Bed rest, pay attention to maintain water and electrolyte balance, avoid exertion and violent coughing. Closely observe changes in the condition (many patients may be in the progressive stage within 2 to 3 weeks after the onset of the disease), and generally give continuous nasal catheter oxygen (oxygen concentration is generally 1 to 3L/min).
Pulse volume oxygen saturation (SpO2) is monitored daily or continuously as needed.
Regular review of blood and urine routine, blood electrolytes, liver and kidney function cardiac enzyme profile, T lymphocyte subpopulations (when available) and X-ray chest radiographs.
(2) symptomatic treatment
1 fever > 38.5 ℃, or generalized pain is obvious, the use of antipyretic and analgesic medicine high fever given ice packs, alcohol baths, cooling blankets and other physical cooling measures for children to prohibit the use of salicylic acid antipyretic and analgesic medicine.
2 cough, sputum can be given to suppress cough, expectorant drugs
3 heart, liver, kidney and other organ function damage should be taken corresponding treatment.
4Patients with diarrhea should pay attention to fluid replacement and correction of water and electrolyte imbalance.
(C) The use of glucocorticoids
The purpose of applying glucocorticoids is to inhibit the abnormal immunopathological reaction and reduce the systemic inflammatory reaction, so as to improve the general condition of the body, reduce the exudative damage to the lungs, and prevent or alleviate the later stage of pulmonary fibrosis. The indications for the application of hormones are as follows: ① severe toxic symptoms persist high fever, the highest temperature still exceeds 39 ℃ after symptomatic treatment for more than 3 days; ② X-ray chest film shows multiple or large shadows, rapid progression of the lesions within 48 hours of the area of the lesion increased > 50% and accounted for more than 1/3 of the total area of the lungs on the orthopnea; ③ to meet the diagnostic criteria of acute lung injury (ALI) or ARDS. One of the above indications can be applied.
The recommended dose for adults is equivalent to methylprednisolone 80-320mg/d administered intravenously. The specific dose can be adjusted according to the condition and individual differences. When the clinical manifestations of improvement or chest X-ray shows the absorption of the shadow in the lungs, gradually reduce the amount of discontinuation of the general every 3 to 5 days to reduce the amount of 1/3, usually intravenous administration of 1 to 2 weeks can be changed Oral prednisone or prednisolone. Usually not more than 4 weeks should not be too large a dose or too long a course of treatment, should be applied at the same time acid-producing agents and gastric mucosal protective agents, should also be vigilant for secondary infections, including bacterial or / and fungal infections, but also to pay attention to the potential spread of tuberculosis foci of infection.
(D) antiviral therapy
Currently no specific drugs have been found for SARS-CoV Clinical retrospective analysis of the data showed that ribavirin and other commonly used antiviral drugs do not have a significant therapeutic effect on this disease. Protease inhibitors such as Kaletra Lopinavir and Ritonavir can be tried
(E) Immunotherapy
Thymidine interferon, gammaglobulin and other non-specific immune enhancers have not yet been confirmed on the efficacy of this disease, and are not routinely recommended for use in the recovery period of SARS serum has not been confirmed. The clinical efficacy of SARS recovery serum has not been confirmed, and it can be tried under close observation in high-risk patients with a clear diagnosis
(F) Use of antimicrobial drugs
The application of antimicrobial drugs aims to two main purposes: one is to be used for the experimental treatment of patients with suspected illnesses in order to help in differential diagnosis; and the other is to be used for the treatment and control of secondary bacterial and fungal infections
Given the fact that SARS is often confused with community acquired pneumonia (CAP), which is a common causative agent of the disease, the use of antimicrobial drugs is not recommended. Given that SARS is often confused with community-acquired pneumonia (CAP), which is commonly caused by Streptococcus pneumoniae, Mycoplasma bovis, and Haemophilus influenzae, new quinolones or β-lactams combined with macrolides may be used for experimental treatment when the diagnosis is unclear. The causative agents of secondary infections include gram-negative bacilli, drug-resistant gram-positive cocci fungi and Mycobacterium tuberculosis, and appropriate antimicrobial drugs should be targeted.
