1, syndrome differentiation and treatment
(1) the syndrome of epidemic drugs invading the lung: it is more common in the early stage.
Symptoms: fever at first, or aversion to cold; Headache, general pain, and drowsiness of limbs; Dry cough, scanty phlegm, or sore throat; Shortness of breath, fatigue and dry mouth. White or yellow tongue coating, slippery pulse.
Treatment: clearing lung, detoxifying and eliminating dampness.
Basic prescription and reference dose:
Yin Hua 15g warping 15g Scutellaria baicalensis Georgi 10g Bupleurum chinense 10g Artemisia annua 15g cardamom 6g (beaten) fried almonds 9g raw coix seed 15g radix adenophorae 15g reed rhizome/kloc-0.
Add and subtract: (1) mint for those who have no sweat; (2) gypsum and rhizoma anemarrhenae are added in extreme heat; (3) For those with greasy fur, Xiang Lei and Eupatorium odoratum are added; (4) removing Rhizoma Anemarrhenae and adding Rhizoma Coptidis and Rhizoma Zingiberis Preparata; (5) Pinellia ternata and bamboo shavings are added to patients with nausea and vomiting.
(2) Syndrome that the epidemic toxin blocks the lung: it is more common in the early and advanced stages.
Symptoms: high fever, sweating and fever, and general pain; Cough, less phlegm, chest tightness and shortness of breath; Diarrhea, nausea and vomiting, or bloating, or constipation, or loose stool's discomfort; Dry mouth does not want to drink, shortness of breath, fatigue; Even restless. The tongue is red or crimson, the coating is yellow and greasy, and the pulse is slippery.
Treatment: clearing away heat and toxic materials, dispersing lung and eliminating dampness.
Basic prescription and reference dose:
Gypsum 45g (fried first) Anemarrhena asphodeloides 10g moxibustion ephedra 6g honeysuckle 20g fried almond 10g raw coix seed 15g Fritillaria thunbergii 10g pseudostellaria heterophylla 10g raw licorice 10g.
Addition and subtraction: (1) Radix Rehmanniae, Radix Paeoniae Rubra and Cortex Moutan are added for patients with dysphoria, red tongue and dry mouth; (2) For those who are short of breath, weak and thirsty, go to Radix Pseudostellariae and Radix Panacis Quinquefolii; (3) Pinellia ternata is added to patients with nausea and vomiting; (4) Fructus Trichosanthis and Radix et Rhizoma Rhei are added for constipation; (5) Areca catechu and Radix Aucklandiae are added for patients with abdominal distension and loose stool discomfort.
(3) Pulmonary obstruction syndrome: it is more common in advanced and severe SARS.
Symptoms: high fever persists or begins to decline; Dyspnea, chest tightness and shortness of breath; Or dry cough, less sputum, or blood in sputum; Shortness of breath and fatigue, purple and dark lips, red or dark tongue, yellow and greasy fur, and slippery pulse.
Treatment: clearing away heat and purging lung, removing blood stasis and turbidity, strengthening body resistance and consolidating constitution. Basic prescription and reference dose:
Lepidium 15g Mulberry Bark 15g Scutellaria baicalensis Georgi 10g Trichosanthes 30g Curcuma Rhizome 10g Curcuma zedoariae 12g Bombyx Batryticatus 10g (package) Denmark/kloc-
Plus or minus: (1) Cornus officinalis is added for patients with shortness of breath, fatigue and severe asthma; (2) Cortex Magnolia Officinalis and Fructus Hordei Germinatus are added to patients with abdominal distension and anorexia; (3) Oral cyanosis plus Notoginseng Radix and Herba Leonuri.
(4) Internal adduction and external detachment syndrome: seen in severe SARS.
Symptoms: respiratory distress, shortness of breath, hyperventilation and less inspiration; The voice is deep, dry and disturbing, even vaguely, sweating and cold limbs. The lips are purple and dark, the tongue is dark red, the fur is yellow and greasy, and the pulse is heavy and thin.
