COVID-19 ÓÖÉ÷ÉÝ Ü&Æ ãFÂªËO of COVID-19 Prevention and... · Contribut ed by Volunt eers...

Contributed by Volunteers

COVID-19 1

:

.

.

.

,

.

(Jack Ma

Foundation) (AliHealth) .

,

,

(Tingbo LIANG)

<COVID-19 >

1

. 1 .

.

.

1 (FAHZU) COVID-19

.

.

FAHZU . COVID-19

. 50

FAHZU 104 , 78

.

. .

‘ ’ ,

.

, . , , ,

, ,

.

.

.

.

.

1

1

I.

1.

1.1

(1) .

.

(2) '3 2 ' , ,

.

(3) . (

) ( ) .

(4)

.

(5)

.

(6) .

1.2

(1) , , , .

(2) .

(3) . /

COVID-19

.

1.3

(1) .

(2)

.

(3) .

2

(4) .

1.4 ,

(1) COVID-19

( 1 ) .

(2) (NAT) .

(3) , ,

COVID-19

.

(4) NAT 24 .

.

24

.

(5) (

).

< 1> COVID-19

14

.

14 SARS-CoV-2

(NAT )

.

14

.

(2 ,

, /

2

).

1

2

.

3

.

,

1~2

.

COVID-19

.

3

.

CT

COVID-19 :

.

(ground-glass opacities)

.

.

.

2.

2.1

, .

.

.

.

2.2

.

2.3

(1) .

(2) 1 .

.

(3) 1.2 ( 4 )

.

.

2.4

(1) .

4

.

(2) COVID-19 , ,

, , .

II.

1.

(1)

.

.

(2) . 4

, ( )

.

(3) , ,

.

(4)

.

2.

(1) ( , , )

, .

(2) .

(3)

.

(4) NAT .

(5) , ,

, SARS-CoV-2 NAT .

14 .

III. COVID-19

5

1 ·

·

·

·

/

· ,

2 ·

· (N95)

·

·

·

·

·

· (

)

· /

· /

· /

3 ·

· (N95)

·

·

·

·

· /

/

, ,

,

· /

· COVID-19 NAT

:

1. .

2. , , , (

, , ) 1

(N95) .

3. / 2

.

IV. COVID-19

1. COVID-19

6

(PPE) :

(N95) /

( :

), ( ), /

( )

1.

2.

3.

4.

(N95) 5. /

6.

7.

8.

7

(PPE) :

/ ( )

( )

( )( :

)

2. COVID-19

1.

2.

3.

4.

5.

6.

7.

8

2.1

(1)

..

(2) 1000mg/L .

(3) 30 .

(4) .

2.2

(1)

..

(2) 1000mg/L

30 . (

).

(3) .

(

).

2.3

(1)

.

(2) , 1 .

.

2.4

(1)

( 40mg/L ).

1.5 .

(2) 10mg/L .

3. COVID-19 /

3.1 (<10mL) / :

9

(1) 1: ( 5,000mg/L )

. ( 5,000mg/L

) 2 .

(2) 2: 5,000mg/L ,

.

3.2 (> 10 mL) / :

(1) .

(2) 1 2 . 1: 30

( 1L )

.

2:

10,000 mg/L

( ). 30

.

(3) , , 20,000mg/L

: 1:2 2 .

(4) .

(5) 5,000mg/L 30

.

(6) .

(7) .

4. COVID-19

4.1

10

: (

).

4.2

(1) 0.23% (

).

(2) 50ml 0.23%

5 .

(3)

.

(4) .

50ml 0.23% 5

1 .

1000mg/L

30

1000mg/L

30

( )

:

.

:

.

,

.

:

,

.

11

(5) 50ml 3

1 .

(6) .

(7) .

(8) .

4.3

(1) 1000mg/L 30 .

(2) 5000mg/L 30 .

(3) .

5.

5.1

(1) , , .

(2) .

(3) .

5.2

(1) .

(2)

.

(3)

.

(4) . .

5.3

(1) ( COVID-19) .

12

(2) 90 oC 30 .

5.4

(1) .

(2)

(3) ( 1000mg/L) . 30

.

6. COVID-19

(1) .

(2) 2

1000mg/L .

(3) 1000 mg/L

.

(4) , ,

.

(5) ,

.

(6) .

13

7. COVID-19

(1) : , ,

.

(2) : , ,

.

(3) : , ,

.

(4) :

(1m ) .

8.

8.1 (PPE)

COVID-19

( : )

0.5%

75%

3

0.05%

75%

0.5%

.

0.05%

. 75%

,

14 .

14

(1) . , .

(2) .

(3) ( , ,

) PPE . ,

(N95), , , ,

.

(4) PPE

.

(5) .

(6)

.