(VII) Psychotherapy
The suspected cases should be reasonably arranged for the admission conditions, to reduce the pressure of the patients worried about the hospital cross-infection; for the confirmed cases, should strengthen the care and explanation to guide the patients to deepen the self-limiting nature of the disease and the understanding of the curability of the disease.
(H) Chinese medicine treatment
This disease is in line with the "Suwen - Assassination Methods", "the arrival of the five epidemics are all infected with each other, no matter how big or small, the disease is similar," the discussion belongs to the category of Chinese medicine plague, fever. Because of the disease because of the epidemic evil from the mouth and nose, the main disease in the lungs, can also involve other organs; the basic mechanism for the evil poison congestion lung damp phlegm stasis obstruction, the lung gas depression, qi yin deficiency deficiency Chinese medicine principle of treatment is early treatment, the importance of dispelling the evil, and early support to prevent the spread of the change.
1 identification and treatment
(1) epidemic poisonous lungs: mostly in the early stage
symptoms: fever or malignant cold; headache, body pain, limb sleepiness; dry cough with little phlegm, or sore throat; shortness of breath, fatigue and dry mouth. White or yellow tongue coating, slippery pulse
Treatment: clearing the lungs and removing toxins, resolving dampness and penetrating evils. Zhi Mu, add Huang Lian Cannon ginger; (5) nausea and vomiting with the addition of the system of half-summer, Zhu Ru.
(2) epidemic poison congestion of the lungs: mostly seen in the early progressive stage.
Symptoms: high fever, sweat and fever, body pain; cough, phlegm, chest tightness, shortness of breath; diarrhea, nausea, vomiting or epigastric distension, or constipation, or loose stools; dry mouth, no desire to drink, shortness of breath, fatigue; or even restlessness. Tongue red or reddish moss yellow greasy, smooth pulse.
Treatment: clearing away heat and removing toxins, promoting lung and resolving dampness.
Basic formula and reference dosage:
Gypsum 45g (first decoction), Zhimo 10g, moxibustion ephedra 6g, silver flower 20g, fried almonds 10g, raw Coix lacryma 15g, zhebei 10g, paisley 10g, raw ganoderma lucidum 10g
Added and subtracted: (1) add Radix Rehmanniae Praeparata, Radix Paeoniae Lactiflorae, and Rhizoma Dandelionis in the case of restlessness and dryness of the tongue, (2) add Radix Rehmanniae Praeparata and Radix et Rhizoma Glycine maxima in the case of shortness of breath and dry mouth. (3) For nausea and vomiting, add Radix et Rhizoma Pinelliae; (4) For constipation, add Psidium Guajava and Rhizoma Rheum; (5) For distension of the epigastric region, add Betel Nut and Wood Fragrance.
(3) Lung closed gasping and suffocating evidence: most common in the progressive stage and severe SARS
Symptoms: high fever does not go down or begins to subside; dyspnea breathlessness chest tightness, wheezing and shortness of breath; or have a dry cough, little sputum or sputum with blood; shortness of breath, fatigue and weakness. Purple lips, red or dark red tongue, yellowish greasy moss, slippery pulse
Treatment: clearing away heat and catharticizing the lungs to dispel blood stasis and resolve turbidity, with supportive measures. Basic formula and reference dosage:
Scapularia hebecarpa hebecarpa 15g, Sangbaipi 15g, Scutellaria baicalensis 10g, Artemisia vulgaris 30g, Curcuma longa 10g, Rhizoma Dioscoreae 12g, Silicea serrata 10g, Danish 15g, septoria 30g, Xixiangshen 15g
Additions and subtractions: (1) shortness of breath, fatigue and wheezing, add Cornus Officinalis; (2) epigastric distension and fullness, poor appetite, add Houpu Maiyao; (3) cyanosis of the lips and lips, add Sanguinarius, The motherwort is also used in the treatment of cyanosis.
(4) internal closure of the external off evidence: seen in severe SARS
Symptoms: respiratory distress, breathlessness, breathing more than inhalation; low speech, disturbed or even dizziness, sweating and cold limbs. Lips and lips purple dark tongue dark red, moss yellow and greasy, the pulse sinking thin to extinction
Treatment: benefit the qi and astringent yin back to the yang fixed off, the turbid open and close.