Treatment: benefiting qi and astringing yin, returning yang to dissipate stagnation, and clearing away turbidity.
Basic prescription and reference dose:
Ginseng Rubra 10 ~ 30g (decocted separately), Radix Aconiti Lateralis Preparata 10g Corni 30g Ophiopogon japonicus 15g Radix Curcumae 10g Radix Notoginseng 6g.
Add and subtract: 1 those who are stunned after taking Angong Niuhuang Pill; (2) cold sweat of the forged keel; Ramulus Cinnamomi and Rhizoma Zingiberis Recens are added for those with cold limbs; 4 add monkey jujube powder to those with phlegm in throat.
(5) Deficiency of both qi and yin, phlegm and blood stasis blocking collaterals syndrome: more common in convalescence.
Symptoms: chest tightness, shortness of breath, fatigue, and asthma when moving; Or see a cough; Conscious fever or low fever, spontaneous sweating, anxiety, insomnia, anorexia, dry mouth and throat. Red tongue with little body fluid, yellow or greasy tongue coating, heavy and thin pulse.
Treatment: Yiqi Yangyin, Huatan Tongluo.
Basic prescription and reference dose:
Codonopsis pilosula 15g Adenophora adenophora 15g Ophiopogon japonicus 15g Radix Paeoniae Rubra 12g Aster 15g Fritillaria thunbergii 10g malt 15g.
Addition and subtraction: (1) Radix Notoginseng, Fructus Schisandrae Chinensis and Fructus Corni are added for patients with shortness of breath, heavy dyspnea and dark tongue; (2) Artemisia annua, Gardenia jasminoides Ellis, and Cortex Moutan are added for patients with spontaneous fever or heart-heat and dark tongue; (3) Poria cocos and Atractylodes macrocephala in loose stool; (4) add vinegar Bupleurum chinense and Cyperus rotundus for anxious people; (5) For patients with insomnia, stir-fried Semen Ziziphi Spinosae and Radix Polygalae are added; (6) Herba Artemisiae Scopariae and Fructus Schisandrae Chinensis are added for patients with liver function injury and elevated transaminase.
2, the application of Chinese patent medicine
Chinese patent medicine should be used dialectically, and can be combined with traditional Chinese medicine decoction.
(1) antipyretic: suitable for early and high fever, and can be selected from Guashuangtuireling capsule, Zi Xue, Xue Xin granule, Xiaozihu tablet (or granule) and Ziyin oral liquid.
(2) Clearing away heat and toxic materials: it is suitable for the early and late stages of epidemic diseases, lung diseases, lung diseases and lung asthma. The injection can be Qingkailing injection, Houttuynia cordata injection, Shuanghuanglian powder injection and compound Sophora flavescens injection. Oral preparations can be Qingkailing oral liquid (capsule), Qingrejiedu oral liquid (granule), Shuanghuanglian oral liquid, Jinlian Qingre granule, Kumou granule, Gegen Qinlian micro pill, Meihua Dianshe pill, purple chip, etc.
(3) Promoting blood circulation, removing blood stasis, eliminating dampness and resolving phlegm: It is suitable for lung obstruction, asthma and asphyxia in the late and severe SARS. The injection can be Danshen injection, Xiangdan injection, Chuanxiong injection and Erigeron breviscapus injection. The oral preparation can be Xuefu Zhuyu oral liquid (or granules), compound Danshen dripping pills, Huoxiang Zhengqi oral liquid (capsules), Houzao powder, etc.