(7) ,

.

(8) .

8.2

(1) COVID-19 .

(2) SARS-CoV-2

.

(3) SARS-CoV-2

.

(4) ( , , ) .

/ (

) .

1000 mg/L

30 .

(5) :

/ (

) .

1000 mg/L

30 .

(6) : (FFU) . 1

. FFU 2 .

9.

(1) PPE: , ,

, , (N95)

15

(PAPR), , , ,

.

(2) : 3000-5000mg/L 0.5%

, , ,

.

(3) : 2 2

.

(4)

,

.

(5) : .

V.

1.

(1)

.

.

(2) , , , ,

,

.

.

(3)

.

2.

(1) (MDT)

.

(2)

.

16

(3) QR ( : QR GREEN

)

,

.

(4) COVID-19 CT AI

,

.

3. COVID-19

(1) ( :

, , )

.

(2)

,

.

FAHZU Internet+ Hospital -

COVID 19 FAHZU Internet+ Hospital 24

.

FAHZU 1 ,

. 3 14 , 1

FAHZU Internet+ Hospital .

:

Alipay .

Alipay( ) "Zhejiang Provincial Online Medical Platform" .

( 1 ) .

.

. Alipay " "

.

Zhejiang Provincial Online Medical

17

Platform .

1

COVID-19 , 1 (FAHZU) Alibaba

FAHZU

.

,

COVID-19 .

1

www.dingtalk.com/en DingTalk .

( ) .

FAHZU .

1: . " " > " " > " " , ID

'YQDK1170' .

2: International Medical Expert Communication Platform of FAHZU QR

.

. ,

.

FAHZU .

AI

.

18

2 I. , FAHZU COVID-19

(MDT)

. , FAHZU , , ICU, , ,

, , (TCM), , , , ,

.

. , ,

, .

MDT . ,

,

.

.

MDT .

. COVID-19 , ,

.

, ,

.

MDT . ,

.

19

MDT COVID-19

.

II.

1. SARS-CoV-2 1.1

, .

( , , ), ( ,

, ), , , .

.

SARS-CoV-2 2 (AT2) 3~5

. ,

.

1.2

SARS-CoV-2 .

. , .

SARS-CoV-2 Open Reading Frame 1a/b(ORF1a/b),

(N) (E) PCR

. . ORF1a/b

/ N /E .

.

30%~40%

50%~60% .

. , ,

,

.

2. 3(BSL-3) .

. ,

Vero-E6 . 96 (CPE) .

. :

10 TCID50

. , (PFU) .

20

3. SARS-CoV-2 .

, ELISA, . 4

IgM IgG

. IgM

10 IgG 12 .

.

4. , ,

C , , , D- ,

, IL-4, IL-6, IL-10,

.

COVID-19 C-

. C

2 . D- ,

.

.

. IL-6 IL-10 . IL-6 IL-

10 .

5. 2 2 .

. 2

, , ,

. .

. 2 G GM

.

6.

. , BSL-3

. ,

21

BSL-2

.

. .

III. COVID-19 COVID-19 ,

CT . X

. COVID-19 CT

, 2~3

. 5~7 CT

. X .

COVID-19 CT ,

(ground glass opacities) .

. " "

.

/ . 7~10

,

.

, " "

. ,

. ,

. CT

SAR-CoV-2

.

22

COVID-19 CT :

1, 2:

3:

4, 5:

6: , " "

IV. COVID-19

COVID-19

. .

(1) SARS-CoV-2 ( : ,

, ) ,

.

SAR-CoV-2 .

(2) , , .

, ,

, .

(3) (3) . .

(4) N-

.

, ,

. ( 7).

23

7: COVID-19 : ,

V. COVID-19

, . ,

,

. SARS-CoV-2

COVID-19 .

, CT

.

.

COVID-2019 .

( ), ( ), , SARS-CoV-2

.

:

1.

.

2.

.

3.

: 30 , 93%

, 300mmHg (PaO2)/ (FiO2).

24~48 50%

.

24

4.

: , ,

ICU .

, , .

: 100mmHg < 30mL / cmH2O,

. , ,

.

: 60mmHg < 100mmHg, 30mL/cmH2O >

15mL/cmH2O,

.

: 60mmHg, < 15mL/cmH2O, ECMO

, . .

VI.

.

, COVID-19

( , , ) SAR-CoV-2

.

1.

FAHZU , / (2 , 12

) (200mg, 12 ) . 49

, 12

(95% CI: 8~15 ). (24 2

) 13.5 (95% CI: 9.5~17.5 ).

, 18~65

( 50kg: 500mg, 50kg: 500mg , 5 500mg).

COVID-19 .

.

25

AIDS /

, .

/ , /

( 1 ) ( 1600mg, 600mg)

. .

