Why do patients with new coronary pneumonia die suddenly the day before?
2020 at 11:55 on February 8th 1952 times reading the source: think tank Outlook
Why did it look good the day before and suddenly passed away one day later? Wang Fusheng (Academician of the Chinese Academy of Sciences, expert of the scientific research group of the new coronavirus joint prevention and control working mechanism, director of the Infectious Disease Diagnosis and Research Center of the Fifth Medical Center of the PLA General Hospital, and director of the National Infectious Disease Clinical Medical Research Center) are accepting reporters from Xinhua This issue was addressed in the interview.
Wang Fusheng:
There may be so many reasons. The main reason is that there are many patients and the incidence is relatively concentrated. In addition, some patients do not pay special attention to the onset of disease, and only go to see when they are seriously ill.
There is another reason, because there are so many patients at once, the whole medical resources should be said to be insufficient. In other words, there were so many patients at the time and there was no direct treatment experience, which put a lot of pressure on clinical medical staff.
In addition, there is another situation. Among the patients who die now, there are some basic diseases, such as diabetes, hypertension, and other diseases, as well as older factors. Therefore, it is possible that these factors have caused the slightly higher mortality rate in Hubei.
According to some media reports in the past few days, the day before the death of some of these people looked good, and after a day they were declared dead.
Why does the disease progress so fast?
Zhong Ming, the first medical expert in Shanghai to assist Wuhan, deputy director of the Department of Critical Medicine, Shanghai Zhongshan Hospital, Zhou Zheng, the medical team leader of the first batch of Henan medical team, deputy director of respiratory medicine in the Second Affiliated Hospital of Zhengzhou University, affiliated to Zhejiang University Medical College Professor Sheng Jifang, the director of the Department of Infectious Diseases at the First Hospital and a member of the Zhejiang Provincial Experts Group for the Diagnosis and Treatment of New Crown Pneumonia,
mentioned the term inflammatory storm.
1 Some early onsets are not very dangerous, but suddenly they will die at an accelerated rate in the later stages
On January 24, Zhong Ming, deputy director of the Department of Critical Care Medicine at Shanghai Zhongshan Hospital, entered the Wuhan Jinyintan Hospital to carry out work. Jinyintan is the first batch of designated hospitals in Wuhan and one of the main choices for critically ill patients with new coronary pneumonia in Wuhan.
Two days ago, in an interview with Southern People Weekly, he said that he had faced many difficulties in the early stage of treatment.
First of all, new coronary pneumonia is not the same as SARS or avian influenza. In many cases, SARS is very severe when the patient comes up. However, the early onset of new crown patients is not very dangerous, but in the later period, there will be an acceleration, and the patient will soon enter a state of multiple organ failure, which will be a storm of inflammation. Once in this state, it is difficult for our treatment to pull it back. This is completely different from the past. Many patients do not die from the lungs. Because the hospital has ECMO (Extracorporeal Cardiopulmonary Support), a ventilator, and various treatment strategies, which can replace the patient's lung function. But many patients die of multiple organ failure outside the lungs, which is very different from the past.
Why is there such a sudden acceleration?
Zhong Ming said that the patient's body may have initiated an inflammatory storm, which caused the failure of various organs. What they observed is that many patients have elevated markers of myocardial damage, so the virus is likely to damage the heart muscle itself, similar to myocarditis, and may damage many other organs.
Some of the patients they treated were mixed with other diseases. After getting pneumonia, the original diseases worsened. For example, there is a patient with acute myocardial infarction who has placed a stent in his body. After his pneumonia has come, there may be severe myocardial ischemia. The people who transferred to them were all deteriorated in ordinary wards or other hospitals, and they were very, very critical, and they would die at any time.
Zhong Ming said that there are still many ECMO equipment at Jinyintan Hospital, but not all critically ill patients can save their lives with ECMO.
Many patients die from multiple organ failure outside the lung, which is not an ECMO replacement. If patients are in this state, ECMO cannot save their lives.
2 Excessive damage to immune cells caused by the inflammatory storm is not just the lungs
It can also cause damage to the kidneys, liver, and heart muscle.
The first group of Henan Province medical team leader of Henan Province and the deputy director of the department of respiratory medicine of the Second Affiliated Hospital of Zhengzhou University were on January 26, that is, at 7 pm on the second day of the new year, arrived in Wuhan by high-speed rail, and then in Wuhan. The Fourth People's Hospital started rescue work.
In an interview with a Dahe newspaper reporter on February 4, he said that in the morning of January 28, the ward they took over was officially opened to treat patients. It was an empty ward at that time, and as a result, 30 beds were filled in half an hour. The patient came over like a tide. The first patient I saw was an unconscious old lady who was a critically ill patient with diabetes combined with a new type of coronavirus pneumonia (suspected). It was fever, cough, shortness of breath, and blood oxygen saturation was only about 75%. They simply divided patients into two categories. Over 65 years of age, with basic diseases such as diabetes, coronary heart disease, renal insufficiency, chronic bronchiectasis, chronic obstructive pulmonary disease, etc., are usually heavier. Indeed, heavier patients are basically older. The vast majority of people under 45 are relatively light.