(4) Righteousness category: it is suitable for those with insufficient righteousness in each period. The injection can be Shengmai injection, Shenmai injection, Shenfu injection and Astragalus injection. Oral preparations can be selected from Shengmai Yin, Bering Colloidal Cadmium, Jinshuibao Capsule, Ningxinbao Capsule, Nuodikang Capsule, Liuwei Dihuang Pill, Buzhong Yiqi Pill, etc. Western medicine treatment of SARS
Although the cause of SARS is basically clear, the pathogenesis is still unclear, and the treatment of the cause is still lacking. Based on the above understanding, clinical treatment should focus on symptomatic treatment and complications treatment. At present, the curative effect is not clear, so long-term and high-dose combined use of various drugs (such as antibiotics, antiviral drugs, immunomodulators, glucocorticoids, etc.) should be avoided as far as possible. ).
(1) General treatment and disease monitoring
Stay in bed, pay attention to maintaining water and electrolyte balance, and avoid fatigue and severe cough. Closely observe the changes of the disease (many patients may be in the advanced stage within 2 ~ 3 weeks after onset). Generally, continuous nasal catheter oxygen inhalation is given in the early stage (the oxygen inhalation concentration is generally 1 ~ 3 L/min).
Pulse oxygen saturation (SpO2) was monitored regularly or continuously every day according to the condition.
Check blood routine, urine routine, blood electrolyte, liver and kidney function, myocardial enzyme spectrum, T lymphocyte subsets (if possible) and X-ray chest film regularly.
(2) Symptomatic treatment
1, fever >; If the body temperature is 38.5℃, or the whole body aches obviously, antipyretic and analgesic drugs can be used. Physical cooling measures such as ice compress, alcohol bath and cooling blanket are given to people with high fever, and salicylic acid antipyretic and analgesic drugs are prohibited for children.
2. Cough and expectoration can be given antitussive and expectorant drugs.
3, heart, liver, kidney and other organ dysfunction, corresponding treatment measures should be taken.
4, diarrhea patients should pay attention to rehydration, correct the imbalance of water and electrolyte.
(c) Use of glucocorticoids
The purpose of glucocorticoid application is to inhibit abnormal immunopathological reaction and alleviate the state of systemic inflammatory reaction, so as to improve the general condition of the body, reduce lung exudation and injury, and prevent or alleviate pulmonary fibrosis in the later stage. The application indications are: ① Poisoning symptoms are serious, with persistent high fever. After symptomatic treatment for more than 3 days, the maximum body temperature still exceeds 39℃; ②X-ray chest film showed multiple or large shadows, which progressed rapidly. Within 48 hours, the focus area increased by >: 50% and accounted for more than 1/3 of the total area of both lungs on chest film. ③ Meet the diagnostic criteria of acute lung injury (ALI) or ARDS. It can be applied to one of the above indications.
The recommended dose for adults is equivalent to 80 ~ 320 mg/d of methylprednisolone, and the specific dose for intravenous administration can be adjusted according to the condition and individual differences. When the clinical manifestations improve or the chest radiograph shows that the lung shadow has been absorbed, the drug should be gradually reduced. Generally, the dosage of 1/3 is reduced every 3 ~ 5 days, and oral prednisone or prednisone can be changed after intravenous injection of 1 ~ 2 weeks. Generally, it does not exceed 4 weeks, and it is not advisable to use too much dose or too long a course of treatment. Acidifier and gastric mucosal protective agent should be used at the same time, and secondary infections, including bacterial and/or fungal infections, should be alert, and the spread of potential tuberculosis infections should be noted.
(4) Antiviral therapy
At present, no specific medicine for SARS-CoV has been found. Clinical retrospective analysis shows that ribavirin and other commonly used antiviral drugs have no obvious therapeutic effect on this disease. Try using protease inhibitors, such as Kaletra, Lopinavir and Ritonavir.
(5) immunotherapy
Non-specific immunopotentiators such as thymosin, interferon and gamma globulin have not been proved to be effective in this disease, so routine use is not recommended. The clinical efficacy of serum in the recovery period of SARS has not been confirmed, and it can be tried under close observation for high-risk patients with clear diagnosis.
(vi) Use of antimicrobial agents
Antibacterials are mainly used for two purposes: one is to treat suspected patients by experiment and help differential diagnosis; Secondly, it is used to treat and control secondary bacterial and fungal infections.