2.

7 .

2 . 3

.

VII.

, ,

, ,

. .

(ALSS)

, .

1.

COVID-19

. ,

.

1.1

.

( 39 °C ) .

(CT) 30%

.

26

CT (48 CT 50% )

.

IL-6 5 ULN .

1.2

0.75 ~ 1.5mg/kg (

, 40 mg ) .

12 40mg . 12

40mg~80mg

. , , , C- , ,

2~3 CT

. CT

, 3 5

. 20mg (Medrol)

.

.

1.3

T-SPOT ,

HBV HCV .

.

. .

.

.

.

.

2.

(ALSS) , ,

27

. , ,

, , - ,

, , . ,

. ,

.

2.1 ALSS

( IL-6) 5 ULN

1 .

CT 10% .

.

+ .

2.2

. , ALSS

.

.

,

.

.

, 3 .

.

.

, ,

. ALSS 2000mL .

.

ALSS

. , ALSS IL-2/IL-4/IL-6/TNF

, .

28

3.

COVID-19 .

.

3.1

(1)

. ,

.

(2)

(SpO2) 93%

.

. PaO2/FiO2 300

.

(3)

(SpO2)

93%~96% 2 88%~92%

. , 85%

92%~95% .

(4)

PaO2/FiO2 . PaO2/FiO2

300mmhg FiO2 .

.

SpO2 93% , PaO2/FiO2 300mmHg (1mmHg = 0.133kPa);

25 ; X-ray

(HFNC) . HFNC

. PaO2/FiO2 200~300mmHg ,

HFNC

40~60L/min .

29

60L/min .

(<100mmHg)

, . ,

.

150mmHg , (60L/min) (> 60%)

1~2

.

(> 60 ) PaO2/FiO2 200mmHg

.

3.2

(1) (NIV)

NIV HFNC COVID-19 .

ARDS .

.

, NIV (2

) . PaO2/FiO2

.

NIV . NIV

.

.

(2)

COVID-19

.

· 1 4~8mL/kg . ,

.

· 30cmH 2O (1cmH 2O = 0.098kPa) 15 cmH 2O

.

· ARDS PEEP .

30

· : 18~25 . .

· , ,

.

ARDS . ,

,

. .

(3)

COVID-19

. PaO2/FiO2 150mmHg

. 16

. PaO2/FiO2 150mmHg 4

.

-

. 4

. .

(4)

.

. .

, 50mL . , 30°

.

(5)

COVID-19 .

,

.

(6) (VAP)

VAP .

.

31

(2 , 20mL

).

.

30~35cmH 2 O (1cmH 2 O = 0.098kPa) 4 .

(

). .

.

(7)

PaO2/FiO2 150mmHg

. .

HFNC NIV .

VIII.

COVID-19 ,

.

. , ,

, 7 20mg

( ) .

, 2 3 ,

32

. ,

.

, ,

.

, C- , ,

. ,

. ,

, , , .

: ,

, ,

, / , 0.5ng/mL ,

.

COVID-19 , , /

.

D- (G )

(GM ) .

.

:

7 ,

, , 2

, G

.

. ,

:

7 , ,

, GM .

IX. ,

33

COVID-19 ( ) . COVID-19

.

,

.

1. (1) .

, ,

.

(2) .

, , .

(3) . ,

.

.

.

(4) .

,

.

2.

COVID-19

. ,

.

(1) .

.

(2) .

, , , .

.

(3) .

.

. ,

.

(4) . kg 25~30kcal, 1.2~2.0g/kg.

(5) .

34

.

.

(6)

.

.

X. COVID-19 ECMO COVID-19 ,

. COVID-19

(ECMO) , ,

, ECMO ,

.

1. ECMO 1.1 ECMO

72

. ECMO

.

(1) PaO2/FiO2 < 80mmHg(PEEP )(2) Pplat 30mmHg, PaCO2 > 55mmHg (3) , > 1/3 , > 48

(4) , >

(5) ECPR .

1.2 ECMO

,

ECMO .

ECMO .

(1) . , < 10mL/cmH2O

(2) .

48 .

(3) PaO2/FiO2 < 100mmHg. 72 .

1.3 ECMO

7 ECMO

59

, , . , +

+ + GS, G/GM ,

, , + D , + ,

, , , +

, , , CRP, PCT 1 1

6

, , , CT

4.3

200mg 1 3

/ 2 12 ( 1 1

1 )

NS 10mL + 40mg 12 IV

NS 100mL + 40mg 1 1 IVGTT

20g 1 1 IVGTT

1.6mg 1 2 IH

NS 10mL + 30mg 1 2 IV

NS 50 mL + 2mg IV-VP

10g 1 1 IVGTT

NS100mL + / 4.5 8 IVGTT

( ) 500mL 1 2

II.

