[Management of corona virus disease-19 (COVID-19): the Zhejiang experience].
Identifieur interne : 000057 ( Main/Exploration ); précédent : 000056; suivant : 000058[Management of corona virus disease-19 (COVID-19): the Zhejiang experience].
Auteurs : Kaijin Xu [République populaire de Chine] ; Hongliu Cai [République populaire de Chine] ; Yihong Shen [République populaire de Chine] ; Qin Ni [République populaire de Chine] ; Yu Chen [République populaire de Chine] ; Shaohua Hu [République populaire de Chine] ; Jianping Li [République populaire de Chine] ; Huafen Wang [République populaire de Chine] ; Liang Yu [République populaire de Chine] ; He Huang [République populaire de Chine] ; Yunqing Qiu [République populaire de Chine] ; Guoqing Wei [République populaire de Chine] ; Qiang Fang [République populaire de Chine] ; Jianying Zhou [République populaire de Chine] ; Jifang Sheng [République populaire de Chine] ; Tingbo Liang [République populaire de Chine] ; Lanjuan Li [République populaire de Chine]Source :
- Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences [ 1008-9292 ] ; 2020.
Descripteurs français
- KwdFr :
- Antibioprophylaxie, Antiviraux (usage thérapeutique), Chine, Choc, Humains, Infections à coronavirus (), Infections à coronavirus (diagnostic), Infections à coronavirus (psychologie), Infections à coronavirus (épidémiologie), Maladie grave (), Médecine traditionnelle chinoise, Pneumopathie virale (), Pneumopathie virale (diagnostic), Pneumopathie virale (psychologie), Pneumopathie virale (épidémiologie), Soutien nutritionnel, Stress psychologique (), Ventilation artificielle, Équilibre hydroélectrolytique.
- MESH :
- diagnostic : Infections à coronavirus, Pneumopathie virale.
- psychologie : Infections à coronavirus, Pneumopathie virale.
- usage thérapeutique : Antiviraux.
- épidémiologie : Infections à coronavirus, Pneumopathie virale.
- Antibioprophylaxie, Chine, Choc, Humains, Infections à coronavirus, Maladie grave, Médecine traditionnelle chinoise, Pneumopathie virale, Soutien nutritionnel, Stress psychologique, Ventilation artificielle, Équilibre hydroélectrolytique.
- Wicri :
- geographic : République populaire de Chine.
English descriptors
- KwdEn :
- Antibiotic Prophylaxis, Antiviral Agents (therapeutic use), China, Coronavirus Infections (diagnosis), Coronavirus Infections (epidemiology), Coronavirus Infections (psychology), Coronavirus Infections (therapy), Critical Illness (therapy), Humans, Medicine, Chinese Traditional, Nutritional Support, Pneumonia, Viral (diagnosis), Pneumonia, Viral (epidemiology), Pneumonia, Viral (psychology), Pneumonia, Viral (therapy), Respiration, Artificial, Shock, Stress, Psychological (therapy), Water-Electrolyte Balance.
- MESH :
- chemical , therapeutic use : Antiviral Agents.
- geographic : China.
- diagnosis : Coronavirus Infections, Pneumonia, Viral.
- epidemiology : Coronavirus Infections, Pneumonia, Viral.
- psychology : Coronavirus Infections, Pneumonia, Viral.
- therapy : Coronavirus Infections, Critical Illness, Pneumonia, Viral, Stress, Psychological.
- Antibiotic Prophylaxis, Humans, Medicine, Chinese Traditional, Nutritional Support, Respiration, Artificial, Shock, Water-Electrolyte Balance.
