“全球疫情会诊室”：中国-秘鲁医护人员在线交流

6月3日晚，中央广播电视总台中国国际电视台（CGTN）的特别节目“全球疫情会诊室”举行中国-秘鲁专场，邀请两国医护人员参与视频对话，分享新冠肺炎疫情应对、患者救治经验。

中方三位专家都曾参与过援鄂医疗组，在武汉疫情严重时期，他们通过一线的救治工作，积累了丰富的诊疗、防护经验。秘鲁自3月6日首例新冠肺炎患者确诊后，疫情日趋严重。据美国约翰斯•霍普金斯大学最新数据，目前秘鲁已确诊新冠肺炎患者人数约17.9万，在南美洲国家中仅次于巴西。该国医务人员希望了解中方经验，尽可能救治患者。

中国驻秘鲁使馆政务参赞李昀也参与了交流。她在致辞中表示，希望两国专家通过深入的沟通和交流，为两国的抗疫工作取得进展做出更多贡献。

李参赞说：“当前新冠疫情正在全球蔓延，各国人民的生命健康从来没有像今天这样休戚与共，紧密相连。病毒不分国界，是全人类共同的敌人，只有团结协作，才是国际社会战胜疫情的最有力武器。”

In the latest episode of CGTN's livestream program "COVID-19 Frontline" held on Wednesday, June 3, CGTN invited medics from Shanghai who had served on the front line of the fight against COVID-19 in Wuhan, to share their treatment experience with counterparts in Peru.

Peru has the second-highest number of COVID-19 cases in South America after Brazil. The country recently reported 8,000 new cases of COVID-19 on a single day, taking the nationwide infection case tally to over 170,000, according to WHO.

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应对新冠，现有医院如何进行相应改造？

How can hospitals better prepare for the pandemic?

罗莎•露兹•洛佩兹（Rosa Luz Lopez Martinez）医生来自秘鲁第二大医院吉尔勒莫•阿尔梅纳拉医院（Hospital Guillermo Almenara），是该院新冠肺炎专用ICU的主任。她说秘鲁目前很难新建新冠肺炎定点医院。她问：现有条件下，如何改造医院的设置，避免院内感染，最大程度保护医护人员和其他非新冠肺炎患者？

上海交通大学医学院附属瑞金医院副院长陈尔真说，防止院内感染最关键的是按照传染病防控流程改造医院区域，划分“三区两通道”，即清洁区、污染区、半污染区；医务人员通道和患者通道。陈院长指出，武汉早期疫情非常严重，而传染病定点医院数量有限，因此大部分综合性医院都是按照这一标准，临时改建为定点医院的。

另外，对患者进行分类救治也很重要。陈院长介绍，在中国，新冠肺炎患者按照病情被区分为轻型、普通型，重症和危重症；定点医院主要收治重症、危重症患者，而轻型、普通型患者进入方舱医院接受集中救治。这样既可以有效控制传染性病例的流动，也能集中医疗资源救治患者。

上海交通大学医学院附属瑞金医院副院长陈尔真分享经验

他提到在救治危重症患者的ICU，足够的氧疗设备、供氧设施，例如ECMO等固然重要，但更为关键的是需要大量有ICU专业背景的医护人员。陈院长说，武汉早期有近18,000重症、危重症患者，而全国调配了19,000名左右ICU专业医护人员支援武汉，因此才能将救治成功率控制在84.9%。

Rosa Luz Lopez Martinez, head of the Medicine Department, Hospital Guillermo Almenara, said in Peru there is no COVID-19 designated hospital, but they built a new ICU to relocate COVID-19 patients, so she wanted to know if there were suggestions about patient management.

Chen Erzhen, vice president of Ruijin Hospital Affiliated to Shanghai Jiaotong University Medical College, said they went through a similar situation in Wuhan during the early stages of the epidemic. After all, the number of designated hospitals for infectious diseases is limited. Therefore, Wuhan temporarily changed general hospitals into designated ones for COVID-19 patients. The most critical issue is how to reconstruct the procedures to prevent and control the infectious disease.

"The most critical point is to classify patients with COVID-19 into mild, moderate, severe and critical types. The designated hospitals are mainly for the treatment of severe and critically ill patients. For patients with mild symptoms, they should be encouraged to go to the temporary hospital for treatment. As long as these patients are properly treated and do not have serious complications, the risk of transmission from these patients can be effectively controlled," Dr Chen said.

In addition to equipment, a large number of doctors and nurses specializing in intensive care is also needed. There were nearly 18,000 critically ill patients in Wuhan and a total of 19,000 ICU professionals were dispatched from across China to support Wuhan. More than 15,600 patients have survived after the treatment, with a cure rate up to 84.9 percent. So when the medical resources are scarce, support from other parts of the country is needed, according to Chen.