2.1 FAHZU Internet+ Hospital

35

ECMO .

. .

(1) . ECMO

.

(2) .

(3) Murry > 2.5

(4) . > 4

(5) . .

2. COVID-19 ECMO 7

.

.

3. (1) V-V .

V-A .

(2) PaO2/FiO2 < 100mmHg , >

6L/min V/A = 0.5/0.5 V-A-V .

(3)

COVID-19 ECMO V-A .

IPPV ECMO .

4. (1) 30% 80% (CO) .

(2) 90% SPO2 . 0.5 FiO2

.

(3) 80kg ( ) 22 Fr(24 Fr)

.

5. :

59

, , . , +

+ + GS, G/GM ,

, , + D , + ,

, , , +

, , , CRP, PCT 1 1

6

, , , CT

4.3

200mg 1 3

/ 2 12 ( 1 1

1 )

NS 10mL + 40mg 12 IV


20g 1 1 IVGTT

1.6mg 1 2 IH

NS 10mL + 30mg 1 2 IV

NS 50 mL + 2mg IV-VP

10g 1 1 IVGTT

NS100mL + / 4.5 8 IVGTT

( ) 500mL 1 2

II.


60

.

: [email protected], [email protected]

2.2 1

FAHZU Internet+ Hospital

"Online FAHZU" "www.zy91.com" Alipay ,

FAHZU QR

( , & )

COVID-19

&

& &

1 1

FAHZU Internet+ Hospital "Online FAHZU"

"www.zy91.com"

36

(1) : = 1:1. PaCO2 < 45mmHg

. COPD PaCO2 < 80% .

(2)

(RR) 10 < RR < 20 .

(3) V-A 7.35-7.45PH

.

6. (1) 50×109/L

50IU/kg .

(2) 50×109/L

25IU/kg .

(3) 40~60 (aPPT)

. D- .

(4) : ECMO

. 3L/min

. 24 .

.

(5) . aPTT

. III(ATIII)

.

.

(6) (HIT). HIT

.

7. ECMO (1) V-V ECMO ECMO

, ECMO 48

.

(2)

, PaO2/FiO2 > 150mmHg 48 ,

,

ECMO . ECMO .

61

: 3 QR

: LIANG Tingbo

: CAI Hongliu, CHEN Yu, CHEN Zuobing, FANG Qiang, HAN Weili, HU Shaohua, LI Jianping, LI Tong, LU Xiaoyang, QIU Yunqing, QU Tingting, SHEN Yihong, SHENG Jifang, WANG Huafen, WEI Guoqing, XU Kaijin, ZHAO Xuehong, ZHONG Zifeng, ZHOU Jianying

www.dingtalk.com/en QR ( 1) DingTalk

, DingTalk ( )

1: “ ” > “ ” > “

” > ID ‘YQDK1170’ 2: FAHZU

QR ( 2)

. , ,

PC

AI &

1: DingTalk 2: FAHZU

QR 3:

37

XI. COVID-19

Behring Kitasato 1891 ,

.

.

.

,

62

1. National Health Commission and National Administration of Traditional Chinese Medicine of the People's Republic of China. Protocols for Diagnosis and Treatment of COVID-19 (7th Trial Version) [EB/OL].(2020-03-04)[2020-03-15].

http://www.nhc.gov.cn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb1989.shtml (in Chinese)

2. National Health Commission of the People's Republic of China. Protocols for Prevention and Control of COVID-19 (6th Version) [EB/OL].(2020-03-09)[2020-03-15].

http://www.nhc.gov.cn/jkj/s3577/202003/4856d5b0458141fa9f376853224d41d7.shtml (in Chinese)

3. Chinese Center for Disease Control and Prevention. Guidelines for Epidemiological Investigation of COVID-19 [EB/OL]. (in Chinese) (2020-03-09)[2020-03-15].

http://www.chinacdc.cn/jkzt/crb/zl/szkb_11803/jszl_11815/202003/t20200309_214241.html

4. Chinese Center for Disease Control and Prevention. Guidelines for Investigation and Management of Close Contacts of COVID-19 Patients [EB/OL]. (in Chinese) (2020-03-09)[2020-03-15].


5. Chinese Center for Disease Control and Prevention. Technical Guidelines for COVID-19 Laboratory Testing [EB/OL]. (in Chinese) (2020-03-09)[2020-03-15].


6. Chinese Center for Disease Control and Prevention. Technical Guidelines for Disinfection of Special Sites [EB/OL]. (in Chinsese) (2020-03-09)[2020-03-15].


7. Chinese Center for Disease Control and Prevention. Guidelines for Personal Protection of Specific Groups [EB/OL]. (in Chinese) (2020-03-09)[2020-03-15].


