D'Amato Gennaro, Acanfora Luca, Delli Paoli Lucrezia, D'Amato Maria
Division of Respiratory and Allergic Diseases, Department of Chest Diseases, High Specialty "A. Cardarelli" Hospital, Naples, and Medical School of Specialization in Respiratory Diseases, Federico II University of Naples.
Managing Director of the Covid-19 nasopharyngeal testing project, for the cooperation agreement between High Specialization in Infectious Diseases "Cotugno Hospital" and "Sovereign Military of Malta" in Naples, Federico II University of Naples.
Multidiscip Respir Med. 2021 Jan 18;16(1):748. doi: 10.4081/mrm.2021.748. eCollection 2021 Jan 15.
In this paper we present our experience on the treatment at home of Covid+ symptomatic patients. One hundred and eighty-two subjects (111 men and 71 women) aged from 32 to 71 years have been consecutively followed at home in telemedicine from 1 September to 24 December 2020. We were informed almost twice daily in morning and evening about body temperature, symptoms (cough, shortness of breath or difficulty breathing, fatigue, muscle of body aches, headache, loss of taste or smell, sore throat, congestion or runny nose, nausea and vomiting, diarrhea), oxygen saturation measured by digital pulse oximetry and blood pressure. Our protocol of treatment was based on early use of prednisone (25 mg in the morning and 12.5 mg in the afternoon) and low molecular weight heparin (4000 UI one or two times daily) initiated just after the positivity of molecular nasopharyngeal test (about 3-4 days as mean time after initiation of symptomatology and not after 7-8 days as suggested by other protocols) and oxygen therapy when necessary. Antibiotics such as azithromycin for six days was added. It is always recommended to associate lansoprazole 30 mg to prevent gastric hemorrhages and potassium and magnesium supplements. This treatment scheme was able to reduce the risk of hospitalization as only 4 patients needed to be admitted to the Hospital, and only two in subintensive department. After negativeness of molecular nasopharyngeal test, patients were invited for a thoracic computerized tomography and laboratory evaluation of d-dimer and other data of inflammation to show eventual lung interstitial involvement characteristic of COVID-19.
在本文中，我们介绍了对新冠阳性有症状患者进行居家治疗的经验。2020年9月1日至12月24日，我们通过远程医疗对182名年龄在32至71岁之间的受试者（111名男性和71名女性）进行了连续的居家跟踪。我们几乎每天早晚两次收到关于体温、症状（咳嗽、呼吸急促或呼吸困难、疲劳、全身肌肉疼痛、头痛、味觉或嗅觉丧失、喉咙痛、鼻塞或流涕、恶心和呕吐、腹泻）、通过数字脉搏血氧仪测量的血氧饱和度和血压的信息。我们的治疗方案基于在鼻咽分子检测呈阳性后（平均在症状出现后约3 - 4天，而非其他方案建议的7 - 8天后）尽早使用泼尼松（早上25毫克，下午12.5毫克）和低分子肝素（每日一次或两次，每次4000国际单位），并在必要时进行氧疗。添加了如阿奇霉素使用六天的抗生素。始终建议联合使用30毫克兰索拉唑以预防胃出血以及补充钾和镁。这种治疗方案能够降低住院风险，因为只有4名患者需要住院，且只有两名患者入住亚重症监护病房。在鼻咽分子检测呈阴性后，患者被邀请进行胸部计算机断层扫描以及d - 二聚体和其他炎症数据的实验室评估，以显示新冠病毒肺炎特有的最终肺间质受累情况。
