Khodakarim Nastaran, Kalantari Saeed, Riahi Taghi, Moradians Vahan, Talebi-Taher Mahshid, Yassin Zeynab, Afshar Hale, Kooranifar Siavash, Aloosh Oldooz, Ziaie Shirin, Zamani Nazanin, Tirkan Atefe, Ramim Tayeb
Department of Internal Medicine, School of Medicine, Hazrat- e Rasoul General Hospital, Iran University of Medical Sciences, Tehran, Iran.
Antimicrobial Resistance Research Center, Iran University of Medical Sciences, Tehran, Iran.
Med J Islam Repub Iran. 2022 Jul 25;36:83. doi: 10.47176/mjiri.36.83. eCollection 2022.
According to the World Health Organization, COVID-19 management focuses primarily on infection prevention, case management, case monitoring, and supportive care. However, due to the lack of evidence, no specific anti-SARS-CoV-2 treatment is recommended. This study aimed to evaluate the effectiveness of plasmapheresis treatment in COVID-19 patients with symptoms of pulmonary involvement on the computed tomography (CT) of the lung. In 2021, an experimental study in critically ill patients admitted to the COVID-19 ward in the Hazrat-e Rasool hospital diagnosed with COVID-19 was conducted in the second phase (pilot study). The diagnosis was confirmed according to clinical signs, CT scan of the lung, and the Polymerase chain reaction (PCR) test. All patients received the usual treatments for COVID-19 disease and underwent plasmapheresis at a dose of 40 cc/kg daily up to 4 doses. All patients were observed for 24 hours for complications of plasmapheresis treatment and simultaneously for symptoms of COVID-19, after which only routine care measures were performed. The next day and 2 weeks after resumption of the treatment, patients experienced COVID-19 symptoms, including shortness of breath, cough, and fever. Blood oxygen saturation, and treatment results were evaluated. Qualitative and rank variables were described using absolute and relative frequencies and quantitative parametric variables were used using mean and confidence interval. Frequencies were compared in groups using the chi-square test. All tests were performed in 2 directions and > 0.05 was considered statistically significant. Of the 120 patients studied, 79 (65.8%) were men and 41 (34.2%) were women. The mean age was 60.30 ± 15.61 years (22-95 years). The mean hospital stay was 12.89 days ± 7.25 days (2-38 days). Increased blood oxygen saturation levels in patients had an increasing trend. Inflammatory indices had a downward trend in patients. The frequency of plasmapheresis had no significant effect on reducing the downward trend of inflammatory markers. The greatest reduction occurred in the first plasmapheresis. Finally, according to the findings, plasmapheresis is one of the appropriate treatments to improve patients' symptoms and reduce cytokine storm. Recovered patients had lower levels of inflammatory markers than those who died.
根据世界卫生组织的说法，新型冠状病毒肺炎的管理主要集中在感染预防、病例管理、病例监测和支持性护理上。然而，由于缺乏证据，不推荐使用特定的抗严重急性呼吸综合征冠状病毒2治疗方法。本研究旨在评估血浆置换疗法对肺部计算机断层扫描（CT）有肺部受累症状的新型冠状病毒肺炎患者的有效性。2021年，在哈兹拉特 - 拉苏尔医院新型冠状病毒肺炎病房收治的确诊为新型冠状病毒肺炎的重症患者中进行了一项实验性研究（第二阶段，试点研究）。根据临床症状、肺部CT扫描和聚合酶链反应（PCR）检测确诊。所有患者均接受了新型冠状病毒肺炎的常规治疗，并每天进行剂量为40 cc/kg的血浆置换，最多进行4次。对所有患者进行24小时的血浆置换治疗并发症观察，并同时观察新型冠状病毒肺炎症状，之后仅采取常规护理措施。在恢复治疗后的第二天和2周，观察患者的新型冠状病毒肺炎症状，包括呼吸急促、咳嗽和发热。评估血氧饱和度和治疗效果。定性和等级变量用绝对和相对频率描述，定量参数变量用均值和置信区间表示。组间频率比较采用卡方检验。所有检验均进行双侧检验，P>0.05被认为具有统计学意义。在120例研究患者中，79例（65.8%）为男性，41例（34.2%）为女性。平均年龄为60.30±15.61岁（22 - 95岁）。平均住院时间为12.89天±7.25天（2 - 38天）。患者的血氧饱和度水平呈上升趋势。患者的炎症指标呈下降趋势。血浆置换频率对降低炎症标志物的下降趋势无显著影响。最大降幅出现在第一次血浆置换时。最后，根据研究结果，血浆置换是改善患者症状和减少细胞因子风暴的合适治疗方法之一。康复患者的炎症标志物水平低于死亡患者。