Abstract
The current epidemic situation of corona virus disease-19 (COVID-19) still remained severe. As the National Clinical Research Center for Infectious Diseases, the First Affiliated Hospital of Zhejiang University School of Medicine is the primary medical care center for COVID-19 inZhejiang Province. Based on the present expert consensus carried out by National Health Commission and National Administration of Traditional Chinese Medicine, our team summarized and established an effective treatment strategy centered on "Four-Anti and Two-Balance" for clinical practice. The "Four-Anti and Two-Balance"strategy included antivirus, anti-shock, anti-hyoxemia, anti-secondary infection, and maintaining of water, electrolyte and acid base balance and microecological balance. Meanwhile, integrated multidisciplinarypersonalized treatment was recommended to improve therapeutic effect. The importance of early viralogical detection, dynamic monitoring of inflammatory indexes and chest radiograph was emphasized in clinical decision-making. Sputum was observed with the highest positive rate of RT-PCR results. Viral nucleic acids could be detected in10% patients'blood samples at acute periodand 50% of patients had positive RT-PCR results in their feces. We also isolated alive viral strains from feces, indicating potential infectiousness of feces.Dynamic cytokine detection was necessary to timely identifyingcytokine storms and application of artificial liver blood purification system. The "Four-Anti and Two-Balance"strategyeffectively increased cure rate and reduced mortality. Early antiviral treatment could alleviate disease severity and prevent illness progression, and we found lopinavir/ritonavir combined with abidol showed antiviraleffects in COVID-19. Shock and hypoxemia were usually caused by cytokine storms. The artificial liver blood purification system could rapidly remove inflammatory mediators and block cytokine storm.Moreover, it also favoredthe balance of fluid, electrolyte and acid-base and thus improved treatment efficacy in critical illness. For cases of severe illness, early and also short periods of moderate glucocorticoid was supported. Patients with oxygenation index below 200 mmHg should be transferred to intensive medical center. Conservative oxygen therapy was preferred and noninvasive ventilation was not recommended. Patients with mechanical ventilation should be strictly supervised with cluster ventilator-associated pneumonia prevention strategies. Antimicrobial prophylaxis should be prescribed rationally and was not recommended except for patients with long course of disease, repeated fever and elevated procalcitonin (PCT), meanwhile secondary fungal infection should be concerned.Some patients with COVID-19 showed intestinal microbialdysbiosis with decreasedprobiotics such as Lactobacillus and Bifidobacterium. Nutritional and gastrointestinal function should be assessed for all patients.Nutritional support and application of prebiotics or probiotics were suggested to regulate the balance of intestinal microbiota and reduce the risk of secondary infection due to bacterial translocation. Anxiety and fear were common in patients with COVID-19. Therefore, we established dynamic assessment and warning for psychological crisis. We also integrated Chinese medicine in treatment to promote disease rehabilitation through classification methods of traditional Chinese medicine. We optimized nursing process for severe patients to promote their rehabilitation. It remained unclear about viral clearance pattern after the SARS-CoV-2 infection. Therefore, two weeks' quarantine for discharged patients was required and a regular following up was also needed.The Zhejiang experience above and suggestions have been implemented in our center and achieved good results. However, since COVID-19 was a newly emerging disease, more work was warranted to improve strategies of prevention, diagnosis and treatment for COVID-19.
PubMed: 32096367
Affiliations:
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Le document en format XML
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<placeName><settlement type="city">Hangzhou</settlement>
<region type="province">Zhejiang</region>
</placeName>
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</author>
<author><name sortKey="Fang, Qiang" sort="Fang, Qiang" uniqKey="Fang Q" first="Qiang" last="Fang">Qiang Fang</name>
<affiliation wicri:level="1"><nlm:affiliation>the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.</nlm:affiliation>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea>the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003</wicri:regionArea>
<placeName><settlement type="city">Hangzhou</settlement>
<region type="province">Zhejiang</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Zhou, Jianying" sort="Zhou, Jianying" uniqKey="Zhou J" first="Jianying" last="Zhou">Jianying Zhou</name>
<affiliation wicri:level="1"><nlm:affiliation>the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.</nlm:affiliation>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea>the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003</wicri:regionArea>
<placeName><settlement type="city">Hangzhou</settlement>
<region type="province">Zhejiang</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Sheng, Jifang" sort="Sheng, Jifang" uniqKey="Sheng J" first="Jifang" last="Sheng">Jifang Sheng</name>
