不同抗病毒方案对新型冠状病毒肺炎患者的临床疗效和安全性观察

来源 :中华危重病急救医学 | 被引量 : 0次 | 上传用户:casterisme
下载到本地 , 更方便阅读
声明 : 本文档内容版权归属内容提供方 , 如果您对本文有版权争议 , 可与客服联系进行内容授权或下架
论文部分内容阅读
目的:通过对宁夏回族自治区确诊新型冠状病毒肺炎(新冠肺炎)患者住院期间抗病毒治疗和出院3个月复查追踪,观察和分析新冠肺炎不同抗病毒方案的临床疗效和近期及远期不良反应。方法:采用单中心回顾性研究方法,选择2020年1月20日至3月15日作者作为宁夏回族自治区卫生健康委员会派驻至本自治区唯一收治新冠肺炎患者的定点医院(宁夏回族自治区第四人民医院)时在隔离病房全程接管收治的新冠肺炎患者。根据抗病毒方案将患者分为常规抗病毒组和非常规抗病毒组,常规抗病毒组给予α-干扰素联合洛匹那韦/利托那韦治疗;非常规抗病毒组给予α-干扰素联合洛匹那韦/利托那韦和阿比多尔或利巴韦林或磷酸氯喹治疗;再按疾病严重程度不同将患者分为轻型(13例)、普通型(45例)、重型(14例)、危重型(1例)。收集患者临床资料、住院时间、首次新型冠状病毒(2019-nCoV)核酸转阴时间、住院费用、出院后14 d 2019-nCoV核酸复阳情况,以及联合使用激素和抗菌药物情况;比较不同抗病毒方案治疗两组入院1、3、7 d和出院1个月、出院3个月血常规、肝功能、血脂水平的差异及不良反应发生情况。结果:①一般资料:共收治新冠肺炎确诊患者75例,最终纳入73例,其中常规抗病毒组47例,非常规抗病毒组26例。对不同临床分型患者分析显示,分型越重,患者年龄越大,合并基础疾病的比例越高,住院时间越长,治疗费用越高。与常规抗病毒组比较,非常规抗病毒组重型和危重型患者比例更高〔分别为34.6%(9/26)比10.6%(5/47),3.8%(1/26)比0(0/47)〕,住院时间(d:16.1±5.6比11.6±3.3)、首次核酸转阴时间更长(d:12.4±4.5比10.0±3.5),住院费用更高〔元:11 984.2(9 000.6,24 424.7)比8 140.4(6 715.7,9 707.7)〕,差异均有统计学意义(均n P0.05)。②实验室检查:随时间延长,两组白细胞计数(WBC)、血小板计数(PLT)、总胆红素(TBil)、三酰甘油(TG)均呈先升高后降低趋势,淋巴细胞计数(LYM)呈先降低后升高趋势。非常规抗病毒组治疗后WBC、PLT、TG均于入院7 d达峰值,分别为(6.53±2.78)×10n 9/L、(250.77±96.12)×10n 9/L、(1.94±0.96)μmol/L,TBil于入院3 d达峰值,为(23.69±12.14)μmol/L,LYM于出院后1个月达峰值,为(1.82±0.50)×10n 9/L;但不同抗病毒方案组间上述指标比较差异均无统计学意义;两组各时间点丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆固醇(TC)比较差异均无统计学意义。③非抗病毒组联合使用激素的比例明显高于常规抗病毒组〔26.9%(7/26)比4.3%(2/47),n P<0.05〕。n 结论:年龄、合并基础疾病与新冠肺炎患者病情相关,非常规抗病毒治疗方案多用于病情重、病毒核酸长期未转阴的新冠肺炎患者,可根据患者对药物的反应和耐受程度,个体化使用抗病毒药物。“,”Objective:To investigate the clinical efficacy and short-term and long-term adverse reactions for different antiviral regiments for coronavirus disease 2019 (COVID-19) in Ningxia Hui Autonomous Region during hospitalization and follow-up in 3 months.Methods:A single-center retrospective study was conducted to enroll the COVID-19 patients in isolation ward of the only designated hospital to receive COVID-19 patients (the Fourth People's Hospital of Ningxia Hui Autonomous Region) when the authors were assigned by the Ningxia Health Commission as experts from January 20, 2020 to March 15, 2020. According to the antiviral regimen, the patients were divided into conventional antiviral group and unconventional antiviral group. The conventional antiviral group received α-interferon combined with Lopinavir/Ritonavir (LPV/R). The unconventional antiviral group was given α-interferon combined with LPV/R and Abidor or Ribavirin or Chloroquine. The patients were divided into mild (13 cases), ordinary (45 cases), severe (14 cases) and critical (1 case) types. The clinical data, length of hospital stay, the first 2019 novel coronavirus (2019-nCoV) nucleic acid negative recovery time, cost of hospitalization, 2019-nCoV nucleic acid positive reversal after 14 days of discharge, and the combination of hormones and antibiotics were collected. The differences in blood routine, liver function, blood lipid level and adverse reactions of antiviral drugs during hospitalization were compared between the two groups at 1, 3 and 7 days after admission and 1 and 3 months after discharge.Results:① General information: a total of 75 patients with