“全球疫情会诊室”：中国与巴西医生交流治疗策略

6月23日晚，中央广播电视总台中国国际电视台（CGTN）的“全球疫情会诊室”网络直播节目举办中国-巴西专场，邀请两国抗疫经验丰富的医生就新冠肺炎患者的治疗策略进行交流讨论。

参与节目的两国嘉宾包括北京协和医院重症医学科副主任周翔，中国中医科学院广安门医院呼吸科主任李光熙，巴西国家医学院院长鲁本斯•贝尔福特（Rubens Belfort），里约撒玛利亚医院院长若泽•卡斯特罗（Jose Eduardo Couto de Castro）等。另外，中国在巴西的中方医学专家代表及中资企业代表也参加了讨论。

周翔是北京协和医院第一批国家援鄂抗疫医疗队的副队长。他于1月26日飞抵武汉，在当地进行了长达92天的工作，主要负责ICU病房重症、危重症患者的救治工作。李光熙也是最早赴鄂支援的中医药学专家之一，两位专家都有丰富的一线抗疫经验。

主持人邹韵在北京演播室

据约翰斯•霍普金斯大学数据，截至6月23日19点，巴西累计确诊新冠肺炎患者已逾114万，单日新增病例接近4万，累计死亡超过5万2千例，仍然处于疫情暴发阶段。

In the latest episodes of CGTN's "COVID-19 Frontline" on Tuesday, June 23, CGTN invited critical care medicine and pulmonary treatment experts from Peking Union Medical College Hospital and Guang'anmen Hospital of China Academy of Chinese Medical Sciences to exchange their experience with their Brazilian counterparts.

Brazil has the second-highest number of confirmed COVID-19 cases in the world behind the United States. To date, there are 1,145,906 COVID-19 cases with 52,645 deaths in Brazil, according to the COVID-19 dashboard by the Center for Systems Science and Engineering at Johns Hopkins University.

巴西的疫情防控和患者治疗

Coronavirus pandemic in Brazil

来自巴西的两位医学专家介绍了巴西疫情发展和患者的救治情况。贝尔福特院长说，巴西第一例确诊病例在2月份被发现，3月份出现了第一例死亡病例。巴西虽然预见到了疫情在国内的暴发，但由于当时国际市场上物资的普遍匮乏，采购检测试剂盒、呼吸机等医疗用品遇到了很大的困难，巴西自主开发试剂盒需要时间，因此初期存在检测不足的情况，也在一定程度上导致了疫情的暴发。

贝尔福特介绍，新冠病毒并未如预期所想，出现热带地区传播力减弱的情况。巴西疫情最严重的亚马逊和东北部地区都是很热的地方。巴西目前采取的防护措施和各国类似，包括社交隔离，戴口罩、勤洗手，加强卫生宣传等。

卡斯特罗院长说，撒玛利亚医院是一家私营医院，从1月份开始为防范疫情做准备，并进行了演练工作，期间吸收了来自中国和欧洲的一些防疫和治疗经验，并对医院容量和床位进行了增建，因此从3月15日接受第一位新冠肺炎患者至今，医院没有出现医护人员因感染而死亡的情况。他希望通过国际交流获得更多的防疫抗疫经验，应对目前的疫情。

中国、巴西专家们参与“全球疫情会诊室”节目

Rubens Belfort, president of the National Academy of Medicine of Brazil, said the first confirmed COVID-19 case in Brazil was reported in February and the first death occurred in March. At that time, many countries had reported the outbreak, and medical materials were in short supply in the international market. So, Brazilian companies began to produce the required materials themselves. The theory that the virus is less contagious in the tropics has been completely disproved in Brazil. The worst COVID-19 hit places in the country are the areas with high temperatures, such as the Amazon area and northeast Brazil.

Now the prevention and control measures that Brazil is taking are similar to those in other countries, like social distancing, wearing masks, washing hands, etc. A lot of tests are also being done in Brazil. The British vaccine is being tested in Brazil, so too is the Chinese vaccine, which is being tested in Sao Paulo, Brazil.

Jose Eduardo Couto de Castro, director of Hospital Samaritano, said in his hospital, of the 3,303 people tested between March 15 and June 15, 1699 people tested positive. He said 338 people were hospitalized in intensive care, and 228 patients were mechanically ventilated. The overall hospital mortality rate reached 12.9 percent. But for the patients in ICU, the mortality rate is 34 percent. For the patients who need assisted ventilation, the mortality rate is as high as 50 percent. "From these figures, you can also see how devastating this unknown disease is. And for us, how difficult it is to treat patients," he said.

无症状感染者如何用药？

Do asymptomatic coronavirus carriers need to be treated?

