新冠肺炎防控经验:以肺炎为重点

L. Moroz
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Apart from that, COVID-19 is often accompanied by coagulopathies together with venous thrombosis, myocardial infarction and disseminated intravascular coagulation syndrome. Risk factors of coagulopathies include sepsis, history of chronic obstructive pulmonary diseases and liver disorders, malignant tumors, fever and acute course of COVID-19. \nObjective. To describe the peculiarities of coronavirus pneumonias treatment. \nMaterials and methods. Analysis of literature data and clinical cases from own practice. \nResults and discussion. 40 % of COVID-19 patients have a mild course, 40 % – moderate, 15 % – severe, and 5 % – critical. The majority of patients with lethal outcomes have at least one from the listed parameters: malignant tumor, morbid obesity, diabetes mellitus, cardiovascular diseases, diseases of kidneys and lungs, hypoalbuminemia, age >60 years old. Diagnosis of coronavirus pneumonia needs to be proved with the help of computer tomography (CT) during the initial visit or hospitalization, then in 2-3 days in case of the absence of improvement, in case of clinical condition worsening, in 5-7 days in case of no dynamics or of positive dynamics. Lung affection according to CT is divided into 4 grades according to the presence of frosted glass symptom, consolidation presence and the percentage of lung parenchyma involvement. Pathogenetic treatment, including off-label drug usage, can decrease the risk of fatal complications. Edaravone (Ksavron, “Yuria-Pharm”) is an antioxidant drug with an anti-inflammatory effect due to cytokine storm inhibition and the possibility to decrease the lung vessels’ endothelium permeability. Edaravone neutralizes free radicals; inhibits lipid peroxidation; activates own antioxidant protection (enzymes superoxiddysmutase, catalase, glutathione peroxidase). It underlines the reasonability of edaravone usage in acute respiratory distress-syndrome. Edaravone prevents the increase of permeability of lung vessels’ endotheliocytes similarly to dexamethasone, but has a lower amount of side effects. L-arginine and L-carnitine (Tivorel, “Yuria-Pharm”) are also actively studied. L-arginine improves microcirculation, promotes vasodilatation, activates Т-cell immunity, stabilizes cells’ membranes, protects cells, has an antioxidant effect, decreases the bronchial spasm and the spasm of pulmonary arteries. In turn, L-carnitine has an immunomodulatory effect, decreases the release of pro-inflammatory cytokines, has an antioxidant, anti-apoptotic and cardioprotective effects. Tivorel decreases the ability of coronaviruses to attach to the cells, counteracts their replication and decreases the endothelial dysfunction. \nConclusions. 1. Pathogenetic treatment, including off-label drug usage, can decrease the unfavorable outcomes of COVID-19. 2. 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引用次数: 0

