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长新冠:快速证据综述。

Long COVID: Rapid Evidence Review.

机构信息

Oregon Health and Science University, Portland, Oregon.

出版信息

Am Fam Physician. 2022 Nov;106(5):523-532.

Abstract

Postacute sequelae of COVID-19, also known as long COVID, affects approximately 10% to 30% of the hundreds of millions of people who have had acute COVID-19. The Centers for Disease Control and Prevention defines long COVID as the presence of new, returning, or ongoing symptoms associated with acute COVID-19 that persist beyond 28 days. The diagnosis of long COVID can be based on a previous clinical diagnosis of COVID-19 and does not require a prior positive polymerase chain reaction or antigen test result to confirm infection. Patients with long COVID report a broad range of symptoms, including abdominal pain, anosmia, chest pain, cognitive impairment (brain fog), dizziness, dyspnea, fatigue, headache, insomnia, mood changes, palpitations, paresthesias, and postexertional malaise. The presentation is variable, and symptoms can fluctuate or persist and relapse and remit. The diagnostic approach is to differentiate long COVID from acute sequelae of COVID-19, previous comorbidities, unmasking of preexisting health conditions, reinfections, new acute concerns, and complications of prolonged illness, hospitalization, or isolation. Many presenting symptoms of long COVID are commonly seen in a primary care practice, and management can be improved by using established treatment paradigms and supportive care. Although several medications have been suggested for the treatment of fatigue related to long COVID, the evidence for their use is currently lacking. Holistic treatment strategies for long COVID include discussion of pacing and energy conservation; individualized, symptom-guided, phased return to activity programs; maintaining adequate hydration and a healthy diet; and treatment of underlying medical conditions.

摘要

新冠病毒感染后遗症,也称为长新冠,影响了数以亿计曾患有急性新冠病毒感染人群中的 10%至 30%。美国疾病控制与预防中心将长新冠定义为急性新冠病毒感染后持续 28 天以上的新出现、复发或持续存在的与急性新冠病毒感染相关的症状。长新冠的诊断可以基于之前的新冠病毒感染临床诊断,并不需要之前的聚合酶链反应或抗原检测结果阳性来确认感染。长新冠患者报告了广泛的症状,包括腹痛、嗅觉丧失、胸痛、认知障碍(脑雾)、头晕、呼吸困难、疲劳、头痛、失眠、情绪变化、心悸、感觉异常和劳累后不适。其表现形式多样,症状可能波动或持续存在,并反复发作和缓解。诊断方法是将长新冠与急性新冠病毒感染后遗症、先前合并症、先前健康状况的显现、再感染、新的急性关注以及疾病迁延、住院或隔离的并发症相区分。长新冠的许多表现症状在基层医疗机构中很常见,通过使用既定的治疗模式和支持性护理,可以改善管理效果。尽管有几种药物被建议用于治疗与长新冠相关的疲劳,但目前缺乏其使用的证据。长新冠的整体治疗策略包括讨论节奏和能量节约;个体化、症状导向、分阶段恢复活动计划;保持充足的水合作用和健康饮食;以及治疗潜在的医疗状况。

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