Jha Ashish K, Kumar Ravikant, Goenka Mahesh K, Dayal Vishwa M
Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
Institute of GastroSceinces, Apollo Gleneagles Hospital, Kolkata, West Bengal, India.
J Dig Endosc. 2020 Mar;11(1):69-72. doi: 10.1055/s-0040-1712547. Epub 2020 May 16.
Patients with novel coronavirus disease 2019 (COVID-19) are at significantly increased risk for mortality and morbidity. Current management remains supportive care, ranging from symptomatic outpatient management to full-intensive care support, including intravenous fluids, invasive, and non-invasive oxygen supplementation. In patients with septic shock, treatment with antibiotics and vasopressors are recommended to keep mean arterial pressure (MAP) ≥ 65 mm Hg and lactate < 2 mmol/L. Because of the lack of effectiveness and possible adverse effects, routine corticosteroids should be avoided unless they are indicated for another reason (exacerbation of asthma or chronic obstructive pulmonary disease [COPD], and septic shock in whom fluids and vasopressors do not restore hemodynamic stability). There is currently no sufficient evidence of efficacy of hydroxychloroquine/chloroquine, remdesivir, and other antivirals in the treatment or prevention of COVID-19. Limited evidence shows that COVID-19 convalescent plasma can be used as a treatment of COVID-19 without the occurrence of severe adverse events. Drug regulatory agencies granted an emergency-use authorization of chloroquine/hydroxychloroquine and remdesivir to treat patients when a clinical trial is not available or participation is not feasible. Chloroquine and hydroxychloroquine are associated with QT interval prolongation and life-threatening cardiac arrhythmia in patients with pre-existing cardiovascular disease. Guidelines are issued for use of convalescent plasma in patients with serious or immediately life-threatening COVID-19. Data from several ongoing randomized controlled trials will provide further evidence regarding the safety and efficacy of these drugs for the treatment of COVID-19.
2019年新型冠状病毒病（COVID-19）患者的死亡和发病风险显著增加。目前的治疗仍为支持性治疗，范围从有症状的门诊管理到全面的重症监护支持，包括静脉输液、有创和无创吸氧。对于感染性休克患者，建议使用抗生素和血管加压药治疗，使平均动脉压（MAP）≥65 mmHg，乳酸水平<2 mmol/L。由于缺乏有效性且可能存在不良反应，应避免常规使用皮质类固醇，除非有其他指征（哮喘或慢性阻塞性肺疾病[COPD]加重，以及液体和血管加压药无法恢复血流动力学稳定性的感染性休克）。目前没有足够证据证明羟氯喹/氯喹、瑞德西韦和其他抗病毒药物在治疗或预防COVID-19方面的疗效。有限的证据表明，COVID-19康复期血浆可用于治疗COVID-19，且不会发生严重不良事件。在没有临床试验或无法参与临床试验时，药品监管机构授予氯喹/羟氯喹和瑞德西韦紧急使用授权以治疗患者。氯喹和羟氯喹与已有心血管疾病患者的QT间期延长和危及生命的心律失常有关。已发布关于在患有严重或危及生命的COVID-19患者中使用康复期血浆的指南。几项正在进行的随机对照试验的数据将为这些药物治疗COVID-19的安全性和有效性提供进一步证据。
