基层新型冠状病毒感染后病症诊治及照护广东专家推荐意见

doi:10.12114/j.issn.1007-9572.2023.0874

摘要/Abstract

摘要： 新型冠状病毒感染后病症（PCC）定义为在有可能或确诊严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）感染的3个月后，出现无法用其他诊断来解释的、至少持续2个月的症状。PCC是生物学因素、心理学因素及社会文化因素综合作用的结果，具有患病数较多、发病机制复杂、症状多样、长期照护需求大的特点。PCC的诊断被视为排除性诊断，可划分为"非重度COVID-19多器官后遗症""肺纤维化后遗症""肌痛性脑脊髓炎或慢性疲劳综合征""体位性直立性心动过速综合征""重症监护后综合征"和"医学或临床后遗症"6种亚型，在整体性评估的基础上，可在多学科协作的模式下，通过药物、膳食、运动、心理干预、患者教育等方法进行治疗和照护。

关键词: 新型冠状病毒感染后病症, 新型冠状病毒感染, 基层, 诊治, 照护, 推荐意见

Abstract:

Post-COVID-19 condition is defined as the presence of symptoms that cannot be explained by other diagnoses, lasting for at least 2 months, occurring three months after a possible or confirmed SARS-CoV-2 infection. It is the result of a complex interplay of biological, psychological, and sociocultural factors, characterized by a high number of affected individuals, complex pathogenesis, diverse symptoms, and a significant need for long-term care. The diagnosis is considered exclusionary and can be classified into six subtypes, including non-severe COVID-19 multiorgan sequelae, pulmonary fibrosis sequelae, myalgic encephalomyelitis or chronic fatigue syndrome, postural orthostatic tachycardia syndrome, post-intensive care syndrome, and medical or clinical sequelae. Based on comprehensive evaluation, treatment and care can be provided through a multidisciplinary approach involving medication, diet, exercise, psychological interventions, patient education, and other methods.

Key words: Post-COVID-19 condition, COVID-19, Primary care, Diagnosis and treatment, Nursing care, Recommendations

广东省健康管理学会基层医疗及健康教育专业委员会,国家呼吸系统疾病临床医学研究中心,国家呼吸医学中心. 基层新型冠状病毒感染后病症诊治及照护广东专家推荐意见[J]. 中国全科医学, 2024, 27(17): 2045-2063. DOI: 10.12114/j.issn.1007-9572.2023.0874.
Primary Healthcare and Health Education Committee of the Guangdong Provincial Health Management Association,National Clinical Research Center for Respiratory Disease,National Center for Respiratory Medicine. Expert Recommendations on the Diagnosis, Treatment, and Care of Post-COVID-19 Conditions for Primary Health Services: Guangdong Province[J]. Chinese General Practice, 2024, 27(17): 2045-2063. DOI: 10.12114/j.issn.1007-9572.2023.0874.

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亚型	主要特征	主要病理生理学机制
NSC-MOS	新型冠状病毒感染通过各种机制对呼吸系统、心血管系统、神经系统、消化系统、泌尿生殖系统等组织器官产生损害，导致亚临床功能障碍	多个系统器官的组织损伤或全系统失调
PFS	因新型冠状病毒感染和/或因新型冠状病毒感染而接受有创机械通气所导致的肺纤维化	以肺部为突出的广泛组织损伤
ME/CFS	持续至少6个月的严重疲劳（休息后无法缓解）、劳累后不适、未充分休息的睡眠、认知障碍及直立不耐受	免疫和神经系统功能障碍
POTS	直立不耐受，即维持直立时自主神经反应异常而引发一系列症状	自主神经系统功能障碍
PICS	因新型冠状病毒感染入住ICU的患者受到危重症疾病、生命支持治疗、ICU特定环境等因素影响，出现不同程度新发或恶化的生理、心理和认知功能障碍	危重症难以完全康复
MCS	新型冠状病毒感染损害慢性病患者或有慢性病风险者的健康；新型冠状病毒感染大流行导致慢性病的疾病管理中断；新型冠状病毒感染后病症可能导致慢性病患者发生其他慢性病或形成新的慢性病患者群体	健康恶化；慢性病急性加重

亚型	主要特征	主要病理生理学机制
NSC-MOS	新型冠状病毒感染通过各种机制对呼吸系统、心血管系统、神经系统、消化系统、泌尿生殖系统等组织器官产生损害，导致亚临床功能障碍	多个系统器官的组织损伤或全系统失调
PFS	因新型冠状病毒感染和/或因新型冠状病毒感染而接受有创机械通气所导致的肺纤维化	以肺部为突出的广泛组织损伤
ME/CFS	持续至少6个月的严重疲劳（休息后无法缓解）、劳累后不适、未充分休息的睡眠、认知障碍及直立不耐受	免疫和神经系统功能障碍
POTS	直立不耐受，即维持直立时自主神经反应异常而引发一系列症状	自主神经系统功能障碍
PICS	因新型冠状病毒感染入住ICU的患者受到危重症疾病、生命支持治疗、ICU特定环境等因素影响，出现不同程度新发或恶化的生理、心理和认知功能障碍	危重症难以完全康复
MCS	新型冠状病毒感染损害慢性病患者或有慢性病风险者的健康；新型冠状病毒感染大流行导致慢性病的疾病管理中断；新型冠状病毒感染后病症可能导致慢性病患者发生其他慢性病或形成新的慢性病患者群体	健康恶化；慢性病急性加重

筛查工具	目标人群	适用环境	优点	缺点
MUST	≥18岁	医院；社区卫生服务中心	简单快速，适用性较高	无法获得准确体质量的患者不能使用，有效性有待验证
NRS2002	18~90岁	医院	循证医学认证	住院需1 d以上，次日8：00前未行手术，意识清醒者
MNA-SF	≥65岁	医院；社区卫生服务中心	简单快速，无创，多考虑慢性病及相关因素，考虑到体质量不详患者的评估	主观性较强

筛查工具	目标人群	适用环境	优点	缺点
MUST	≥18岁	医院；社区卫生服务中心	简单快速，适用性较高	无法获得准确体质量的患者不能使用，有效性有待验证
NRS2002	18~90岁	医院	循证医学认证	住院需1 d以上，次日8：00前未行手术，意识清醒者
MNA-SF	≥65岁	医院；社区卫生服务中心	简单快速，无创，多考虑慢性病及相关因素，考虑到体质量不详患者的评估	主观性较强

亚型	可能的干预措施
NSC-MOS	个性化、多学科康复计划
PFS	肺康复；高压氧；药物治疗（尼达尼布，吡非尼酮）；中医验方（扶正化瘀方，安络化纤丸）；间充质干细胞
ME/CFS	认知行为疗法（有争议）；分级运动疗法（有争议）；针灸及推拿；药物治疗（止痛药，助眠药，抗抑郁药，辅酶Q10）
POTS	增加液体和盐摄入量；紧身衣/弹力袜；非直立运动；药物治疗（米多君，普萘洛尔，氟氢可的松，抗组胺药，甲基多巴）
PICS	他汀类药物；达比加群；血管紧张素转换酶抑制剂（心血管和肾脏系统的调节药）；SGLT-2抑制剂；二甲双胍；β受体阻滞剂；神经肌肉电刺激；虚拟现实疗法；康复计划
MCS	相关的临床指南