias peb tau kawm ntau yam txog COVID-19 (Kab mob khaus laus nas vais lav 2019)thiabraumkab mob, ntau qhov tseem yuav tau piav qhia, suav nrog cov kev tshawb fawb ntev ntev thiab cov qauv rau kev txheeb xyuas cov neeg mob uas muaj kev pheej hmoo siab rau AKII (mob raum raug mob)thiab kev tuag. Cov ntawv ceeb toom tshiab tau piav qhia txog qhov tsis sib xws hauv kev txiav txim siab txog kev noj qab haus huv cuam tshuam rau COVID-19 (Kab mob khaus laus nas vais lav 2019)cov txiaj ntsig thiab cov no yuav tsum tau tsom mus rau kev tshawb fawb. Txawm li cas los xij, ntau txoj haujlwm tseem nyob tom ntej (Daim duab 1). Txawm hais tias COVID-19 (Kab mob khaus laus nas vais lav 2019)txaus ntshai heev, nws ua rau peb nco ntsoov cov lus hais los ntawm Marie Curie, "Tsis muaj dab tsi hauv lub neej yuav tsum ntshai, nws tsuas yog yuav tsum nkag siab xwb. Tam sim no yog lub sijhawm los nkag siab ntau ntxiv, kom peb ntshai tsawg dua." 13(p36)
Daim duab 1. ncua sij hawm ntawm tus kab mob coronavirus 2019 (COVID-19) kev tshawb pom thiab cov lus qhia yav tom ntej, nrog rau qhov tshwj xeeb rau lub raum thiab cov lus nug tsis teb rau kab mob raum thiab COVID-19.
Cov ntawv luv: AKI,mob raum raug mob; CKD,mob ntevraumkab mob; eGFR, kwv yees glomerular pom tus nqi; FDA, US Food and Drug Administration;
HD, hemodialysis; KF, lub raum tsis ua haujlwm; pt, tus neeg mob; SARS-CoV-2, mob hnyav acute respiratory syndrome coronavirus 2; WHO, World Health Organization.
Cov ntaub ntawv
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