(5) Qi and Yin deficiency, phlegm and blood stasis blocking the collaterals: mostly seen in the recovery period.
Symptoms: chest tightness and shortness of breath, fatigue, shortness of breath when moving; or cough; conscious fever or low fever and spontaneous sweating, anxiety, insomnia, dullness, dry mouth and throat. The tongue is red with little fluid, the tongue coating is yellow or greasy, and the pulse is mostly subdued and weak.
Treatment: benefiting qi and nourishing yin, resolving phlegm and clearing channels.
Basic formula and reference dosage:
Dangshen 15g Sha Shen 15g Ophiopogon 15g Radix et Rhizoma Dioscoreae 15g Radix Paeoniae Lactiflorae 12g Aster 15g Fructus Zedoariae 10g Fructus Ophiopogon 15g
Added and subtracted: (1) shortness of breath and asthma heavier tongue darkness, add Panax ginseng, schisandra, cornelian cherry meat; (2) self-consciousness of fever or the heart annoys hot tongue darkness, add Artemisiae aristataeum, Gardeniae jasminoides, dandelion; (3) loose stool, add Fu Ling Bai Shu; (4) loose stool, add Poria cocos and Atractylodis japonicus. (3) loose stools plus Poria cocos atractylodes; (4) anxiety plus vinegar Chaihu, Fragrance; (5) insomnia plus fried jujube nut, far Zhi; (6) liver function impairment transaminase elevation plus Yin Chen Wu Wei Zi.
2 Application of proprietary Chinese medicines
The use of proprietary Chinese medicines should be recognized can be applied in combination with Chinese herbal tonics.
(1) antipyretic class: applicable to the early progress of fever, can use gua shang antipyretic spirit capsule, zixue xinxue granules, small zihu tablets (or granules), zi yin oral solution, etc.
(2) clearing heat and detoxification class: applicable to the early progress of the epidemic poison dao lung evidence, the epidemic virus congestion of the lung evidence, lung closure and wheezing evidence of the injections can be used to choose the Qingkailing injection, fritillaries injection, biflavin powder injection compounded Bitter ginseng injection, etc. Oral agent can be used Qingkailing oral liquid (capsule), clearing heat and detoxification oral liquid (granules) Shuanghuanglian oral liquid, Jinlian clearing heat particles, bitter particles of Ge Ge Gen Baicalin and Lian micro-pills, Plum Blossom Tongue Pointing Dan, Zijin Ingot, etc.
(3) blood circulation and eliminate blood stasis and dampness, eliminate phlegm: for the progress of the stage and the severe SARS lung closure of gasping and suffocating evidence. Injections can be used danshen injection, shandan injection chuanxiong injection, dengjian xinxin injection, etc.. Oral agent can be used to blood by blood stasis oral solution (or granules) compound danshen drip pill, patchouli Zhengqi oral solution (capsule), monkey jujube powder, etc.
(4) to support the positive category: for all stages of deficiency of positive qi injections can be used in the injection of the blood pulse injection, ginseng and wheat injection, ginseng and aconite injection, astragali injection, etc.. Oral agent can be used Sheng Vein Drink, Bailing Gum Cadmium Jinshuibao Capsules, Ningxinbao Capsules, Nodikang Capsules Liuweidihuang Pill, tonifying Zhongyiqi Pill and so on.
The principle of treatment of severe SARS
Although most of the SARS patient's condition can be natural remission, but about 30% of the cases belong to the severe cases, some of which may progress to acute lung injury or ARDS, or even death, therefore, the severe patients must be close dynamic observation, strengthen the monitoring, timely respiratory support, rational use of glucocorticoids, strengthen the nutritional support and organ function protection, pay attention to the water and electrolytes. and organ function protection, pay attention to water electrolyte and acid-base balance to prevent and treat secondary infections, and timely management of comorbidities.