In view of the fact that SARS is often confused with community-acquired pneumonia (CAP), which is usually caused by Streptococcus pneumoniae, Mycoplasma and Haemophilus influenzae. When the diagnosis is not clear, we can choose new quinolones or β -lactams combined with macrolides for experimental treatment. The pathogens of secondary infection include Gram-negative bacilli, Gram-positive cocci, fungi and Mycobacterium tuberculosis, and appropriate antimicrobial agents should be selected accordingly.
(7) Psychotherapy
For suspected cases, the admission conditions should be arranged reasonably to reduce the pressure of patients worried about cross-infection in the hospital; For confirmed cases, it is necessary to strengthen nursing and explanation, and guide patients to deepen their understanding of the self-limitation and cure of the disease.
Principles of treatment of severe SARS
Although most SARS patients can be relieved naturally, about 30% of them are severe, and some may progress to acute lung injury or ARDS, or even death. Therefore, close observation, intensive monitoring, timely respiratory support, rational use of glucocorticoids, enhanced nutritional support and organ function protection, attention to water, electrolyte and acid-base balance, prevention and treatment of secondary infections, and timely treatment of complications are necessary for critically ill patients.
1, guardianship and general treatment
General treatment and condition monitoring are basically the same as those of non-severe patients, but the monitoring of vital signs, fluid intake, electrocardiogram and blood sugar should be strengthened in severe patients. When the blood sugar is higher than the normal level, insulin can be used to control it within the normal range, which may help reduce complications.
2. Respiratory support therapy
Patients with severe SARS should always monitor the changes of SpO2. The decrease of SpO2 after exercise is an early manifestation of respiratory failure and should be treated in time.
(1) oxygen therapy: in severe cases, continuous nasal catheter oxygen inhalation should be given even if there is hypoxia at rest. People with hypoxemia usually need a high flow of inhaled oxygen to keep SpO2 _ 2 _ 2 at 93% or above. If necessary, they can choose a mask to inhale oxygen. Try to avoid activities without oxygen therapy (such as going to the toilet and physical examination, etc.). ). If the oxygen flow is greater than or equal to ≥5L/min (or the inhaled oxygen concentration is greater than or equal to 40%), SpO2
(2) Non-invasive positive pressure artificial ventilation (NIPPV): NIPPV can improve the symptoms of dyspnea, improve the oxygenation function of the lungs, help patients through the critical period, and may reduce the application of invasive ventilation. Its application indications are: ① Breathing times > 30 times/minute; ② Under the condition of 5L/min oxygen inhalation, SpO 2
The common modes and corresponding parameters of NIPPV are as follows: ① Continuous positive airway pressure (CPAP), the common pressure level is generally 4 ~10cmh2o (1cmh2o = 0.098kpa); ② Pressure support ventilation (PSV)+ positive expiratory pressure ventilation (PEEP), the PEEP level is generally 4 ~ 10 cmH2O, and the inspiratory pressure level is generally 10 ~ 18 cmH2O. Oxygen concentration of inhaled gas (fio2)
When using noninvasive positive pressure ventilation, we should pay attention to the following matters: (1) choose a suitable sealed nose mask or nose-mouth mask; Continuous application throughout the day (including sleep time), the interval should be less than 30 minutes. At the beginning of application, the pressure level starts from low pressure (for example, 4cmH2O) and gradually increases to a given pressure level; When coughing violently, you should consider temporarily disconnecting the ventilator pipe to avoid air pressure injury; If the expected effect can not be achieved after using NIPPV2 for 2 hours (SpO2≥93%, shortness of breath improved), invasive ventilation can be considered instead.
(3) Invasive positive pressure artificial ventilation: The indications of invasive positive pressure artificial ventilation for SARS patients are as follows: ① Non-invasive positive pressure ventilation is intolerant, or dyspnea is not improved, and oxygenation improvement is not satisfactory, PAO 2.