<affiliation wicri:level="1"><nlm:affiliation>the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.</nlm:affiliation>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea>the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003</wicri:regionArea>
<placeName><settlement type="city">Hangzhou</settlement>
<region type="province">Zhejiang</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Liang, Tingbo" sort="Liang, Tingbo" uniqKey="Liang T" first="Tingbo" last="Liang">Tingbo Liang</name>
<affiliation wicri:level="1"><nlm:affiliation>the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.</nlm:affiliation>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea>the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003</wicri:regionArea>
<placeName><settlement type="city">Hangzhou</settlement>
<region type="province">Zhejiang</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Li, Lanjuan" sort="Li, Lanjuan" uniqKey="Li L" first="Lanjuan" last="Li">Lanjuan Li</name>
<affiliation wicri:level="1"><nlm:affiliation>the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.</nlm:affiliation>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea>the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003</wicri:regionArea>
<placeName><settlement type="city">Hangzhou</settlement>
<region type="province">Zhejiang</region>
</placeName>
</affiliation>
</author>
</analytic>
<series><title level="j">Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences</title>
<idno type="ISSN">1008-9292</idno>
<imprint><date when="2020" type="published">2020</date>
</imprint>
</series>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Antibiotic Prophylaxis</term>
<term>Antiviral Agents (therapeutic use)</term>
<term>China</term>
<term>Coronavirus Infections (diagnosis)</term>
<term>Coronavirus Infections (epidemiology)</term>
<term>Coronavirus Infections (psychology)</term>
<term>Coronavirus Infections (therapy)</term>
<term>Critical Illness (therapy)</term>
<term>Humans</term>
<term>Medicine, Chinese Traditional</term>
<term>Nutritional Support</term>
<term>Pneumonia, Viral (diagnosis)</term>
<term>Pneumonia, Viral (epidemiology)</term>
<term>Pneumonia, Viral (psychology)</term>
<term>Pneumonia, Viral (therapy)</term>
<term>Respiration, Artificial</term>
<term>Shock</term>
<term>Stress, Psychological (therapy)</term>
<term>Water-Electrolyte Balance</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Antibioprophylaxie</term>
<term>Antiviraux (usage thérapeutique)</term>
<term>Chine</term>
<term>Choc</term>
<term>Humains</term>
<term>Infections à coronavirus ()</term>
<term>Infections à coronavirus (diagnostic)</term>
<term>Infections à coronavirus (psychologie)</term>
<term>Infections à coronavirus (épidémiologie)</term>
<term>Maladie grave ()</term>
<term>Médecine traditionnelle chinoise</term>
<term>Pneumopathie virale ()</term>
<term>Pneumopathie virale (diagnostic)</term>
<term>Pneumopathie virale (psychologie)</term>
<term>Pneumopathie virale (épidémiologie)</term>
<term>Soutien nutritionnel</term>
<term>Stress psychologique ()</term>
<term>Ventilation artificielle</term>
<term>Équilibre hydroélectrolytique</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antiviral Agents</term>
</keywords>
<keywords scheme="MESH" type="geographic" xml:lang="en"><term>China</term>
</keywords>
<keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Infections à coronavirus</term>
<term>Pneumopathie virale</term>
</keywords>
<keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="psychologie" xml:lang="fr"><term>Infections à coronavirus</term>
<term>Pneumopathie virale</term>
</keywords>
<keywords scheme="MESH" qualifier="psychology" xml:lang="en"><term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Coronavirus Infections</term>
<term>Critical Illness</term>
<term>Pneumonia, Viral</term>
<term>Stress, Psychological</term>
</keywords>
<keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Antiviraux</term>
</keywords>
<keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Infections à coronavirus</term>
<term>Pneumopathie virale</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Antibiotic Prophylaxis</term>
<term>Humans</term>
<term>Medicine, Chinese Traditional</term>
<term>Nutritional Support</term>
<term>Respiration, Artificial</term>
<term>Shock</term>
<term>Water-Electrolyte Balance</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr"><term>Antibioprophylaxie</term>
<term>Chine</term>
<term>Choc</term>
<term>Humains</term>
<term>Infections à coronavirus</term>
<term>Maladie grave</term>
<term>Médecine traditionnelle chinoise</term>
<term>Pneumopathie virale</term>
<term>Soutien nutritionnel</term>
<term>Stress psychologique</term>
<term>Ventilation artificielle</term>
<term>Équilibre hydroélectrolytique</term>
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<keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>République populaire de Chine</term>