1Monitoring and general treatment
General treatment and monitoring of the condition is basically the same as that of non-critical patients, but critically ill patients should also strengthen the monitoring of vital signs, fluid intake and output, electrocardiogram, and blood glucose. When the blood glucose is higher than normal, insulin can be applied to control it in the normal range, which may help to minimize the complications
2Respiratory support treatment
SARS patients should be frequently monitored for SpO2, which is the most common form of respiratory support in the world. SARS patients should be frequently monitored for changes in SpO2 A fall in SpO2 after activity is an early manifestation of respiratory failure and should be given prompt treatment.
(1) Oxygen therapy: continuous nasal cannula oxygen should be given to severe cases even if hypoxia manifests itself in the resting state. Those with hypoxemia usually need a higher flow of inhaled oxygen to maintain SpO2 at 93% or above, and if necessary, mask oxygen should be used should try to avoid activities away from oxygen therapy (e.g., going to the restroom, medical examination, etc.). If the oxygen flow ≥ 5L/min (or inhaled oxygen concentration ≥ 40%) under the condition of SpO2 <93%, but the respiratory rate is still 30 times/min or more, the respiratory load is still maintained at a high level should be considered in a timely manner non-invasive artificial ventilation.
(2) non-invasive positive pressure artificial ventilation (NIPPV): NIPPV can improve the symptoms of respiratory distress to improve the oxygenation function of the lungs, which is conducive to the patient through the danger period, and may reduce the application of invasive ventilation, the application of its indications: ① respiratory rate of > 30 times/min; ② under the condition of oxygen inhalation of 5L / min, SpO2 <93%. Contraindications are: ① life-threatening conditions requiring emergency endotracheal intubation; ② impaired consciousness; ③ vomiting, upper gastrointestinal bleeding; ④ airway secretions and sputum expectoration; ⑤ inability to cooperate with the treatment of NIPPV; ⑥ hemodynamic instability and multiorgan dysfunction.
The commonly used modes of NIPPV and the corresponding parameters are as follows: ①continuous positive airway pressure ventilation (CPAP) commonly used pressure level is generally 4-10cmH2O (1cmH2O = 0.098kPa); ②Pressure Support Ventilation (PSV) + expiratory unpositive pressure ventilation (PEEP), the PEEP level is generally 4-10cmH2O, and the level of inspiratory pressure is usually 10～18cmH2O inhalation oxygen concentration (FiO2) <0.6, should maintain the partial pressure of arterial oxygen (PaO2) ≥70mmHg, or SpO2 ≥93%
The application of NIPPV should pay attention to the following matters: choose the appropriate sealed nasal mask or oro-nasal mask; the whole day of continuous application (including the sleep time) intervals should be shorter than 30 minutes. When applying NIPPV, the pressure level should be gradually increased from low pressure (e.g., 4 cmH2O) to a constant pressure level; when coughing violently, consideration should be given to temporarily disconnecting the ventilator tubing in order to avoid the occurrence of pneumatic injuries; if NIPPV is applied for 2 hours and still fails to achieve the expected results (SpO2 ≥ 93%, shortness of breath improves), consideration can be given to switching to invasive ventilation
(3) Invasive positive-pressure artificial ventilation: the use of positive-pressure artificial ventilation for patients with SARS should be considered as an alternative to the use of NIPPV. The indications for the implementation of invasive positive pressure artificial ventilation in SARS patients are: ① NIPPV treatment intolerance or dyspnea without improvement, unsatisfactory oxygenation improvement, PaO2 <70mmHg and show a trend of deterioration; ② life-threatening clinical manifestations or multi-organ failure, the need for emergency endotracheal intubation resuscitation.
The way and method of establishing an artificial airway should be selected according to the experience of each hospital and the specific situation of the patient in order to shorten the operation time and reduce the chance of cross-infection of the medical personnel involved, transoral intubation or fiberoptic bronchoscopy induced transnasal intubation tracheotomy can be used in the case of strict protection can be carried out only after the establishment of the other artificial airway, in order to ensure the safety.