8. Technical Guidelines for Prevention and Control of COVID-19, Part3: Medical Institutions, Local Standards of Zhejiang Province DB33/T 2241.3—2020. Hangzhou, 2020 (in Chinese)

9. Chinese Center for Disease Control and Prevention. Distribution of Novel Coronavirus Pneumonia [EB/OL]. (in chinese) [2020-03-15].

http://2019ncov.chinacdc.cn/2019-nCoV/

10. Wang C, Horby PW, Hayden FG, et al. A novel coronavirus outbreak of global health concern [J]. Lancet 2020;395(10223):470-473. doi: 10.1016/S0140-6736(20)30185-9.

11. China CDC has Detected Novel Coronavirus in Southern China Seafood Market of Wuhan [EB/OL]. (in Chinese) (2020-01-27)[2020-03-15].

http://www.chinacdc.cn/yw_9324/202001/t20200127_211469.html

12. National Health Commission of the People's Republic of China. Notification of Novel

38

. WHO

"

" . COVID-19 ,

.

.

.

.

1. .

1.1.

2 (

) 18 55 . 50kg( ) 45kg( ).

1 . 2 .

1.2

, 200~400mL( ).

1.3

.

(1) SARS-CoV-2

(2) SARS-CoV-2 IgG IgM 160

320 . , >

3mL .

. IgG

, SARS-CoV-2 IgG

. ,

320 .

2. 2.1

(1) COVID-19

(2) COVID-19

CT COVID-19 .

39

: , 3 COVID-19

. , 3

. ,

NK , ,

.

2.2

(1) ,

(2) IgA ,

.

2.3 1

200mL .

XII. (TCM)

1. COVID-19 , , , .

“ ” “ ” . “

” . “ ” .

“ ( ) " .

. , .

, , ( ) , “

” . ( ) ( ) .

, . ( )

( · )

( ) . ,

. COVID-19

, .

2. (1)

6g, 10g, 30g, 6g, 15g, 10g, 30g, 15g,

20g, 12g, 12g.

(2)

9g, 30g, 10g, 6g, 15g, 20g, 15g, 12g,

63

Coronavirus Pneumonia Temporarily Named by the National Health Commission of the People's Republic of China [EB/OL]. (in Chinese) (2020-02-07)[2020-03-15]. http://www.nhc.gov.cn/mohwsbwstjxxzx/s2908/202002/f15dda000f6a46b2a1ea1377cd80434d.shtml.

13. Gorbalenya AE, Baker SC, Baric RS, et al. Severe Acute Respiratory Syndrome-related Coronavirus- The Species and its Viruses, a Statement of the Coronavirus Study Group [J/OL]. BioRxi 2020. doi:10.1101/2020.02.07.937862.

14. WHO. Novel Coronavirus(2019-nCoV) Situation Report–22 [EB/OL].(2020-02-11)[2020-03-15]. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/

15. Bureau of Disease Control and Prevention, National Health Commission of the People's Republic of China. Novel coronavirus infection pneumonia is included in the management of notifiable infectious diseases [EB/OL]. (in Chinese) (2020-01-20)[2020-02-15]. http://www.nhc.gov.cn/jkj/s7915/202001/e4e2d5e6f01147e0a8d f3f6701d49f33.shtml

16. Chen Y, Liang W, Yang S, et al. Human Infections with the Emerging Avian Influenza A H7N9 virus from Wet Market Poultry: Clinical Analysis and Characterisation of Viral Genome [J]. Lancet 2013;381(9881):1916-1925. doi: 10.1016/S0140-6736(13)60903-4.

17. Gao HN, Lu HZ, Cao B, et al. Clinical Findings in 111 Cases of Influenza A (H7N9) Virus Infection [J]. N Engl J Med 2013;368(24):2277-2285. doi:10.1056/NEJMoa1305584.

18. Liu X, Zhang Y, Xu X, et al. Evaluation of Plasma Exchange and Continuous Veno-venous Hemofiltration for the Treatment of Severe Avian Influenza A (H7N9): a Cohort Study [J]. Ther Apher Dial 2015;19(2):178-184. doi:10.1111/1744-9987.12240.

19. National Clinical Research Center for Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases. Expert Consensus on Novel Coronavirus Pneumonia Treated with Artificial Liver Blood Purification System [J]. Chinese Journal of Clinical Infectious Diseases 2020,13. (in Chinese) doi:10.3760/cma.j.issn.1674-2397.2020.0003.

20. Weill D, Benden C, Corris PA, et al. A Consensus Document for the Selection of Lung Transplant Candidates: 2014—An Update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation [J]. J Heart Lung Transplant 2015;34(1):1-15. doi: 10.1016/j.healun.2014.06.014.

