严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染：一家三级医院在2020年大流行期间治疗新型冠状病毒肺炎（COVID-19）患者的经验。
Severe infection due to the SARS-CoV-2 coronavirus: Experience of a tertiary hospital with COVID-19 patients during the 2020 pandemic.
作者信息
Rodríguez A, Moreno G, Gómez J, Carbonell R, Picó-Plana E, Benavent Bofill C, Sánchez Parrilla R, Trefler S, Esteve Pitarch E, Canadell L, Teixido X, Claverias L, Bodí M
机构信息
Servicio de Medicina Intensiva, Hospital Universitari de Tarragona Joan XXIII, Tarragona, España; URV/IIPSV/CIBERES, España.
Servicio de Medicina Intensiva, Hospital Universitari de Tarragona Joan XXIII, Tarragona, España.
出版信息
Med Intensiva (Engl Ed). 2020 Dec;44(9):525-533. doi: 10.1016/j.medin.2020.05.018. Epub 2020 Jun 19.
OBJECTIVE
To describe the clinical and respiratory characteristics of a cohort of 43 patients with COVID-19 after an evolutive period of 28 days.
DESIGN
A prospective, single-center observational study was carried out.
SETTING
Intensive care.
PATIENTS
Patients admitted due to COVID-19 and respiratory failure.
INTERVENTIONS
None.
VARIABLES
Automatic recording was made of demographic variables, severity parameters, laboratory data, assisted ventilation (HFO: high-flow oxygen therapy and IMV: invasive mechanical ventilation), oxygenation (PaO, PaO/FiO) and complications. The patients were divided into three groups: survivors (G1), deceased (G2) and patients remaining under admission (G3). The chi-squared test or Fisher exact test (categorical variables) was used, along with the Mann-Whitney U-test or Wilcoxon test for analyzing the differences between medians. Statistical significance was considered for p<0.05.
RESULTS
A total of 43 patients were included (G1=28 [65.1%]; G2=10 [23.3%] and G3=5 [11.6%]), with a mean age of 65 years (range: 52-72), 62% males, APACHE II 18 (15-24), SOFA 6 (4-7). Arterial hypertension (30.2%) and obesity (25.6%) were the most frequent comorbidities. High-flow oxygen therapy was used in 62.7% of the patients, with failure in 85%. In turn, 95% of the patients required IMV and 85% received ventilation in prone decubitus. In the general population, initial PaO/FiO improved after 7 days (165 [125-210] vs.194 [153-285]; p=0.02), in the same way as in G1 (164 [125-197] vs. 207 [160-294]; p=0.07), but not in G2 (163 [95-197] vs. 135 [85-177]). No bacterial coinfection was observed. The incidence of IMV-associated pneumonia was high (13 episodes/1000 days of IMV).
CONCLUSIONS
Patients with COVID-19 require early IMV, a high frequency of ventilation in prone decubitus, and have a high incidence of failed HFO. The lack of improvement of PaO/FiO at 7 days could be a prognostic marker. .
目的
描述43例新冠肺炎患者在病程28天后的临床和呼吸特征。
设计
开展一项前瞻性、单中心观察性研究。
地点
重症监护室。
患者
因新冠肺炎和呼吸衰竭入院的患者。
干预措施
无。
变量
自动记录人口统计学变量、严重程度参数、实验室数据、辅助通气（高频振荡通气：高流量氧疗和有创机械通气：有创机械通气）、氧合（动脉血氧分压、动脉血氧分压/吸入氧分数值）及并发症。患者分为三组：存活者（G1组）、死亡者（G2组）和仍在住院的患者（G3组）。采用卡方检验或Fisher精确检验（分类变量），以及Mann-Whitney U检验或Wilcoxon检验分析中位数之间的差异。p<0.05认为具有统计学意义。
结果
共纳入43例患者（G1组=28例[65.1%]；G2组=10例[23.3%]；G3组=5例[11.6%]），平均年龄65岁（范围：52 - 72岁），男性占62%，急性生理与慢性健康状况评分系统II评分为18分（15 - 24分），序贯器官衰竭评估评分6分（4 - 7分）。动脉高血压（30.2%）和肥胖（25.6%）是最常见的合并症。62.7%的患者使用了高流量氧疗，其中85%治疗失败。相应地，95% 的患者需要有创机械通气，85% 的患者接受俯卧位通气。总体而言，7天后初始动脉血氧分压/吸入氧分数值有所改善（165[125 - 210] vs.194[153 - 285]；p = 0.02），G1组情况相同（164[125 - 197] vs. 207[160 - 294]；p = 0.07）,但G2组并非如此（163[95 - 197] vs. 135[85 - 177]）。未观察到细菌合并感染。有创机械通气相关肺炎发生率较高（13例/1000天有创机械通气）。
结论
新冠肺炎患者需要早期进行有创机械通气，俯卧位通气频率高，且高频振荡通气失败率高。7天时动脉血氧分压/吸入氧分数值无改善可能是一个预后指标。
Zotero 插件