The specific mode of ventilation for invasive positive-pressure artificial ventilation can be selected according to the hospital equipment and the experience of the clinician, and a pressure-limited mode of ventilation is generally available. For example, in the early stage, pressure-regulated volume-controlled ventilation (PRVC) + PEEP pressure-controlled ventilation (PC) or volume-controlled ventilation (VC) + PEEP can be chosen; after improvement, it can be changed to synchronized intermittent command ventilation (SIMV) + pressure-supportive ventilation (PSV) + PEEP, and before deconditioning, it can be used as PSV + PEEP
The ventilation parameters should be based on the "lung protective ventilation strategy". The ventilation parameters should be set according to the principle of "lung protective ventilation strategy": ① Apply small tidal volume (6-8ml/kg) to increase the ventilation frequency appropriately, and limit the inspiratory plateau pressure to 35cmH2O; ② Add appropriate PEEP to keep the alveoli open and let the atrophied alveoli open up to avoid the tugging injury caused by the alveoli repeatedly closing and opening during tidal breathing. The range of therapeutic PEEP is 5-20 cmH2O with an average of about 10 cmH2O. Attention should also be paid to the effects on the circulatory system due to elevated PEEP.
During ventilation, patients who are uncoordinated and anxious should be adequately sedated and, if necessary, given inotropes to prevent a decrease in oxygenation. The following sedative drugs are available: ① Midazolam Maleate (Midazolam Maleate), first given 3~5mg intravenous injection and then given 0.05~0.2mg Vi-kg-1-h-1 hold. Propofol (Propofol), first given 1mg/kg intravenously and then given 1~4mg-kg-1-h-1 maintenance. On the basis of these can be intermittent use of morphine drugs as needed, if necessary, plus the use of muscle relaxants muscle relaxants can choose Vecuronium Bromide (Vecuronium Bromide) 4mg intravenous injection, if necessary, can be repeated.
3 Application of glucocorticoids
For severe cases and meet the criteria for acute lung injury should be timely and regular use of glucocorticoids, in order to reduce the exudation of the lungs, injury and later pulmonary fibrosis and improve the oxygenation function of the lungs. Currently, most hospitals use an adult dose of methylprednisolone equivalent to 80-320 mg/d, which can be adjusted according to the condition and individual differences. A few critically ill patients may consider short-term (3-5 days) methylprednisolone shock therapy (500 mg/d). When the condition is in remission or/and chest radiographs are absorbed, the dosage can be gradually reduced and discontinued, and generally can choose to reduce the dosage by 1/3 every 3-5 days
4 Clinical nutritional support
Since most of the critically ill patients suffer from malnutrition, early on the patients should be encouraged to eat easy-to-digest food. When the condition deteriorates and normal feeding is not possible, clinical nutritional support should be given in a timely manner using a combination of enteral and extrathoracic nutritional routes, with non-protein calories of 105-126KJ (25-30kcal)-kg-1-h-1, and an appropriate increase in the proportion of fats to reduce the load on the lungs. Medium/long-chain mixed fat emulsion has little effect on liver function and immune aspects. Protein intake is 1 to 1.5 g-kg-1-h-1 Excessive amounts may have adverse effects on liver and kidney function. Water-soluble and fat-soluble vitamins should be supplemented. Try to maintain plasma albumin at normal levels
5Prevention and treatment of secondary infections
Seriously ill patients are usually immunocompromised requiring close monitoring and timely management of secondary infections, and prophylactic anti-infective therapy may be prudent when necessary.