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<front><div type="abstract" xml:lang="en">The current epidemic situation of corona virus disease-19 (COVID-19) still remained severe. As the National Clinical Research Center for Infectious Diseases, the First Affiliated Hospital of Zhejiang University School of Medicine is the primary medical care center for COVID-19 inZhejiang Province. Based on the present expert consensus carried out by National Health Commission and National Administration of Traditional Chinese Medicine, our team summarized and established an effective treatment strategy centered on "Four-Anti and Two-Balance" for clinical practice. The "Four-Anti and Two-Balance"strategy included antivirus, anti-shock, anti-hyoxemia, anti-secondary infection, and maintaining of water, electrolyte and acid base balance and microecological balance. Meanwhile, integrated multidisciplinarypersonalized treatment was recommended to improve therapeutic effect. The importance of early viralogical detection, dynamic monitoring of inflammatory indexes and chest radiograph was emphasized in clinical decision-making. Sputum was observed with the highest positive rate of RT-PCR results. Viral nucleic acids could be detected in10% patients'blood samples at acute periodand 50% of patients had positive RT-PCR results in their feces. We also isolated alive viral strains from feces, indicating potential infectiousness of feces.Dynamic cytokine detection was necessary to timely identifyingcytokine storms and application of artificial liver blood purification system. The "Four-Anti and Two-Balance"strategyeffectively increased cure rate and reduced mortality. Early antiviral treatment could alleviate disease severity and prevent illness progression, and we found lopinavir/ritonavir combined with abidol showed antiviraleffects in COVID-19. Shock and hypoxemia were usually caused by cytokine storms. The artificial liver blood purification system could rapidly remove inflammatory mediators and block cytokine storm.Moreover, it also favoredthe balance of fluid, electrolyte and acid-base and thus improved treatment efficacy in critical illness. For cases of severe illness, early and also short periods of moderate glucocorticoid was supported. Patients with oxygenation index below 200 mmHg should be transferred to intensive medical center. Conservative oxygen therapy was preferred and noninvasive ventilation was not recommended. Patients with mechanical ventilation should be strictly supervised with cluster ventilator-associated pneumonia prevention strategies. Antimicrobial prophylaxis should be prescribed rationally and was not recommended except for patients with long course of disease, repeated fever and elevated procalcitonin (PCT), meanwhile secondary fungal infection should be concerned.Some patients with COVID-19 showed intestinal microbialdysbiosis with decreasedprobiotics such as <i>Lactobacillus</i>
and <i>Bifidobacterium</i>
. Nutritional and gastrointestinal function should be assessed for all patients.Nutritional support and application of prebiotics or probiotics were suggested to regulate the balance of intestinal microbiota and reduce the risk of secondary infection due to bacterial translocation. Anxiety and fear were common in patients with COVID-19. Therefore, we established dynamic assessment and warning for psychological crisis. We also integrated Chinese medicine in treatment to promote disease rehabilitation through classification methods of traditional Chinese medicine. We optimized nursing process for severe patients to promote their rehabilitation. It remained unclear about viral clearance pattern after the SARS-CoV-2 infection. Therefore, two weeks' quarantine for discharged patients was required and a regular following up was also needed.The Zhejiang experience above and suggestions have been implemented in our center and achieved good results. However, since COVID-19 was a newly emerging disease, more work was warranted to improve strategies of prevention, diagnosis and treatment for COVID-19.</div>
</front>
</TEI>
<affiliations><list><country><li>République populaire de Chine</li>
</country>
<region><li>Zhejiang</li>
</region>
<settlement><li>Hangzhou</li>
</settlement>
</list>
<tree><country name="République populaire de Chine"><region name="Zhejiang"><name sortKey="Xu, Kaijin" sort="Xu, Kaijin" uniqKey="Xu K" first="Kaijin" last="Xu">Kaijin Xu</name>
</region>
<name sortKey="Cai, Hongliu" sort="Cai, Hongliu" uniqKey="Cai H" first="Hongliu" last="Cai">Hongliu Cai</name>
<name sortKey="Chen, Yu" sort="Chen, Yu" uniqKey="Chen Y" first="Yu" last="Chen">Yu Chen</name>
<name sortKey="Fang, Qiang" sort="Fang, Qiang" uniqKey="Fang Q" first="Qiang" last="Fang">Qiang Fang</name>
<name sortKey="Hu, Shaohua" sort="Hu, Shaohua" uniqKey="Hu S" first="Shaohua" last="Hu">Shaohua Hu</name>
<name sortKey="Huang, He" sort="Huang, He" uniqKey="Huang H" first="He" last="Huang">He Huang</name>
<name sortKey="Li, Jianping" sort="Li, Jianping" uniqKey="Li J" first="Jianping" last="Li">Jianping Li</name>
<name sortKey="Li, Lanjuan" sort="Li, Lanjuan" uniqKey="Li L" first="Lanjuan" last="Li">Lanjuan Li</name>
<name sortKey="Liang, Tingbo" sort="Liang, Tingbo" uniqKey="Liang T" first="Tingbo" last="Liang">Tingbo Liang</name>
<name sortKey="Ni, Qin" sort="Ni, Qin" uniqKey="Ni Q" first="Qin" last="Ni">Qin Ni</name>
<name sortKey="Qiu, Yunqing" sort="Qiu, Yunqing" uniqKey="Qiu Y" first="Yunqing" last="Qiu">Yunqing Qiu</name>
<name sortKey="Shen, Yihong" sort="Shen, Yihong" uniqKey="Shen Y" first="Yihong" last="Shen">Yihong Shen</name>
<name sortKey="Sheng, Jifang" sort="Sheng, Jifang" uniqKey="Sheng J" first="Jifang" last="Sheng">Jifang Sheng</name>
<name sortKey="Wang, Huafen" sort="Wang, Huafen" uniqKey="Wang H" first="Huafen" last="Wang">Huafen Wang</name>
<name sortKey="Wei, Guoqing" sort="Wei, Guoqing" uniqKey="Wei G" first="Guoqing" last="Wei">Guoqing Wei</name>
<name sortKey="Yu, Liang" sort="Yu, Liang" uniqKey="Yu L" first="Liang" last="Yu">Liang Yu</name>
<name sortKey="Zhou, Jianying" sort="Zhou, Jianying" uniqKey="Zhou J" first="Jianying" last="Zhou">Jianying Zhou</name>
</country>
</tree>
</affiliations>
</record>
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