FAHZU 1947 1 (FAHZU)

. 6 , , ,

. , FAHZU

14 .

( ) ,

6,500 .

40

20g, 15g, 12g, 20g, 9g.

(3)

12g, 15g, 6g, ( ) 6g, 15g, 30g, 10g, 20g,

15g, 30g, 6g.

(4)

.

(5) ( )

30g, 20g, 15g, 20g, 6g, 15g, 10g, 6g,

20g, 15g, 15g.

. 1 .

. , .

XIII. COVID-19 COVID-19

. ,

.

1. - (Lopinavir-Ritonavir) (Arbidol)

COVID-19 51.9% .

.

,

. .

(1) - (Lopinavir-Ritonavir) -

(Darunavir-Cobicistat) : , , , , ,

, . .

(2) (Arbidol): .

, . .

, (Metoprolol),

(Propranolol) .

60 .

(3) (Fapilavir): , , , , ,

.

.

(4) (Chloroquine phosphate): , , , , ,

41

. . (ocular toxicity)

. . ( : ),

, .

2. (Therapeutic Drug Monitoring,

TDM) . < 1> .

,

.

< 1> COVID-19 TDM

-(Lopinavir-Ritonavir)ritonavir

( ) 30

( ) 30

:

( )

( )

(Imipenem) 10

(Meropenem) 10

MIC

(Vancomycin) 30 10~20mg/L ( MRSA

: 15~20mg/L)

.

,

1

.

(Linezolid) 30

.

42

.

(Vorizonazole) 30

.

3. - (Lopinavir-Ritonavir) CYP3A

. ,

.

< 2> .

< 2>

-

(Lopinavir-Ritonavir)

CYP3A

( : ,

, )

,

.

(Rivaroxaban) AUC

153% ,

(Atorvastatin) 5.9 ,

(Midazolam) 13

.

TDM

.

(Amiodarone,

),

(Quetiapine,

),

(Simvastatin,

)

.

-

(Darunavir-Cobicistat)

CYP3A / CYP2D6

,

. -

(Lopinavir-Ritonavir) .

-(Lopinavir-Ritonavir)

.

(Arbidol) CYP3A4, UGT1A9 , ,

.

________

43

(Fapilavir) (Theophylline)

.

(acetaminophen)

1.79 .

(Pyrazinamide)

.

(Repaglinide)

.

________

(Chloroquine phosphate) ________

QT

( :

,

,

)

.

> "—": , TDM: , AUC: ,

UGT1A9: 1A9.

4. , , ,

(CRRT) , (ECMO)

. .

(1)

- (Lopinavir-Ritonavir) . (Fapilavir

Favipiravir), (Chloroquine phosphate) .

(2) (Penicillin),

(Cephalosporins) .

(3) ( )

(Linezolid),

(Moxifloxacin), (Ceftriaxone) .

(4) 24 (CRRT) (Vancomycin)

1g, 0.5g, 12 . (Imipenem)

, 1 2g .

44

XIV. COVID-19

1. COVID-19 19 , , , ,

. .

COVID-19 48%

,

. .

SARS-CoV-2

.

2. ( , , ,

) . (SRQ-20),

(PHQ-9), (GAD-7) .

(HAMD), (HAMA),

(PANSS) .

.

.

3. 3.1

45

, .

. , .

, ,

.

(Olanzapine) (Quetiapine) 2 .

3.2.

COVID-19

. ,

.

(Citalopram), (Escitalopram) ,

(Estazolam), (Alprazolam)

(Benzodiazepine) , (Olanzapine)

(Quetiapine) .

XV. COVID-19

, , , .

1. , , ,

. - - .

1.1

, , , , ADL

. , ,

.

1.2.

COVID-19 , ,

.

(1) . ( ) ,

V/Q( ) .

.

,

(30°-45°-60°) .

. , .

46

(2) . ,

.

.

.

: .

. , 1

V/Q( ) .

.

: . ,

,

.

. , . 12~15 .

(3) (Active Cycle of Breathing Technique, ACBT).

.

( , , ) .

.

(4) (Positive Expiratory Pressure Trainer). COVID-19

( ) .

1 . ,

.

, .

.

(5) . , , , .

XVI. COVID-19 . ,

.

, FAHZU . ,

.

47

1. (1) : 70 . 70

.

(2) : .

, (4~6 ) , , ECMO

.

(3) : CT, ECMO ,

.

(4) : a. CT

,

. b. ,

. c.

. ,

.

(5) COVID-19 : 24 2

. COVID-19

3

. , , , ,

,

. ,

.

(6) : COVID-19

, ( )

. ,

.

(7) COVID-19 : ICU

.

2. 2014 ISHLT Consensus . (International Society for Heart

and Lung Transplantation) (2014

).