confirmed COVID-19 were admitted, and 73 patients were eventually enrolled, including 47 cases in the conventional antiviral group and 26 cases in the unconventional antiviral group. Patients with different clinical classification were analyzed, the higher the clinical classification and the patients' age, the higher the proportion of primary diseases and the cost of treatment, and the longer the length of hospital stay. Compared with conventional antiviral group, in unconventional antiviral group the percentage of severe and critical patients were higher [34.6% (9/26) vs. 10.6% (5/47), 3.8% (1/26) vs. 0 (0/47)], the length of hospital stay (days: 16.1±5.6 vs. 11.6±3.3), first nucleic acid negative recovery time (days: 12.4±4.5 vs. 10.0±3.5) were longer, and hospitalization cost was higher [Yuan: 11 984.2 (9 000.6, 24 424.7) vs. 8 140.4 (6 715.7, 9 707.7)], with statistically significant differences (alln P 0.05).② Laboratory tests: during the hospitalization, white blood cell count (WBC), platelet count (PLT), total bilirubin (TBil) and three acyl glycerin (TG) levels were first increased and then reduced, lymphocyte count (LYM) was first decreased and then increased in two groups. In the unconventional antiviral group, WBC [(6.53±2.78)×10 n 9/L], PLT [(250.77±96.12)×10n 9/L], and TG [(1.94±0.96) μmol/L] all reached their peak values at 7 days after admission. TBil peaked at 3 days after admission, which was (23.69±12.14) μmol/L, and LYM reached the peak 1 month after discharge, which was (1.82±0.50)×10 n 9/L; however, there was no statistical significance among the above indicators between two groups. There were no statistically significant differences in alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total cholesterol (TC) between the two groups at each time point. ③The ratio of combined use of hormones in the non-antiviral group was significantly higher than that in the conventional antiviral group [26.9% (7/26) vs. 4.3% (2/47), n P < 0.05].n Conclusions:Age and associated primary diseases are related to the severity of COVID-19 patients. Unconventional antiviral treatment regimens are mostly used for severe COVID-19 patients whose ucleic acid did not turn negative for a long time. Individual antiviral therapy can be used based on the patients' response and tolerance to drugs.
其他文献
  无齿螳臂相手蟹是长江口潮间带和潮上带的优势种之一,具有重要的生态的功能.为探求无齿螳臂相手蟹异速生长的不同阶段,于2009年10月至2010年9月期间采集样本,通过聚类和
会议
狗牙根拔节前后喷施矮壮素和多效唑,可明显抑制主茎和分蘖茎的伸长,缩短节间长,解除了植株的顶端优势,显著地促进了分蘖的大量发生,但对根系的生长也产生一定的抑制作用。此外,施用
  采用比较作业法,在黄海区中对出水孔直径分别为8、15、18、20、22 mm的鳗鱼笼对星康吉鳗(Conger myriaster)的选择性进行研究.用SELECT(Share Each Lengths Catch Total)
会议
目的探讨Clara细胞分泌蛋白16(CC16)及可溶性晚期糖基化终产物受体(sRAGE)联合检测对急性呼吸窘迫综合征(ARDS)诊断及预后评估的临床意义。方法选择2019年7月至2020年9月入住天津医科大学朱宪彝纪念医院重症监护病房(ICU)的100例ARDS患者作为ARDS组,并选择同期入住ICU的100例非ARDS患者作为对照。收集患者的一般资料、生命体征、血气分析、血清CC16和sRAGE
  根据1999-2009年春季和秋季黄海南部以及东海的渔业调查资料和捕捞统计资料,分别从小黄鱼群体组成结构和性成熟原则描述了黄海南部、东海北部外海、长江口-舟山海域和浙江
  多溴联苯醚(PBDEs)具有环境持久性、生物积累性和生物毒性,并可通过"蚱蜢效应"在全球范围内远距离传输,是持久性有机污染物(POPs)的一种。目前,PBDEs对海洋环境的影响正
会议
目的:分析助产护理干预对提高高龄产妇自然分娩率的应用价值.方法:选择2018年1月—2019年12月,收治的40例高龄产妇作为研究对象,并分为观察组(20例,接受助产护理干预)和对照