The way and method of establishing artificial airway should be selected according to the experience of each hospital and the specific situation of patients. In order to shorten the operation time and reduce the chance of cross infection among medical staff, oral intubation or nasal intubation can be induced by fiberoptic bronchoscope under strict protection. Tracheotomy can only be performed if other artificial airways are established in advance to ensure safety.
The specific ventilation mode of invasive positive pressure artificial ventilation can be selected according to the hospital equipment and the experience of clinicians. Generally, pressure-limited ventilation mode can be selected. For example, pressure regulating volume control (PRVC)+PEEP, pressure control (PC) or volume control (VC)+PEEP can be selected in the early stage. After improvement, it can be changed to synchronous intermittent mandatory ventilation (SIMV)+ pressure support ventilation (PSV)+PEEP, and PSV+PEEP can be used before going offline.
Ventilation parameters should be set according to the principle of "lung protective ventilation strategy": ① use a small tidal volume (6 ~ 8 ml/kg), appropriately increase the ventilation frequency, and limit the pressure of inspiratory platform to 35cmH2O②; ② appropriately increase PEEP to keep the alveoli open and open the collapsed alveoli, so as to avoid traction injury caused by repeated opening and closing of alveoli during tidal breathing. The range of PEEP treatment is 5 ~ 5 ~ 20 cmh2o, with an average of about 65438±00 cmh2o. At the same time, we should pay attention to the influence of PEEP increase on the circulatory system.
In the process of ventilation, patients with respiratory disharmony and anxiety should be fully calm, given muscle relaxants when necessary, and prevent the decline of oxygenation function. The following sedatives can be used: ① midazolam, intravenous injection of 3~5mg, and then injection of 0.05 ~ 0.2 mg vitamin? kg- 1？ H- 1 hold. (2) Propofol, 1mg/kg intravenous injection, and then 1 ~ 4 mg? kg- 1？ H- 1 maintenance. On this basis, morphine can be used intermittently as needed, and muscle relaxants can be added when necessary. Vecuronium bromide (4 mg) can be used intravenously as a muscle relaxant and can be reused if necessary.
3. Application of glucocorticoid
For severe cases that meet the standard of acute lung injury, glucocorticoid should be used regularly in time to reduce the exudation and injury of lung and pulmonary fibrosis in the later stage and improve the oxygenation function of lung. At present, the adult dose used in most hospitals is equivalent to 80 ~ 320 mg/d of methylprednisolone, which can be adjusted according to the condition and individual differences. A few critically ill patients can consider short-term (3 ~ 5 days) methylprednisolone pulse therapy (500mg/d). When the disease is relieved or/and absorbed by chest X-ray, gradually reduce the dose and stop using it. Generally, you can choose to reduce 1/3 every 3 ~ 5 days.
4. Clinical nutrition support
Because most severe patients are malnourished, patients should be encouraged to eat digestible food at an early stage. When the illness becomes worse and you can't eat normally, you should give clinical nutrition support in time and combine enteral nutrition with parenteral nutrition. Non-protein heat is 105 ~ 126 kJ (25 ~ 30 kcal)? kg- 1？ H- 1, appropriately increase the proportion of fat and reduce the lung load. Medium/long chain mixed fat emulsion has little effect on liver function and immunity. The input of protein is 1 ~ 1.5g? kg- 1？ Too much H- 1 may have adverse effects on liver and kidney function. Water soluble and fat soluble vitamins should be supplemented. Try to keep the plasma albumin at a normal level.
5. Prevention and treatment of secondary infection
Severe patients usually have low immune function, so it is necessary to closely monitor and deal with secondary infection in time, and if necessary, preventive anti-infection treatment can be carried out cautiously.
