5月25日晚，中央广播电视总台中国国际电视台（CGTN）特别节目“全球疫情会诊室”邀请山东大学齐鲁医院援鄂医务人员与波黑医疗专家就新冠肺炎患者救治的专业问题展开交流讨论，通过视频会议分享疫情防控经验。
波黑巴尼亚卢卡大学医院院长、前塞族共和国卫生部部长兰库·什克尔比奇（Ranko Škrbić）和塞族共和国大学临床中心两位重症监护室主任科瓦塞维奇（Peđa Kovačević），米尔卡·兰德瑞奇（Milka Jandrić）一起参加了交流。
据约翰斯·霍普金斯大学最新数据显示，目前波黑累计确诊新冠肺炎患者2406例，死亡146例。近期疫情已有所缓解，波黑塞族共和国议会于21日通过决议，于23日起取消宵禁，但政府强调，目前仍有新增确诊病例，希望市民做好个人防护。
As the COVID-19 pandemic continues across the globe, different therapies to treat the patients have been the most discussed topics among doctors and medical experts around the world.
On Monday's episode of "COVID-19 Frontline," doctors and experts from Qilu Hospital of Shandong University in east China talked with their counterparts from Bosnia and Herzegovina (BiH) in an online discussion to exchange their experience in treating COVID-19 patients.
After the epidemic broke out in China, Qilu hospital sent to Wuhan a medical team of 131 doctors and nurses experienced in treating patients with severe and multiple complications.
As of May 26, BiH has reported 2,406 COVID-19 cases and 146 deaths.
最有效的抗病毒药物治疗方式是什么？
Antiviral treatment
什克尔比奇教授首先问了抗病毒药物的使用情况，请中方专家介绍中国在新冠肺炎患者救治中使用过的抗病毒药物以及疗效。
波黑巴尼亚卢卡大学医院院长、前塞族共和国卫生部部长兰库·什克尔比奇通过视频会议向中方医生提问齐鲁医院内分泌科副主任侯新国医生介绍，根据中方的诊疗方案，在武汉的临床实践中，使用到了阿尔法干扰素，洛匹那韦/利托那韦，利巴韦林，氯喹和阿比多尔等。侯医生说，在治疗中并未发现其中某一种药物的功效明显强于其他，特别是对于重症和危重症病人，这些药物没有明显疗效。他补充说，内地版诊疗方案建议联合用药不要超过两种，因此没有尝试过三种药物联合使用，但近期香港专家发表的论文中提到，试验证实三种药物联合治疗的效果要明显好于单药治疗，因此他认为目前仍需要进一步研究。侯医生说，目前没有针对新冠病毒的特效药，因此最好的方法是给患者提供足够的支持和营养，控制患者的血糖、血压等指标，确保患者肝功能肾功能正常运转，保持心理健康，提高他们自愈的可能性，并尽可能降低死亡率。Ranko Škrbić, dean of the Department ofPharmacology at University of Banja Luka, asked about the most effective antiviral therapy that has been used in the Chinese hospital against the coronavirus.
Hou Xinguo, Deputy Director of Endocrinology Department at Qilu Hospital, said that several antiviral drugs including alpha-interferon, ribavirin and abidol have been recommended in the COVID-19 diagnosis and treatment guideline issued by China's health authorities. But based on their clinical experience, the antivirals could be useful on patients only at the early stage of infection, as they did not have significant effects on severely ill patients. He added that according to the guideline, no more than two antiviral drugs should be used in combination.Since there is no magic cure for the disease, the best strategy is to give the patients enough supportive care, including sufficient nutrition and efforts to control their underlying conditions such as hypertension and diabetes. Special attention should also be paid to the mental health of patients. All these efforts are aimed at helping patients improve their immunity to fight against the virus, which has helped reduce the mortality rate dramatically in China.Are corticosteroids effective in treating COVID-19?兰德瑞奇医生提到了皮质类固醇的使用情况，在她所在的医院，医生们使用甲强龙，每公斤体重每天1-2毫克，疗程7天左右。她希望了解在何种情况下应用，剂量是多少等具体问题。山东大学齐鲁医院援鄂医护人员与波黑医学专家展开线上交流呼吸与危重症医学科副教授张一说，根据临床经验，皮质类固醇一般不适用于轻症和普通型患者，而只应用于危重症患者。通常在患者无输氧条件下血氧饱和度低于39%时使用，用药和疗程与波黑医生一样，也是甲强龙，每公斤体重每天1-2毫克，疗程7天。张教授说，使用皮质类固醇治疗要特别注意它的副作用，例如真菌感染等，同时，需要观察患者的氧合指标、CT影像，以及患者的炎症反应，例如是否有发热现象或者白介素6升高等症状发生。重症医学科副教授王昊补充说，此前，世界卫生组织曾表示没有证据证明类固醇有效。而根据他的经验，类固醇不能减少急性呼吸窘迫综合征的发病风险，但在两种情况下可以考虑使用，一是出现炎症风暴，病情急剧恶化，CT影像发展较快的患者；另一类是严重急性呼吸窘迫综合征伴随脓毒性休克的患者。