However, this disease has a characteristic that some patients may be relatively mild in the first two days, and suddenly worsen on the third day or later. If it is not treated in time, it may die. This may be related to patient infection and the resulting "inflammatory storm".
"Inflammation storm" is that the patient's infection activates the body's immune cells, causing excessive damage to the immune cells. Normal immunity is protection, and excessive immunity is damage, which not only causes damage to the lungs, but also causes damage to the kidneys, liver, and heart muscle.
For example, after our body is infected, the body's white blood cells and lymphocytes will start secreting a cytokine. The cytokine acts like a correspondent or herald, attracting these spare white blood cells and lymphocytes distributed in other parts of the muscle to the site of the lesion, killing the microbial virus and bacteria. In the middle, it will release an inflammatory mediator. Moderate release is normal. Excessive release will not only kill viruses and bacteria, but also cause damage to normal cells.
Zhou Zheng said that after the "inflammatory storm", the patient's condition tends to turn sharply, and soon he will have unconsciousness, rapid breathing, and then there will be decreased blood oxygen saturation, even coagulation dysfunction, oliguria and anuria, and elevated transaminase . Various organs fail, not just the lungs, which is the reason for the high mortality and mortality of many patients with new coronary pneumonia, especially the elderly.
There are basic diseases. Under the action of the "inflammatory storm", many patients cause multiple organ failure and cause death. This is more likely to occur in critically ill and critically ill patients, and it is very scary. low.
At present, no statistics have been done.
According to the condition of their ward, from January 28 to February 4, more than half of the inflammatory storms accounted for more than a dozen severe patients.
Zhou Zheng said that in a certain period of time, a small amount of hormones can be used to suppress this inflammatory response, but this varies from person to person.
3 If a second inflammatory storm comes, patients will soon be defeated
As of 24:00 on February 5, a total of 954 confirmed cases had been reported in Zhejiang Province, and a total of 81 patients had been discharged. No deaths were reported.
The First Affiliated Hospital of Zhejiang University School of Medicine is the designated hospital for the diagnosis and treatment of new coronary pneumonia in Zhejiang Province, and it is also the only provincial designated comprehensive hospital. It is responsible for the diagnosis and treatment of critically infected people in the province. Both were severe and critically ill who were referred from all over the province.
Professor Sheng Jifang, director of the Department of Infectious Diseases of Zhejiang University First Hospital and a member of the Zhejiang Provincial Expert Group for the Diagnosis and Treatment of New Coronary Pneumonia, said that specific programs for patients with severe and critical illness are mainly antiviral, nutritional support, and control of cytokine storms. One is to control the cytokine storm, and the other is to inhale high flow oxygen so that there is not a large amount of exudation in the lungs.
Professor Sheng Jifang introduced that during the test, it was found that the indicators of inflammation of patients with new coronary pneumonia are very high. High indicators can cause human cytokine storms, leading to consequences such as multiple organ failure. Therefore, for critically ill patients, we must properly control the inflammatory factor storm. Some patients' disease progresses rapidly, and it may be mainly a secondary inflammatory factor storm, and the patients are quickly defeated. Because the target organ of the inflammatory factor storm is the lung, the lungs ooze in large quantities and form white lungs. At this time, if there is no corresponding respiratory support treatment, the mortality rate will increase.
In addition to controlling the storm of inflammatory factors, another is oxygen therapy. "We found this time that with a high volume of oxygen inhalation, patients could inhale for a day or two or two or three with a special device, and the situation would stabilize."
Director Sheng Jifang told reporters that the team was closely monitoring the patient's lung CT every day. For patients with new coronary pneumonia, the lung images gradually changed from solid to light, and they gradually became cloud-like, just like the clouds in the sky.
If it ’s like a dark cloud, then this person is dangerous; if it ’s such a thin tile cloud, it ’s better; if it ’s scattered, it ’s not a big problem. In addition, it depends on the CT of the patient where the affected lung is. Patients with upper and middle lung involvement are better, this patient is better; those with upper, middle, and lower lung involvement, especially those with middle and lower lung involvement, are often heavier. Because our human lungs are large in the lower middle area, oxygen exchange also relies mainly on the lower middle area.
In response to these experiences, Director Sheng Jifang has developed a set of methods to identify severe patients with new coronary pneumonia. "The key is to move the pass forward, identify it early, assess it in place, and treat it in place."
Director Sheng Jifang specially reminded that the diagnosis must be made early. The earlier you go to the hospital, the better the effect, and the later the delay, the heavier it is. "In addition, the severity of new coronary pneumonia has a lot to do with the underlying conditions of the patients themselves. For example, those who are older and have basic diseases often have a relatively severe condition."
During this time, Professor Sheng Jifang had remote consultations with a dozen or twenty patients from all over the province every day, and each hospital had to go through the treatment plan. "For the treatment of critically ill patients, it must be homogenized with our Zhejiang University First Hospital."
Professor Sheng Jifang said that after the homogenization treatment plan, many patients gradually recovered in the local designated hospitals. However, if you encounter patients with rapid disease progression and basic diseases, you must transfer them to the First Hospital of Zhejiang University for further treatment. "Most of the patients we are currently treating are severe and critically referred from all over the province, which is our responsibility and mission."
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