药物治疗和激素的使用

Medication and use of hormones

在交流中，洛佩兹医生提到患者出现炎症因子风暴的情况下，秘鲁医院使用托珠单抗，以及糖皮质激素等药物，她希望中方医生介绍中国使用药物和激素的情况。

瑞金医院呼吸科副主任李庆云说，在治疗策略上，最重要的是阻止病情恶化，因此中方医生在治疗中发现并总结了一些早期预警指标，包括淋巴细胞的进行性下降，或上升后再次下降；外周血炎症因子，包括白介素6、C反应蛋白的持续上升；乳酸水平进行性增高；CT影像学显示肺部疾病快速进展等。

中国、秘鲁医生参与交流

李主任说，上述综合指标预示着该患者的病情正在恶化，需要对患者生命体征、氧饱和度进行监测，并及时进行治疗。他指出，此时医生需要尽可能早地抑制炎症风暴，防止患者病情从中度转化为重度。

他也介绍了中国诊疗方案中推荐的抗病毒和抗炎症风暴药物，例如阿比多尔、克力芝、氯喹等。根据中国版诊疗方案，联合用药不要超过三种，以避免产生副作用。

激素的使用主要针对氧合指标恶化、影像学迅速进展、机体炎症反应过度激活等情况，使用时一般采用每千克体重1-2毫克小剂量甲强龙，疗程5-7天。他指出，大剂量激素可能会延缓机体对病毒的清除，因此不建议大剂量或长期使用。李主任还介绍了免疫调节和免疫治疗类药物，例如丙种球蛋白、胸腺肽等。

Martinez mentioned the use of Tocilizumab and glucocorticoids as well as other drugs in Peruvian hospitals when treating the patients with cytokine storm. She would like to know how Chinese doctors' medication and the use of hormones.

Li Qingyun, deputy director of Respiratory Department, Ruijin Hospital Affiliated to Shanghai Jiaotong University Medical College, said the most important thing is to prevent the disease from deteriorating. There are indicators during treatment, including progressive decline of lymphocyte, the continuous increase of peripheral blood inflammatory factors, such as interleukin6 and C-reactive protein, increased level of lactic acid and rapid progression of pulmonary diseases shown on CT scan.

Li also introduced the antiviral and anti-inflammatory cytokine storm drugs recommended to use in China, such as arbidol, lopinavir, ritonavir and chloroquine. He mentioned that according to the official guideline, no more than three combined drugs should be used in order to avoid side effects. Besides, high doses or long-term use of hormones are not recommended.

医院哪些区域需要使用负压？

The use of negative pressure space in hospitals 

同样来自吉尔勒莫•阿尔梅纳拉医院的里卡多•伊列斯卡斯•穆乔（Ricardo Illescas Mucha）和几位同事一起参与了交流。他们提到医院CT资源有限，经常需要反复清理，希望了解中方CT室的清洁标准。另外穆乔医生和同事们也提到负压病房的问题，并希望中方医生介绍负压病房在中国医院的使用情况。

陈院长说，负压病房主要用于ICU，因为负压是否能够有效防止院内感染，目前尚存争议，因此在使用中非常慎重。他指出CT室没有必要使用负压，但为了避免检查过程中，不同患者之间产生交叉感染，也必须要做好防控，每次使用完毕，需要用酒精等消毒液对相关设备进行擦拭、喷洒。

另外，所有进入CT室的患者都应当佩戴N95口罩，检查人员也要注意做好个人防护。

Ricardo Illescas Mucha, head of the Medicine Department, Hospital Guillermo Almenara in Peru, said his hospital has limited number of CT equipment. He wanted to know the cleaning procedure for CT rooms and the use of negative pressure rooms in Chinese hospitals. 

Chen Erzhen said whether negative pressure can effectively prevent nosocomial infection remain a controversial issue. It is not necessary to use negative pressure in the CT room, but to avoid cross-infection among patients during the examination, the equipment should be wiped with disinfectants after each use. 

如何有效防止院内感染？

How to prevent nosocomial infections?

穆乔医生和另一位前来参加节目的秘鲁医生胡安•阿尔贝托•桑迪拉纳（Juan Alberto Santillana Callirgos）在交流中都提到院内感染的问题，并希望中方医生分别从医护人员和患者的防护上详细介绍。

主持人邹韵在北京演播室主持节目

上海第一人民医院急诊危重病科主任王瑞兰说，在中国，所有院内感染的防控措施都严格按照国际标准执行。所有医护人员都需要按照三级防控标准操作。

在进入传染病病房之前，所有医护人员必须经过培训，并通过考试。进入污染区之前穿戴防护设备，离开之前脱换和消毒，都有医院岗位防控人员进行全程监督，即使在清洁区，口罩和消毒设备也必不可少。

在患者中，则通过分诊来有效控制疫情传播。疫情期间，所有前来就诊的患者都需要通过核酸检测或影像学检查，排除新冠肺炎感染。疑似感染者需要在发热门诊接受医学观察，直到排除感染的可能性。确诊患者则会转送到定点医院接受治疗。

Juan Alberto Santillana Callirgos, head of the Health Insurance Department, Hospital EsSalud Edgardo Rebagliati Martins in Peru, asked about what should be done to prevent nosocomial infections.

Wang Ruilan, director of Critical Care Medicine, Shanghai General Hospital, said all medical staff must be trained and pass an examination before entering the infectious diseases ward. Even in the clean area, masks and disinfection equipment are essential. Besides, confirmed patients are sent to designated hospitals for treatment. At the same time, hospitals minimize family visits to COVID-19 patients in order to prevent the spread of the virus.

本场直播持续一个多小时。截止目前，“全球疫情会诊室”已经举行了60多场直播，为受疫情影响的各国医护人员提供了沟通和交流的平台。

In later episodes of "COVID-19 Frontline," more frontline doctors and experts from Wuhan 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.

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