Tracking and management of recovering patients
Follow-up of SARS patients during the recovery period can help to understand the occurrence and severity of physiological dysfunction and psychological disorders, and help to formulate well-targeted treatments and interventions to minimize the adverse effects on patients' physiology and psychology. More importantly, the follow-up of SARS patients during the recovery period will help to understand SARS more comprehensively, and the results will be of great significance in predicting the scale of future SARS epidemics, formulating reasonable preventive and curative measures, and understanding the body's self-repairing pattern after SARS-CoV infection. In the previous period of the treatment of SARS in the mainland of China, it was common to apply a large number of drugs, such as glucocorticoid antiviral drugs, antibacterial drugs, immunomodulators, and so forth. During the follow-up process, attention should be paid to distinguish whether certain abnormalities come from SARS itself or from the therapeutic drugs
(I) Tracking and management of major physiological dysfunctions in patients recovering from SARS
1Lung dysfunction
Preliminary results of the follow-up indicate that a considerable number of SARS patients still retained symptoms of chest tightness, shortness of breath, and difficulty in breathing after activity after being discharged from the hospital, which is a significant problem in severely ill patients. Symptoms, which are particularly common in critically ill patients Review of X-ray chest radiographs and HRCT may reveal varying degrees of pulmonary fibrosis-like changes and lung volume reduction, blood gas analysis may show a decrease in PaO2, and pulmonary function tests may show restrictive ventilatory dysfunction (including total lung volume and residual air volume) and reduced diffusion function usually most pronounced with changes in HRCT. Notably, some recovering patients have post-activity dyspnea but have no abnormalities on X-ray chest radiographs, HRCT and pulmonary function tests. The combination of physical decline after illness and psychological factors may be related to shortness of breath Therefore, SARS patients, especially those with severe disease, should have regular review of PaO2 and pulmonary function (including lung volume, ventilation and diffusion function) in addition to regular review of X-ray chest radiographs and HRCT after discharge from the hospital.
2Hepatic and renal function impairment
Some SARS patients were discharged from the hospital with residual hepatic and renal function impairment, but the cause is still unclear, and the possibility of pharmacological damage cannot be excluded. Among them, liver function abnormalities are more common, mainly manifested as alanine aminotransferase (ALT) and aspartate aminotransferase (AST) abnormalities, most of which are mild and do not need to be dealt with, while a few need liver protection therapy. With the prolongation of the discharge time, generally can recover to normal, rarely left with lasting liver function damage, SARS patients should be discharged from the hospital should be regularly rechecked liver and kidney function until normal or clearly have other causes.
3Osteoporosis and ischemic necrosis of the femoral head
Osteoporosis and ischemic necrosis of the femoral head are not uncommon in patients recovering from SARS, and it has not yet been confirmed that this abnormality is related to the spread of SARS lesions to the bone. The key to preventing and controlling this disease is to control the dose and duration of glucocorticosteroids by strictly controlling the indications for the use of glucocorticosteroids. For patients with long-term high-dose glucocorticoid use, regular review of bone density hip X-ray should be conducted after discharge, especially for patients with osteoarthritic symptoms, and MRI of the femoral head should be performed if necessary for early detection of ischemic lesions of the femoral head.
(II) Psychological disorders and interventions in patients recovering from SARS
1 Characteristics of psychological disorders
According to the results of the existing survey, a considerable portion of the SARS patients still have psychological disorders after discharge from the hospital, which is worthy of attention. The psychological barriers mainly have the following characteristics
(1) Behavioral level
SARS patients do not dare to visit friends and relatives casually as before after recovery for fear of being rejected by others; they do not dare to get close to the crowd when they go out for fear of being infected by other diseases; they are overly concerned about cleanliness after returning home and wash their hands carefully for fear that they will bring home germs and viruses from the outside world; they are very sensitive to their own health condition and are afraid of the after-effects of SARS. They are very sensitive to their own health condition and are afraid of the after-effects of SARS
(2) Emotional level
SARS patients feel inferior, distressed and sad because they have not yet been accepted by their friends and neighbors; they can't forget the horrible experience of having been infected with SARS, and the scenes that come to their minds at all times make them suffer a great deal; they are overly concerned about their own health and keep a high level of vigilance to the outside world, fearing that they may be infected with something again. They are often anxious because they are afraid of the recurrence of similar horrible experiences, and they are distressed by many maladaptive behaviors in their current lives.
(3) Cognitive level
Part of the patients believe that the reason for SARS is that they did not take better protective measures and that the disease is a punishment for themselves; that their friends and coworkers used to be so nice to them, but now they are all ignoring them, and people around them are not accepting them, and society has become a less beautiful place; that SARS will not go away like this, and that it may come back at any time, and that better protective measures must be taken to prevent it. I believe that SARS will not go away and may come back at any time, and that I must take better protective measures to avoid it; I believe that I must still have a lingering illness and therefore I always feel physically sick, and so on.