Milka Jandrić, head of the Department of Intensive Care for COVID-19 Patients at University Clinical Center of Republika Srpska, asked about the use of corticosteroids - a drug that lowers inflammation inside the body, in the treatment. Zhang Yi, an associate professor at the Respiratory and Critical Care Medicine Department of Qilu Hospital, said they generally did not give corticosteroids to mild patients, but to severe patients, which works. A key indicator for using it is that a patient's oxygen saturation (SaO2) is below 39 percent, he said. But he reminded that special attention should be paid to the drug's side effects, such as fungal infection. Meanwhile, doctors should watch for the patients' oxygenation index, CT imaging results and inflammatory reactions. Wang Hao, an associate professor at ICU of Qilu Hospital, added that the World Health Organization has stated there's no evidence to prove the efficacy of corticosteroids. And based on his experience, the drug cannot reduce the risk of acute respiratory distress syndrome. However, he said, it can be used under two circumstances – when a patient suffers from severe cytokine storm and the condition deteriorates dramatically, and when a patient has severe acute respiratory distress syndrome accompanied with septic shock.Tips for performing prone position ventilation科瓦塞维奇医生的问题是关于需要俯卧位通气的患者，包括如何进行治疗，需要注意哪些方面的问题等。
护理部副主任曹英娟说，在武汉支援期间，机械通气和非机械通气患者中都有使用俯卧位通气的情况，大部分取得了不错的效果。已经有循证医学证据表明，俯卧位通气可以改善重度急性呼吸窘迫综合征患者的氧合，降低死亡率，对患者和医护人员的健康都有帮助。她指出，在使用中就患者安全而言，要避免呼吸机断联，避免皮肤创伤和表皮水肿，并注意观察患者是否会出现迅速的氧合下降和哮喘等症状。而医护人员在操作中要注意防护，穿戴规范的个人防护装备，防止气溶胶传播等。曹主任说，护士还需要特别关注一些有冲突的临床指标，例如血压不稳，骨盆骨折，脊柱骨折，大出血等的状况，并表示，如果护士人手不足，可能会在操作上遇到一些问题。Peđa Kovačević, head of the Clinic for Intensive Care for Non-surgical Branches at University Clinical Center of Republika Srpska, asked about performing prone position ventilation for patients. Cao Yingjuan, Deputy Director of the Nursing Department at Qilu Hospital, said that prone position ventilation has proved to be effective to improve the oxygenation of patients with severe acute respiratory distress syndrome and help to reduce the fatality rate. To ensure the patients remain safe during the process, accidental disconnection of the ventilators, skin injuries and epidermal edema of the patients should be avoided. The medical staff should also watch out if patients have such symptoms as rapid decline of oxygenation index and asthma, she noted. All the medics should wear proper personal protective equipment (PPE) during the whole process, against possible aerosol transmission of the virus.
How to use heparin – a blood thinner兰德瑞奇医生在交流中还问了肝素的使用剂量问题，是应当用治疗剂量，还是普通预防剂量？王昊医生说，援鄂期间，他所在的医院收治的患者大多属于重症或危重症，大部分患者都卧床不起，不能起身行走活动，因此患静脉血栓栓塞的风险很高，针对这部分患者，通常使用低分子肝素，采用预防剂量。如果患者已经出现静脉血栓栓塞的症状，或者有其他的血栓症状，则需要使用治疗剂量。
CGTN主持人焦旸在北京演播室中主持“全球疫情会诊室”他补充说，最近在一则文献中看到，新冠肺炎患者死亡后尸检报告显示患者有肺部血管微血栓，这也说明，如果患者没有冲突反应，应当用低分子肝素来治疗危重症。张一教授提到，根据临床观察，新冠肺炎患者很容易出现D-二聚体升高的情况，因此使用低分子肝素进行抗凝血治疗非常重要。Dr. Jandrić also asked about the use of heparin, which is an anticoagulant (blood thinner) that prevents the formation of blood clots. She wanted to know whether to give the patients preventive dose or therapeutic dose.
Preventive dose of a drug refers to the smallest amount that prevents the occurrence of symptoms, while therapeutic dose means the mount of medication required to treat a disease.Dr. Wang Hao said they mainly treated severe and critically ill patients in Wuhan, who usually faced high risk of venous thromboembolism (VTE) – blood clots in the veins. So generally they gave most of the patients preventive dose of low molecular heparin for the prevention of VTE. But if the patients already had symptoms of VTE, they would give them therapeutic dose of heparin.Dr. Zhang added that based on their observation, anticoagulation treatment with low molecular heparin is very important for severe COVID-19 patients.在交流中，双方还探讨了恢复期血浆疗法、ICU患者体外膜肺氧合的使用，普通民众和医护人员的防护，以及如何预防跨境传播等问题。直播进行了一个多小时。截止目前，CGTN的“全球疫情会诊室”已经举办了近60场直播节目，中国抗疫一线医生已经与三十多个国家的医学专家进行了线上交流。In later episodes of "COVID-19 Frontline," more Chinese frontline doctors and experts will join in to share their experience with their colleagues from other parts of the world. If you have any questions regarding COVID-19, you can share with us using #MyOpinionOnCOVID19 on Facebook.