Follow-up and treatment of rehabilitation patients
For SARS patients, follow-up in convalescence can help to understand the occurrence and severity of patients' physiological and psychological disorders, help to formulate targeted treatment and intervention measures, and minimize the adverse effects on patients' physiology and psychology. More importantly, the follow-up work of patients in the recovery period of SARS will help to understand SARS more comprehensively, and the results are of great significance to predict the epidemic scale of SARS in the future, formulate reasonable prevention and control measures, and understand the self-repair law of the body after SARS-CoV infection. During the treatment of SARS in Chinese mainland, many drugs were widely used, such as glucocorticoids, antiviral drugs, antibacterial drugs and immunomodulators. Therefore, attention should be paid to distinguish whether some abnormalities come from SARS itself or from therapeutic drugs during the follow-up visit.
(1) Tracking and handling the major physiological dysfunction of SARS patients in recovery period.
1, pulmonary dysfunction
The preliminary follow-up results show that a considerable number of SARS patients still have symptoms such as chest tightness, shortness of breath and dyspnea after exercise after discharge, especially in severe patients. Re-examination of chest X-ray and HRCT can reveal pulmonary fibrosis-like changes and lung volume reduction in different degrees, blood gas analysis can lead to the decrease of PaO2 _ 2, and pulmonary function examination shows that restrictive ventilation dysfunction (including whole lung volume and residual lung volume) and diffusion function decrease. HRCT changes are usually the most obvious. It is worth noting that some convalescent patients have difficulty breathing after exercise, but X-ray chest film, HRCT and pulmonary function examination are normal. Comprehensive physical decline and psychological factors after illness may be related to shortness of breath. Therefore, SARS patients, especially severe patients, should regularly review PaO2 and lung function (including lung volume, ventilation function and diffusion function) in addition to X-ray chest film and HRCT after discharge.
2, liver and kidney function damage
Some SARS patients left liver and kidney function damage after discharge, but the reason is not clear, and the possibility of drug-induced damage cannot be ruled out. Among them, abnormal liver function is more common, mainly manifested as abnormal alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Most of them are mild and do not need treatment, and a few need liver protection treatment. With the extension of discharge time, they can generally return to normal, and rarely leave persistent liver function damage. After leaving the hospital, SARS patients should regularly check their liver and kidney functions until they are normal or have other reasons.
3. Osteoporosis and avascular necrosis of femoral head
Osteoporosis and avascular necrosis of femoral head in convalescence of SARS patients are not uncommon. At present, it has not been confirmed that this abnormal performance is related to the spread of SARS lesions to bones. It mainly occurs in patients who use glucocorticoids in large doses for a long time. The key to prevention and treatment is to strictly grasp the indications of glucocorticoid and control the dose and course of treatment of glucocorticoid. For long-term high-dose glucocorticoid users, bone mineral density and X-ray film of hip joint should be reviewed regularly after discharge, especially for patients with osteoarthrosis symptoms, and MRI examination of femoral head should be carried out when necessary to find ischemic lesions of femoral head early.
Psychological barriers of SARS patients in recovery period and intervention measures
1, characteristics of psychological disorder
Judging from the existing survey results, a considerable number of SARS patients still have psychological barriers after discharge, which deserves attention. Its psychological disorder mainly has the following characteristics.
(1) behavior level
After recovery, SARS patients dare not visit relatives and friends casually as before, for fear of being rejected by others; When you go out, you dare not get close to the crowd, for fear that you may be infected with any disease again; Pay too much attention to cleaning and wash your hands carefully after returning home, so as not to bring home external bacteria and viruses; Very sensitive to their own health, afraid of the emergence of SARS sequelae.
(2) Emotional level
SARS patients feel inferior, distressed and sad because they are not fully accepted by their friends and neighbors. I can't forget the terrible experience of being infected by SARS, and the scenes that appear in my mind from time to time make them miserable; Too much attention to their own health makes them always keep a high degree of vigilance against the outside world, fearing that similar terrible experiences will happen again, so they often feel anxious and distressed about many unsuitable behaviors in their current lives.