(4) common psychological disorders
The common psychological disorders of SARS recovery patients include depression, obsessive-compulsive disorder, anxiety disorder, phobia, and post-traumatic stress disorder (PTSD), etc.
These psychological disorders are caused both by the physiological and psychological abnormality caused by the disease itself as well as by the adverse reactions caused by the use of drugs. Especially large doses of long course of application of corticosteroids, after stopping the drug can produce a series of symptoms, such as fatigue mood and so on.
2 Intervention programs for psychological disorders
(1) Outpatient follow-up
The SARS patients who have been discharged from the hospital were followed up by the psychological outpatient clinic on a regular basis to fill out the Symptom Self-assessment Scale (SCL-90), the Post-traumatic Stress Disorder Scale (PTSD), the Self-assessment Scale for Anxiety (SAS), and the Self-assessment Scale for Depression (SDS) to understand their psychological status. To understand their psychological status, and at the same time using interviews to briefly understand whether they need psychological help for each follow-up individual to establish a relatively complete set of mental health files for individuals in need of help to make an appointment to the outpatient clinic for counseling and treatment.
(2) Outpatient psychological counseling and treatment
Individual counseling therapy and group counseling therapy can be used in a combination of targeted solutions to the psychological problems of patients, such as explaining that patients in the recovery period are not infectious. If necessary, medication to improve symptoms can be used in conjunction with psychotherapy. For patients who are unable to come to the outpatient clinic for counseling due to a number of factors, individual counseling and treatment can be provided through telephone counseling.
(3) Group psychological education
After more than one outpatient psychological counseling and treatment, according to the psychological problems of SARS patients in different periods of recovery, we provide targeted group mental health education to help them understand themselves and learn certain self-adjustment methods.
Attached: SARS recovery patients follow-up recommendations
SARS patients should be discharged from the hospital in the conditions of the unit to focus on follow-up patients should be discharged from the hospital 2 months every 2 weeks at least 1 follow-up, 2 months after discharge can be appropriate to extend the follow-up time depending on the individual situation, should be adhered to if necessary, follow-up to 1 year after discharge follow-up program should include: ① clinical symptoms and physical examination; ② general Items: routine blood test, liver and kidney function, electrocardiogram, arterial blood gas analysis, T lymphocyte subpopulation (if available), etc. Items that are normal for two consecutive times may not be reviewed in the next follow-up; ③ Lung function (including volumetric ventilation and diffusion function); ④ X-ray chest radiographs and HRCT (if necessary); ⑤ Bone mineral density, hip X-ray and femoral head MRI (if necessary); ⑥ serum SARS-CoV-specific antibody IgG; ⑥ serum SARS-CoV-specific antibody IgG; ⑥ serum SARS-CoV-specific antibody IgG; and ⑥ serum SARS-CoV-specific antibody. CoV-specific antibody IgG; ⑦ Psychological state evaluation.
Characteristics of SARS in children and considerations for diagnosis and treatment
(I) Characteristics of clinical manifestations
Based on the limited experience of the SARS epidemic in Beijing in 2003, compared with adults, the incidence of SARS in children is relatively low (accounting for 2%-5% of the total number of cases), and the clinical manifestations are milder. Generally there is no serious respiratory failure without mechanical ventilation, no fatal cases and sequelae of pulmonary fibrosis-like changes; less headache, joint and muscle pain and fatigue symptoms; the absorption of lung shadows is more rapid than in adult patients; CD4 +, CD8 + cells are not as serious as in adult patients; there can be mild myocardial and liver damage, but quickly recovered from it. There is no evidence of transmission from children to their family members and other close contacts.
(2) diagnosis and treatment considerations
Children SARS diagnostic principles are the same as those of adults, but SARS other than viral, as well as Mycoplasma pneumoniae pneumonia, Chlamydia pneumoniae pneumonia in children are more frequent, attention should be paid to the exclusion of
Children SARS treatment can be based on the principles of treatment for adults, but children are less likely to need institutional ventilation, prohibit salicylic acid analgesic tie-ups, also should not use thymidine for children. It is also inappropriate to use thymidine for children should be more rigorous control of the use of glucocorticoids indications, dosage and duration of treatment.