根据计算机断层资料评价病证小容量输液治疗病毒性社区获得性肺炎(COVID-19)的疗效

М. Lynnyk, V. Іgnatieva, G. Gumeniuk, O. Tarasenko, S. Opimakh, I. Chumak, L. Halai, V. Polischuk, N. Vlasova
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引用次数: 3

摘要

背景。在SARS-CoV-2的致病因治疗尚未开发的大流行时期,对社区获得性病毒性肺炎(COVID-19)患者采用综合的个体综合征致病方法治疗是极其重要的。寻找新的常用药物可以影响细胞因子风暴的抑制,消除内皮功能障碍和加速肺的修复过程是相关的。同时,非肠外给药方式提供了最大的生物利用度。对象。根据计算机断层扫描(CT)资料,评价证候致病小容量输液治疗病毒性病因性社区获得性肺炎(COVID-19)的疗效。材料和方法。我们检查了12例病毒性病因性社区获得性肺炎(COVID-19)患者(男9例,女3例,年龄18 ~ 62岁),这些患者在疾病急性期被指定到SI“以乌克兰NAMS F.G. Yanovsky命名的国家细菌学和肺病研究所”治疗。10例患者(男8例,女2例,年龄21 ~ 57岁)2 ~ 3个月前因病毒性社区获得性肺炎(COVID-19)从其他医疗机构转诊至本所。除标准治疗外,所有患者均给予小容量输注治疗,每天1-2次,连用10天:Reosorbilact静脉输注200 ml /天;Xavron(依达拉奉)30mg,用100ml生理盐水稀释,静脉给予;替佛瑞尔(左旋精氨酸和左旋肉碱)静脉输注100毫升/天。胸部CT在Aquilion TSX-101A (Toshiba, Japan)扫描仪上进行对比分析。结果和讨论。治疗前,病毒性病因性社区获得性肺炎(COVID-19)患者在急性期和肺炎后均出现全身性炎症过程,胸部CT显示相同的影像学症状:存在“磨玻璃”和实变。肺实质病变范围为30% ~ 60%。疗程结束后,所有患者的临床效果均为阳性,放射动力学阳性证实了这一点。同时,50%的急性COVID-19患者和40%的COVID-19后综合征患者肺部病理改变完全消退。结论。在患者入院时冠状病毒感染的急性期,建议在小容量输液治疗方案中额外使用依达拉奉、l -精氨酸与左旋肉碱固定联合、高渗晶体溶液等药物进行证候致病治疗。该疗法适用于新冠病毒感染后出现临床症状、全身性炎症实验室参数及胸部CT特征性病理改变的患者。
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Evaluation of the treatment efficacy in the patients with viral etiology community acquired pneumonia (COVID-19) with the use of syndrome-pathogenetic small volume infusion therapy according to computer tomography data
BACKGROUND. In a pandemic, when the etiotropic therapy of SARS-CoV-2 has not yet been developed, a comprehensive individual syndrome-pathogenetic approach to the treatment of patients with community-acquired pneumonia of viral etiology (COVID-19) is extremely important. The search for new commonly available drugs that can affect the inhibition of the cytokine storm, eliminate endothelial dysfunction and accelerate reparative processes in the lungs is relevant. At the same time the parenteral way of administration of the drugs provides the maximum bioavailability. OBJECT. To evaluate the treatment efficacy in the patients with viral etiology community-acquired pneumonia (COVID-19) with the use of syndrome-pathogenetic small volume infusion therapy according to computed tomography (CT) data. MATERIALS AND METHODS. We examined 12 patients (9 men and 3 women aged 18 to 62 years) with viral etiology community-acquired pneumonia (COVID-19), who were appointed for the treatment to the SI “National institute of phthisiology and pulmonology named after F.G. Yanovsky of the NAMS of Ukraine” in the acute period of the disease. 10 patients (8 men and 2 women aged 21 to 57 years) were referred to the institute from other medical institutions, where they were treated for viral etiology community-acquired pneumonia (COVID-19) 2-3 months ago. In addition to standard therapy all patients were additionally prescribed small volume infusion therapy 1-2 times a day for 10 days: Reosorbilact intravenous infusion 200 ml per day; Xavron (edaravon) 30 mg, which was diluted in 100 ml of saline, was administered intravenously; Tivorel (L-arginine and L-carnitine) intravenous infusion 100 ml per day. CT of the chest was performed on a scanner Aquilion TSX-101A (Toshiba, Japan) followed by comparative analysis. RESULTS AND DISCUSSION. Prior to treatment, patients with the viral etiology community-acquired pneumonia (COVID-19) had a systemic inflammatory process in both the acute and post-COVID-19 periods, which according to chest CT showed the same radiological symptoms: the presence of “ground-glass” and consolidation. Lesions of the lung parenchyma ranged from 30 to 60 %. After the course of treatment, all patients had a positive clinical effect, which was confirmed by positive radiological dynamics. At the same time, complete regression of pathological changes in the lungs was observed in 50 % of the patients with acute COVID-19 and in 40 % of the patients with post-COVID-19 syndrome. CONCLUSIONS. In the acute period of coronavirus infection when the patient is admitted to the hospital, it is advisable to additional use of the syndrome-pathogenetic treatment with such drugs: edaravon, a fixed combination of L-arginine and L-carnitine, hyperosmolar crystalloid solution in the regimen of small volume infusion therapy. This therapy can be used for patients in the post-COVID-19 period, when clinical symptoms, laboratory parameters of systemic inflammation, as well as characteristic pathological changes on chest CT present.
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