China News Service, Beijing, April 25 (Reporter Du Yan) Beijing first reported the diagnosis of new coronary pneumonia cases on January 20. As of 24:00 on April 24, Beijing has reported a total of 174 confirmed cases imported abroad and 118 discharged cases cured; a total of 419 locally confirmed cases and 407 cured discharged cases have been reported. Experts detailed on the 25th how to continue to improve the cure rate, reduce the mortality rate, and prevent patients from turning into heavy and critical.
There are only 3 critical cases left
Beijing New Coronary Pneumonia Critical Care Expert Group Leader and Beijing Tiantan Hospital Vice President Zhou Jianxin said at a press conference held on the 25th that all diagnosed cases accounted for about 20% of severe and critical cases, of which 41 were critically ill patients. Including overseas imports and local patients. At present, local critically ill cases have been "cleared". There are only 3 cases of overseas critically ill cases, aged 67, 65 and 62 years old.
He talked about that in order to continuously improve the cure rate and reduce the mortality rate, Beijing has set up a critical care expert group composed of experts from critical hospitals, cardiopulmonary bypass, traditional Chinese medicine, nursing and other experts from February. Carry out active and effective rescue work.
Strengthen early disease identification
Zhou Jianxin said that the critical illness expert group has fully absorbed the treatment experience of domestic and foreign counterparts, and constantly improved the standardized treatment plan. Among them, strengthen the early recognition of diseases, "about 10 days after the onset of disease is a watershed for disease outcomes, early diagnosis and treatment for changes in blood lymphocytes, inflammatory factors, oxygenation indicators, lung imaging, to prevent patients from becoming severe Conversion. "
Standardize lung protective ventilation strategy
He said that for those who are not effective in conventional oxygen therapy, use nasal high-flow oxygen therapy and non-invasive ventilation, and evaluate lung recruitment and compliance, and standardize the use of lung protective ventilation strategies. In the 41 critically ill patients admitted, prone ventilation was adopted, and the effective rate was more than 90%.
Maintain cyclic stability
He said that critically ill patients have more than one septic shock in the course of treatment, and it is very important to maintain the stability of the circulation. For patients with shock, early volume response assessment and restrictive fluid therapy should be carried out.
Standardize the use of antibiotics
Zhou Jianxin said that patients are prone to secondary bacterial or fungal infections at a later stage, observe the sputum traits and retain them in time for bacteriological cultivation, and formulate anti-infection plans based on specific pathogens.
Management of intestinal function
He also introduced that critically ill patients often have gastrointestinal diffuse ulcers or even bleeding. Through gastrointestinal endoscopy, the bleeding site is clearly identified and the lesion is treated under endoscopy.
Chinese and Western medicine cooperative operations
During the epidemic situation, Beijing gave full play to the advantages of traditional Chinese medicine, treating each patient's core pathogenesis and syndrome differentiation at different stages, and personalized drug delivery. Zhou Jianxin said that in the disease progression period, detoxification, cooling blood and Tongfu diarrhoea are the mainstay, and in the recovery period of the disease, Yiqi Yangyin and tonifying the earth are mainly used. It has a good effect in reducing fever, improving respiratory symptoms, restoring gastrointestinal function, hemostasis and enhancing the physical strength of patients.
Careful care
In the process of treating patients, the nursing expert group developed a number of operating procedures, especially for the management of critically ill patients to adopt cluster management measures, such as the prevention of ventilator-associated pneumonia, pressure injury, and venous thrombosis of the lower extremities. To improve the quality of care.
As the saying goes "three points of treatment, seven points of care". Zhang Zhiyun, director of the nursing department of Beijing Ditan Hospital, said that this sentence is a scientific summary of medical practice and an important link in the treatment of patients with new coronary pneumonia.
She said that since the outbreak, Beijing has established an expert group consisting of multiple intensive care experts from five hospitals to guide the care of critically ill patients through video consultations every day, unify the process standards, carry out assessments, standardize, Standardize and homogenize the care of critically ill patients.
Among them, a nursing plan was developed for each critically ill patient, covering the patient's various treatments, main nursing measures, rehabilitation training and rest, strict planning implementation and handover, regular evaluation of the effect, timely adjustment of the plan, to ensure that critical patients receive Effective care can maximize the recovery of patients.
She said that with the close cooperation of the medical care team, most of the critically ill patients improved, or were transferred to the general ward, or discharged.
Management of critically ill patients during recovery
At present, there is no uniform guideline for extracorporeal membrane oxygenation and hemofiltration. Zhou Jianxin said that the expert group has formulated a daily evaluation of the withdrawal and specific operation procedures for the withdrawal, and the withdrawal will be initiated once the conditions are met. Severe patients often have poor lung compliance after evacuating extracorporeal membrane oxygenation. The expert team conducts spontaneous breathing tests and muscle strength assessments daily, develops personalized rehabilitation programs, and performs early rehabilitation exercises.
Zhou Jianxin emphasized that "one person, one strategy" for critically ill patients. The Severe Expert Group adhered to daily consultations for critically ill patients, and formulated standardized procedures for the treatment of tracheal intubation, prone position ventilation, and extracorporeal membrane oxygenation. At the same time, a daily screening system for ordinary and heavy patients was established, and special personnel were used to screen patients for important indicators such as body temperature, breathing, oxygen, and index, and early warning was provided for potential risks, and early intervention was carried out.
As of April 24, Beijing has successfully removed 4 cases of extracorporeal membrane oxygenation in critically ill patients, the longest use time is 35 days, and the oldest patient is 78 years old; 10 cases of using ventilator alone were removed, the longest use The time was 42 days and the oldest patient was 85 years old. (Finish)