(3) Cognitive level
Some patients think that the cause of SARS is that they have not taken protective measures, and getting sick is a punishment for themselves; I feel that my friends and colleagues used to be so kind to me, but now they ignore them, and the people around me don't accept themselves, so the society becomes less beautiful; I believe that SARS will not disappear like this, and it may come again at any time. Better protection measures must be taken to avoid it. I think I must still have a legacy, so I always feel sick and so on.
(4) Common mental illness
The common psychological diseases of SARS patients in convalescence mainly include depression, obsessive-compulsive disorder, anxiety, phobia and post-traumatic stress disorder (PTSD).
These psychological disorders include both physiological and psychological abnormalities caused by the disease itself and adverse reactions caused by drug use. In particular, high-dose and long-term use of corticosteroids will produce a series of symptoms such as fatigue and depression after withdrawal.
2. Mental disorder intervention plan.
(1) Outpatient Follow-up For discharged SARS patients, follow-up is used to make them go to the psychological clinic for regular review, and fill in the symptom checklist 90 (SCL-90), post-traumatic stress disorder survey scale, self-rating anxiety scale (SAS) and self-rating depression scale (SDS) to dynamically understand their psychological status, and at the same time, interview is used to briefly understand whether they need psychological help, so as to establish a relatively complete set of follow-up individuals.
(2) outpatient psychological consultation and treatment
Individual counseling and group counseling can be combined to solve patients' psychological problems, such as explaining that convalescent patients are not infected. If necessary, drugs to improve symptoms can be used in combination with psychotherapy. For patients who can't come to the clinic for consultation due to some factors, individualized psychological consultation and treatment can be carried out by telephone consultation.
(3) collective psychological education
After many outpatient psychological consultations and treatments, targeted collective mental health education was conducted to help SARS patients understand themselves and learn some methods of self-adjustment.
Attachment: Follow-up suggestions for SARS patients in convalescence
SARS patients should be followed up in qualified units after discharge. Patients should be followed up at least once every two weeks within 2 months after discharge 1 time, and the follow-up time should be appropriately extended according to their personal conditions after 2 months, and if necessary, they should be followed up to 1 year after discharge. Follow-up items should include: ① clinical symptoms and physical examination; ② General items: blood routine, liver and kidney function, electrocardiogram, arterial blood gas analysis, T lymphocyte subsets (when conditions permit), etc. Two consecutive normal projects may not be reviewed at the next follow-up; ③ Lung function (including lung volume, ventilation function and diffusion function); ④X-ray chest film and HRCT (if necessary); ⑤ Bone mineral density, X-ray film of hip joint and MRI of femoral head (if necessary); ⑥ Psychological evaluation of serum SARS coronavirus specific antibody IgG⑦ ⑥.
Characteristics of infectious atypical pneumonia in children and matters needing attention in diagnosis and treatment
(1) Clinical features
According to the limited experience of SARS epidemic in Beijing in 2003, compared with adults, the incidence of SARS in children is lower (accounting for 2% ~ 5% of all cases) and the clinical manifestations are lighter. Generally, there is no severe respiratory failure, no need for mechanical ventilation treatment, no death cases and pulmonary fibrosis-like changes; Headache, joint muscle pain and fatigue symptoms are relieved; The absorption of lung shadow is faster than that of adult patients; The decline of CD4+ and CD8+ cells is not as serious as that of adult patients. There may be slight myocardial and liver damage, but it will recover soon. At present, there is no basis for children to spread to family members and other close contacts.
(2) Matters needing attention in diagnosis and treatment
The diagnosis principle of SARS in children is the same as that in adults, but viruses other than SARS, mycoplasma pneumoniae pneumonia and chlamydia pneumoniae pneumonia are more common in children and should be excluded.
The treatment of SARS in children can refer to the treatment principles of adults, but children need less institutional ventilation, salicylic acid is forbidden to reduce fever and relieve pain, and thymosin is not suitable. For children, the indications, dosage and course of treatment of glucocorticoid should be strictly controlled.