中国-巴西中医药国际合作基地的周强医生在提问环节时说，接诊中出现了一些治愈患者核酸检测仍呈阳性的情况，也有无症状感染者前来就诊。对于没有临床症状、但核酸检测呈阳性的情况，是否应该继续给患者用药？持续用药是否会造成损害？

李光熙医生说，无症状患者没有必要用药，患者的心理疏导可能更为有效；另外，对于已经治愈的确诊患者，即使核酸检测呈阳性，也不建议服用药物。

周翔医生说，对于长阳的治愈患者，病毒检测方式非常重要，因为确认这一部分人群是否还具有传染性，会不会造成疾病的传播，也是防疫工作的重要环节。他说，仅仅通过PCR测试，无法查出病毒是死是活，因此需要对这部分患者进行病毒全基因组测序和病毒培养的检测方式。

周医生说，根据对武汉很多康复病例的密切追踪和流行病学调查，发现他们当中没有造成再次传染的患者，也没有获得完整的病毒序列。通过这种测试方式，可以确定是否需要继续对患者进行隔离和治疗。这对于患者和患者家庭都是十分必要的。 

Zhou Qiang, director of China-Brazil International Cooperation Base of Chinese Medicine Products, said regarding COVID-19 patients who don't show any symptoms, some doctors said they don't need to be treated with medicine; they just need to stay at home. While others suggest that they take medicine, which may have side effects. So, he wanted to know how to treat asymptomatic patients.

Li Guangxi, director of Respiratory Department of Guang'anmen Hospital of China Academy of Chinese Medical Sciences, answered that there is no need to give drugs to patients who don't have symptoms. Instead, he recommended that patients do more exercise and take care of their mental health. Whether it's traditional Chinese medicine or Western medicine, it's not recommended that they be used long term.

Zhou Xiang, deputy director of Critical Care Medicine at Peking Union Medical College Hospital, added that the virus testing method is very important for cured patients with positive test results to confirm whether they are still infectious. He said PCR can't tell whether the virus is alive or not, whole-genome sequencing and viral culture are also needed for these patients.

关于机械通气策略的探讨

About mechanical ventilation

周翔医生说，巴西医生提到需要机械通气的患者病亡率大约为50%，相对美国纽约州的病亡率而言明显偏低。他希望巴西医生们分享一下在机械通气方面的经验。

对此，卡斯特罗医生表示，巴西在实际治疗中取得的进展也是在国际经验分享的基础上得以实现的。通过吸取其他国家的经验，结合患者救治的实践，巴西的医生们总结出了不要过早进行气管插管以及呼吸机治疗的策略，这也降低了需要机械通气的患者病亡率。他介绍，巴西医生主要采取了低压高流量吸氧的做法。

里约联邦大学医学教授帕特里夏•洛克（Patricia Rocco）补充说，不管是插管还是高流量通气，医生们关注的主要是肌肉的使力。肌肉太使力的情况会导致病变，从而造成严重后果，这是患者病情恶化的一个关键点。

北京协和医院重症医学科副主任周翔在节目中发言

周翔医生也分享了两个中国患者的治疗情况。两位患者都经历了病情恶化到逐渐好转的变化过程，也都采取了气管插管的治疗方法。他介绍，中方的经验是在无创氧疗无效，或者患者病情没有明显改善的情况下，尽快进行有创机械通气。在交流中，他也介绍了中方医生在肺复张和俯卧位治疗方面的经验。

Brazilian doctors mentioned that the mortality rate of COVID-19 patients requiring mechanical ventilation is about 50 percent, which is significantly lower than that of Wuhan in China and New York in the United States. Zhou Xiang asked the Brazilian doctors to share their strategy of mechanical ventilation.

Jose Eduardo Couto de Castro said the progress made in Brazil is achieved on the basis of international experience. By drawing on the experience of other countries and combining with the treatment practice, it's recommended not to do intubation nor mechanical ventilation at an early stage. Brazilian doctors mainly adopt the high-flow oxygen therapy. 

Dr Zhou Xiang also shared the treatment of two Chinese patients, both of whom received intubation. He said that invasive mechanical ventilation should be carried out as soon as possible when non-invasive oxygen therapy is ineffective or the patient's condition has not improved significantly. During the webinar, he also shared the experience of Chinese doctors in the treatment of lung recruitment and prone position.

节目持续了近两小时。巴西医生们一再强调，国际社会的合作交流对于巴西应对新冠肺炎疫情至关重要。贝尔福特院长也表示，希望世界各国都能够从科学的角度看待疫情。只要正确应对，人类一定能够彻底战胜病毒。

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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