48

XVII. COVID-19

1.

(1) 3 ( <37.5°C).

(2) .

(3) 2 ( >24h)

.

(4) .

(5) .

(6) SpO2>93% .

(7) .

2.

. ,

.

3

.

3.

2 . :

, .

, .

.

2 ( ) .

4.

49

.

48 .

1 , 2 1 . ,

, , CT

. 3 , 6 .

5.

. ,

. (24

2 , 3 , ,

)

.

. .

(1) COVID-19 .

(2) .

(3) , 3 (24 )

malgunbd .

(4) .

50

3 I. (HNFC) 1.

HFNC

. .

.

.

. ,

(FiO2), .

2.

, ,

, , > 40 ,

HFNC

.

3.

, , (2500mg/L)

. ,

(2500mg/L) .

II.

1.

. (PPE)

. ,

.

. , 30

.

2. , ,

51

. 4 (

, CPOT), 2 (RASS/BISS).

. ,

. CAM-ICU COVID-19

. , , , ,

.

3. (VAP)

(VAP) ,

30~45° , 4~6 , 4

(ETT) 30~35cmH2O , 4

, , 1~2

10mL ,

. .

(2500mg/L) ,

.

4.

(1) ,

.

(2)

.

5.

.

(2500mg/L) .

.

6. (PPV)

. 2 .

52

III. (ECMO, Extra Corporeal Membrane

Oxygenation)

1. (ECMO)

1 .

, , , , ,

, , , ,

, ,

, .

2. .

, , ,

, ,

, .

3. : .

4. .

. , , .

(25~50IU/kg) (7.5~20IU/kg/h)

. 40~60

(APTT) .

. .

.

5. “ ” .

1 6mL/kg (

1 10~20 ).

6. , (MAP) 60~65mmHg , (CVP)

8mmHg , (SpO2) 90% ,

.

53

7. , .

8. .

IV. (ALSS)

. , ,

.

1.

ALSS .

, , , , , , ,

. .

(1)

3 .

(2)

, , , , ,

( , )

.

(3)

. , , .

.

(4)

35mL/min . .

(5)

. ,

.

(6)

54

“ ” , 35mL/min .

SARS-Cov-2 ,

.

(7)

, ,

.

2.

(1) :

, .

(2) ALSS :

,

, 48

.

(3) ALSS :

. , 6

24 .

.

V. (Continuous Renal Replacement

Treatment, CRRT)

1. CRRT

.

, .

. ,

.

2.

(1) :

24

.

, 2

55

.

.

(2) .

. 4 -

.

.

3.

(1) , , .

(2) 24 .

.

VI. 1.

, ,

. , , ,

. .

. (PEEP)

(VALI) . , 1

.

2.

(1) :

.

.

.

(2) 4 . <100mL

.

(3) :

. 30

.

(4) (HFNC) : 4

56

.

.

.

3.

.

4. ,

.

.

5. VTE

. , D-

VTE .

6. ,

. .

.

.

57

I. COVID-19

1. COVID-19 1.1

, ,

1.2

2019 RNA ( ) ( ) 1 1

2019 RNA ( ) ( ) 1 1

, , , + OB,

+ D , + , ASO + RF + CPR + CCP, ESR, PCT, ABO + RH

, , + , 4 ,

, , G/GM ,

, , , CT

1.3

200mg 1 3

/ 2 12

1 1 3

2. COVID-19 2.1

, ,

2.2

2019 RNA ( ) ( ) 1 1

2019 RNA ( ) ( ) 1 1

, , , + OB,


, , + , 4 ,

, , G/GM ,

, , , CT

2.3

58

200mg 1 3

/ 2 12

1 1 3


3. COVID-19 3.1

, ,

3.2

2019 RNA ( ) ( ) 1 1

2019 RNA ( ) ( ) 1 1

, , , + OB,


, , + , 4 ,

, , G/GM ,

, , , CT

3.3

200mg 1 3

/ 2 12

1 1 3



1 1 1

20g 1 1 IVGTT


4. COVID-19 4.1

, ,

4.2

2019 RNA ( ) ( ) 1 1

2019 RNA ( ) ( ) 1 1

, ABO + RH , , + OB, 4

일상적 항목, 호흡기 바이러스 검사, 갑상선 기능. 심전도, 심장 가스 분석 + 전해

액 + 젖산 + GS, G/GM 검사, 혈액 배양 한 번

혈액 일상 검사, 생화학 프로파일, 응고 기능 + D 다이머, 혈액 가스 분석 + 젖산,

뇌나트륨이뇨 펩타이드, 심장 효소, 혈청 트로포닌의 정량 분석, 면역글로불린 +

보체, 사이토카인, 가래 배양, CRP, PCT 1일 1회

매 6시간마다 혈당 측정

간, 쓸개, 췌장 및 비장 초음파, 심초음파 및 폐 CT 스캔

4.3 약물

아르비돌 정제 200mg 1일 3회 경구 투여

로피나비르/리토나비르 정제 2개 매 12시간마다 투여(또는 다루나비르 정제 1개 1

일 1회 투여)