摘要

背景。冠状病毒是RNA病毒,它有一个冠状的外层。这些病毒对呼吸道上皮有趋向性。SARS-CoV(严重急性呼吸综合征冠状病毒)、MERS-CoV(中东呼吸综合征冠状病毒)和新型冠状病毒SARS-CoV-2是能够影响人体有机体的最重要的冠状病毒。冠状病毒病(COVID-19)的发病机制包括冠状病毒在呼吸道上皮内复制和弥漫性肺泡细胞损伤,并发病毒性肺炎或急性呼吸窘迫综合征。新冠肺炎的主要症状包括发热(83- 99%)、食欲不振(40- 84%)、咳嗽(59- 82%)、疲劳(44- 70%)、嗅觉丧失(15- 30%)、肌痛(11- 35%)。此外,COVID-19常伴有凝血功能障碍,包括静脉血栓形成、心肌梗死和弥散性血管内凝血综合征。凝血功能障碍的危险因素包括败血症、慢性阻塞性肺疾病和肝脏疾病史、恶性肿瘤、发烧和COVID-19急性病程。目标。描述冠状病毒肺炎治疗的特点。材料和方法。文献资料及临床病例分析。结果和讨论。40%的COVID-19患者病程为轻度,40%为中度,15%为重度,5%为危重。大多数致死性结局的患者至少有以下所列参数中的一项:恶性肿瘤、病态肥胖、糖尿病、心血管疾病、肾脏和肺部疾病、低白蛋白血症、年龄>60岁。冠状病毒肺炎的诊断需要在首次就诊或住院期间通过计算机断层扫描(CT)进行证实,如果没有好转,则在2-3天内,如果临床情况恶化,则在5-7天内,如果没有动态或积极动态。根据有无磨砂玻璃症状、有无实变及肺实质受累比例,CT将肺部病变分为4个级别。病原治疗,包括超说明书用药,可降低致命并发症的风险。依达拉奉(Ksavron,“Yuria-Pharm”)是一种抗氧化药物,由于抑制细胞因子风暴和可能降低肺血管内皮通透性而具有抗炎作用。依达拉奉能中和自由基;抑制脂质过氧化;激活自身抗氧化保护(酶超氧化物歧化酶,过氧化氢酶,谷胱甘肽过氧化物酶)。强调依达拉奉治疗急性呼吸窘迫综合征的合理性。依达拉丰与地塞米松类似,可以阻止肺血管内皮细胞通透性的增加,但副作用较小。l -精氨酸和l -肉碱(Tivorel,“Yuria-Pharm”)也在积极研究中。l -精氨酸改善微循环,促进血管扩张,激活Т-cell免疫,稳定细胞膜,保护细胞,具有抗氧化作用,减少支气管痉挛和肺动脉痉挛。反过来,左旋肉碱具有免疫调节作用,减少促炎细胞因子的释放,具有抗氧化、抗凋亡和心脏保护作用。替佛瑞尔降低了冠状病毒附着在细胞上的能力,抵消了它们的复制,减少了内皮功能障碍。结论:1。病原治疗,包括超说明书用药,可以减少COVID-19的不良后果。2. 依达拉奉能中和自由基;抑制脂质过氧化;激活自身抗氧化保护。3.l -精氨酸和l -肉碱改善微循环,促进血管舒张,具有免疫调节、抗氧化和心脏保护作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The experience of management of COVID-19: focus on the pneumonia
Background. Coronaviruses are the RNA viruses, which have a crown-shaped outer layer. These viruses have a tropism to the respiratory epithelium. SARS-CoV (coronavirus of the severe acute respiratory syndrome), MERS-CoV (coronavirus of the Middle East respiratory syndrome) and the new coronavirus SARS-CoV-2 are the most significant coronaviruses, able to affect a human organism. Coronavirus disease (COVID-19) pathogenesis includes the coronavirus replication in the respiratory epithelium and the diffuse alveolocyte injury with the development of viral pneumonia or acute respiratory distress syndrome. The main symptoms of COVID-19 include fever (83-99 %), appetite loss (40-84 %), cough (59-82 %), fatigue (44-70 %), anosmia (15-30 %), myalgia (11-35 %). Apart from that, COVID-19 is often accompanied by coagulopathies together with venous thrombosis, myocardial infarction and disseminated intravascular coagulation syndrome. Risk factors of coagulopathies include sepsis, history of chronic obstructive pulmonary diseases and liver disorders, malignant tumors, fever and acute course of COVID-19. Objective. To describe the peculiarities of coronavirus pneumonias treatment. Materials and methods. Analysis of literature data and clinical cases from own practice. Results and discussion. 40 % of COVID-19 patients have a mild course, 40 % – moderate, 15 % – severe, and 5 % – critical. The majority of patients with lethal outcomes have at least one from the listed parameters: malignant tumor, morbid obesity, diabetes mellitus, cardiovascular diseases, diseases of kidneys and lungs, hypoalbuminemia, age >60 years old. Diagnosis of coronavirus pneumonia needs to be proved with the help of computer tomography (CT) during the initial visit or hospitalization, then in 2-3 days in case of the absence of improvement, in case of clinical condition worsening, in 5-7 days in case of no dynamics or of positive dynamics. Lung affection according to CT is divided into 4 grades according to the presence of frosted glass symptom, consolidation presence and the percentage of lung parenchyma involvement. Pathogenetic treatment, including off-label drug usage, can decrease the risk of fatal complications. Edaravone (Ksavron, “Yuria-Pharm”) is an antioxidant drug with an anti-inflammatory effect due to cytokine storm inhibition and the possibility to decrease the lung vessels’ endothelium permeability. Edaravone neutralizes free radicals; inhibits lipid peroxidation; activates own antioxidant protection (enzymes superoxiddysmutase, catalase, glutathione peroxidase). It underlines the reasonability of edaravone usage in acute respiratory distress-syndrome. Edaravone prevents the increase of permeability of lung vessels’ endotheliocytes similarly to dexamethasone, but has a lower amount of side effects. L-arginine and L-carnitine (Tivorel, “Yuria-Pharm”) are also actively studied. L-arginine improves microcirculation, promotes vasodilatation, activates Т-cell immunity, stabilizes cells’ membranes, protects cells, has an antioxidant effect, decreases the bronchial spasm and the spasm of pulmonary arteries. In turn, L-carnitine has an immunomodulatory effect, decreases the release of pro-inflammatory cytokines, has an antioxidant, anti-apoptotic and cardioprotective effects. Tivorel decreases the ability of coronaviruses to attach to the cells, counteracts their replication and decreases the endothelial dysfunction. Conclusions. 1. Pathogenetic treatment, including off-label drug usage, can decrease the unfavorable outcomes of COVID-19. 2. Edaravone neutralizes free radicals; inhibits lipid peroxidation; activates own antioxidant protection. 3. L-arginine and L-carnitine improve the microcirculation, promote vasodilatation, have an immunomodulatory, antioxidant and cardioprotective effects.
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