Source:
http://news.southcn.com/gd/content/2020-02/14/content_190322421.htm
Experts: Several clear early warning factors for new coronary pneumonia have been identified
Low oxygenation index for over twelve hours, watch out!
2020-02-14 07:00 Source: Southern Network Li Xiuting Zhu Xiaofeng
Since the outbreak, Li Yueping, director of the ICU of the Infectious Diseases Center of the Eighth People's Hospital of Guangzhou City, has been at the forefront of fighting the epidemic. She is responsible for the isolation of the first district, which is the place where the eighth hospital of Guangzhou city treats severe and critically ill patients. As of February 12, a total of 13 critically ill patients and more than 20 critically ill patients have been treated. At the same time, she is also carrying out non-stop scientific research on the treatment of new coronary pneumonia.
Recently, she accepted an exclusive interview with Nanfang Daily to introduce the treatment of patients with severe coronary disease and critically ill patients with new coronary pneumonia, and responded to public concerns about antiviral drugs for new coronary pneumonia.
Key words Severe warning
Cytokine storm is most likely induced by hypoxia
Nanfang Daily: Why do some patients get worse and some patients get better?
Li Yueping: We are conducting research on early and critical illness warning factors and found several very clear early warning factors, namely lymphocyte decline, lactate dehydrogenase increase, D2 polymer increase, continuous oxygenation index decrease, Viremia and so on.
In addition, we found that exacerbated patients had an oxygenation index of only 100-150 mmhg (normal value 400-500 mmhg) for more than 12 hours. Such patients may induce cytokine storms due to hypoxia.
Many people have said that cytokine storms are sudden, but according to our daily observations from critical medical experts, cytokine storms are not sudden. It is likely to be induced by hypoxia. The same thing is that many people seem to have mild symptoms, shortness of breath, and respiratory distress are not obvious, but in fact, the oxygenation index has decreased significantly, and CT indicates multiple lung fields.
So oxygen therapy is very important in the treatment of new coronary pneumonia. Whether it is oxygen inhalation, high-flow oxygen therapy, non-invasive ventilation, or tracheal intubation, it is necessary to ensure that the patient's oxygen is sufficient. If a patient's oxygen supply can be guaranteed in the early stage, his chance of sudden development of severe illness will be a little smaller. At present, the Eighth People's Hospital of Guangzhou City has a pressurized central oxygen supply and the protection is adequate.
Key words intensive treatment
Maintain organ function, help patients "pass"
Nanfang Daily: Which antiviral drugs are currently effective?
粤 Li Yueping: Kelizhi, Abidol, Chloroquine, Redecvir, these are the antiviral drugs that many people have high hopes for. We started this study on January 28. We set strict entry criteria, exclusion criteria, and observation indicators, as well as blank control groups to observe the efficacy of Abidol and Kelizhi. But so far, neither drug has had very encouraging results.
We started the experimental research on chloroquine on February 8. In cooperation with the Zhongshan Fifth Hospital of Zhuhai, we launched a multi-center experimental study on chloroquine against viruses. Cao Bin of Beijing is also conducting a multi-center experiment on Radixivir to observe the antiviral effect. To date, these antivirals have not shown efficacy. From the cell level, to the tissue level, and then to the human level, the effect may be far worse.
Nanfang Daily: Is it safe to find effective antiviral drugs?
粤 Li Yueping: Antiviral effects are one thing, but severe cases are another. Even with antiviral drugs, can it prevent the disease from progressing to severe cases? Not necessarily, this is related to everyone's immune status and subsequent cytokine storms. Virus testing has turned negative for several of our patients, but his condition has worsened. Even if there are antiviral drugs, they may not be able to completely treat all the critically ill patients.
Therefore, in the treatment of new coronary pneumonia, critical medicine is very important, that is, to maintain the function of each organ of the patient, to slowly survive the duration of the virus, including the support of the ventilator to the lung, ECMO Support for cardiopulmonary function.
This time with new coronary pneumonia, the virus has a long duration, lung failure has a long time, and it takes a long time to support it. We now have 3 patients on ECMO. Of the 8 patients who were transferred to the Institute, there were also 3 of them. It has been 10 days. No patient has been successfully taken offline yet. Now we are in a quarantine area and we have gathered the three "ace soldiers" of infection, severe illness and breathing, hoping to work together to overcome this disease.
Keywords Outbreak control
Wash your hands frequently while wearing a mask
Nanfang Daily: Do you think this disease is terrible in the face of severe patients every day?
Li Yueping: Not so scary. I have also experienced SARS. Compared with SARS, the incidence of new coronary pneumonia is generally mild and the mortality rate is not so high. If it is not Hubei, in other provinces and cities with sufficient medical resources, the mortality rate may be less than 1% Compared with the SARS case fatality rate of 10% and the avian influenza case fatality rate of about 30%, it is relatively low.
I saw so many patients, and I judged it as a "castrated version" of SARS and "enhanced version" of the flu, which is a bit worse than the flu, and the case fatality rate is higher than the flu. Compared with SARS, its course will be longer and more contagious, but the disease is obviously milder. For mild and common type, we do not need to be too panic, it is still a self-limiting disease.
Nanfang Daily: Many experts have mentioned that this virus is very cunning.
粤 Li Yueping: We often say that if the virus is fierce, it is not cunning, if it is cunning, it is not vicious. If the virus wants to survive, it cannot kill the host, so it can spread the virus to more places.
New crown pneumonia may be like the flu, and will live with people for many years. When the number of occult infections in the population increases and the general availability of antibodies increases, the disease will certainly be quiet. Now we have detected that some people have antibodies, but it is not a protective antibody, it is still difficult to say.
The vaccine goes from preparation and then to large-scale human application. It must take a while. I don't think the vaccine can be counted on yet. Or try to cure the patient first, cut off the transmission route, and protect the susceptible people.
Nanfang Daily: What are the difficulties in controlling the epidemic?
粤 Li Yueping: We control an infectious disease. One is to control the source of the infection, the other is to cut off the transmission route, and the other is to protect the susceptible people. This virus transmission path can be cut off, and susceptible people can be protected, but the difficulty in controlling it lies in controlling the source of infection, and the virus will take longer to spread.
如果 If the patient is in the incubation period, he may not have fever at all in the early stage, and his body temperature may not be detected. A dominant infection may be followed by 20 to 100 recessive infections.
As for the route of transmission, the new crown virus will be transmitted through contact, droplets, and possibly aerosol. Many people are afraid of aerosols now, but after all, aerosols need a medium. If there is wind, there is actually no big problem. Talking about toxicity without dosage is a "rogue", and the same is true for viruses, which do not have a certain amount and are not a problem.
Nowadays, it is advisable to wear masks and wash your hands extensively. No matter how you wash your hands before touching anything, and then wash your hands after touching, the two most important points are these. As long as the respiratory tract isolation and hand hygiene isolation are done, the chance of infection is very small.
Nanfang Daily reporter Li Xiuting Zhu Xiaofeng Correspondent Jia Weidong
Edit: Chen Yuchen