NS 10mL + 메틸프레드니솔론 40mg 매 12시간마다 IV 투여

NS 100mL + 판토프라졸 40mg 1일 1회 IVGTT 투여

면역글로불린 20g 1일 1회 IVGTT 투여

흉선 펩타이드 1.6mg 1주일 2회 IH 투여

NS 10mL + 암브록솔 30mg 1일 2회 IV 투여

NS 50 mL + 이소프레날린 2mg IV-VP 한 번 투여

사람 혈청 알부민 10g 1일 1회 IVGTT 투여

NS100mL + 피페라실린/타조박탐 4.5 8시간마다 IVGTT 투여

경장영양 현탁액(액상 펩티소브) 500mL 비위관 영양공급 1일 2회 투여

II.


60

.


2.2 1



FAHZU QR

( , & )

COVID-19

&

& &

1 1


"www.zy91.com"

60

.




FAHZU QR

( , & )

COVID-19

&

& &

1 1


"www.zy91.com"


2.2 1

61

: 3 QR

: LIANG Tingbo



, DingTalk ( )

1: “ ” > “ ” > “

” > ID ‘YQDK1170’

2: FAHZU

QR ( 2)

. , ,

PC

AI &


QR 3:

61

: 3 QR

: LIANG Tingbo



, DingTalk ( )

1: “ ” > “ ” > “

” > ID ‘YQDK1170’

2: FAHZU

QR ( 2)

. , ,

PC

AI &


QR 3:

62






















61

: 3 QR

: LIANG Tingbo



, DingTalk ( )

1: “ ” > “ ” > “

” > ID ‘YQDK1170’ 2: FAHZU

QR ( 2)

. , ,

PC

AI &


QR 3:

62






















63











. 6 , , ,

. , FAHZU

14 .

( ) ,

6,500 .

63











. 6 , , ,

. , FAHZU

14 .

( ) ,

6,500 .

62






















15. doi: 10.1016/j.healun.2014.06.014.

FAHZU 1947년에 저장대학교 의과대학 제1 (FAHZU)은 저장 대학교의

. 6개 캠퍼스로 , 의료 서비스, 의학 , 과학 및

치료를 종합 의료 성장했다. 종합적으로 , FAHZU는

내 14 있다.

종합 병원으로 ( ) , 전국 저명한

학자들과 인재를 약 6,500여 명의 있다.

FAHZU에는 총 4,000개 환자용 베드를 갖추고 있다. 2019년에는 약 5백만 명의 응급

및 외래 환자가 본 캠퍼스 병원에 다녀갔다.

지난 수년간, FAHZU는 장기 이식외과, 췌장외과, 감염내과, 혈액내과, 신장내과,

비뇨의학과, 임상약리학과 등 분야에서 저명한 프로그램을 성공적으로 운영해왔다.

FAHZU는 많은 이들에게 암 근치절제술을 알리고 장기 생존을 할 수 있게 돕고 있다.

또한, FAHZU는 간, 췌장, 폐, 신장, 장 및 심장 이식이 가능한 종합 병원이다. SARS,

H7N9형 조류 인플루엔자, COVID-19와의 싸움에서 많은 경험과 의미 있는 결과를

얻었다. 그 결과로 이곳 의료진들은 뉴잉글랜드 저널 오브 메디슨(New England Journal

of Medicine), 란셋(Lancet), 네이처(Nature), 사이언스(Science)와 같은 저널에서 많은

논문을 발표하기도 했다.

FAHZU는 외국 인재들과 교류 및 협력을 아끼지 않고 해왔다. 전 세계 30여 개 유수

대학교와 파트너십을 맺고 있다. 이곳 전문 의료진과 기술을 인도네시아, 말레이시아

등 다양한 국가와 교류를 통해 뜻깊은 성과를 이루고 있다.

엄격하게 진리를 추구하는 핵심 가치관을 바탕으로 FAHZU는 도움이 필요한

모두에게 뛰어난 의료 서비스를 제공하고자 노력하고 있다.

자세한 내용을 확인하려면

QR 코드를 스캔하세요

COVID-19 ÓÖÉ÷ÉÝ Ü&Æ ãFÂªËO of COVID-19 Prevention and... · Contribut ed by Volunt eers...

Documents

Transcript of COVID-19 ÓÖÉ÷ÉÝ Ü&Æ ãFÂªËO of COVID-19 Prevention and... · Contribut ed by Volunt eers...