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新型冠状病毒肺炎后患者的随访。肺部后遗症

[Follow-up of patients after COVID-19 pneumonia. Pulmonary sequelae].

作者信息

Chérrez-Ojeda Iván, Gochicoa-Rangel Laura, Salles-Rojas Antonio, Mautong Hans

机构信息

Universidad de Especialidades Espíritu Santo, Samborondón, Ecuador.

出版信息

Rev Alerg Mex. 2020 Oct-Dec;67(4):350-369. doi: 10.29262/ram.v67i4.847.

Abstract

Coronavirus disease 2019 (COVID-19) is an infection caused by SARS-CoV-2 that has caused an unprecedented pandemic with a high rate of morbidity and mortality worldwide. Although most cases are mild, there are a considerable number of patients who develop pneumonia or even acute respiratory distress syndrome (ARDS). After having recovered from the initial disease, many patients continue with various symptoms (fatigue, dry cough, fever, dyspnea, anosmia, and chest pain, among others.), which has led to consider the possible existence of "post-COVID-19 syndrome". Although the definition and validity of this syndrome are not clear yet, several studies report that individuals who have recovered from COVID-19 may have persistent symptoms, radiological abnormalities, and compromised respiratory function. Current evidence suggests that there is a large number of pulmonary sequelae after COVID-19 pneumonia (interstitial thickening, ground glass opacities, crazy paving pattern, and bronchiectasis, among others.). Likewise, it seems that pulmonary function tests (spirometry, DLCO, 6MWT, and measurement of maximum respiratory pressures), in addition to high-resolution computed axial tomographies (CAT scan), are useful for the assessment of these post-COVID-19 pulmonary sequelae. This review aims to describe the possible pulmonary sequelae after COVID-19 pneumonia, as well as to suggest diagnostic procedures for their correct assessment and follow-up; thus, allowing proper management by a multidisciplinary medical team.

摘要

2019冠状病毒病(COVID-19)是由严重急性呼吸综合征冠状病毒2(SARS-CoV-2)引起的一种感染,已在全球范围内引发了一场前所未有的大流行,发病率和死亡率都很高。虽然大多数病例症状较轻,但仍有相当数量的患者会发展为肺炎,甚至急性呼吸窘迫综合征(ARDS)。在从最初的疾病中康复后,许多患者仍有各种症状(包括疲劳、干咳、发热、呼吸困难、嗅觉丧失和胸痛等),这使得人们开始考虑“COVID-19后综合征”可能存在。尽管这种综合征的定义和有效性尚不清楚,但多项研究报告称,从COVID-19中康复的个体可能会有持续症状、影像学异常以及呼吸功能受损。目前的证据表明,COVID-19肺炎后存在大量肺部后遗症(如间质增厚、磨玻璃影、铺路石样改变和支气管扩张等)。同样,除高分辨率计算机断层扫描(CAT扫描)外,肺功能测试(肺活量测定、一氧化碳弥散量、6分钟步行试验和最大呼吸压力测量)似乎对评估这些COVID-19后的肺部后遗症也很有用。本综述旨在描述COVID-19肺炎后可能出现的肺部后遗症,并提出正确评估和随访的诊断程序;从而使多学科医疗团队能够进行适当的管理。

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