7月22日上午，中央广播电视总台中国国际电视台（CGTN）“全球疫情会诊室”网络直播节目举行了中国、墨西哥专场。北京大学第一医院的三位抗击新冠肺炎的一线医生与来自墨西哥萨尔瓦多•祖比兰国家医学营养研究所的同行们就新冠肺炎患者的救治方法进行交流，并分享经验。 墨西哥疫情依然不容乐观。美国约翰斯•霍普金斯大学数据显示，截止7月22日，墨西哥已确诊新冠肺炎患者超过35万6千例，病亡人数超过4万。 In the latest episode of CGTN's Livestream program "COVID-19 Frontline" held on July 22, CGTN invited three prominent health experts from Peking University First Hospital, one of the top hospitals under China's National Health Commission to exchange experience treating COVID-19 patients with peers from Mexico's National Institute of Medical Sciences and Nutrition Salvador Zubiran. As of July 22, there were over 356,000 confirmed COVID-19 cases in Mexico with over 40,000 deaths, according to Johns Hopkins University. 中国、墨西哥医生们在线交流 如何应对病人激增而导致药物出现紧缺的情况？ 萨尔瓦多•祖比兰国家医学营养研究所灾害应对计划部的胡安•古铁雷斯•梅西亚（Juan Gutierrez Mejia）在节目中提到墨西哥许多医院出现了药物紧缺的情况，有些药物甚至在市场上也很难采购到，他问中国医生们是否遇到过类似情况，以及应当怎样应对。 北大一院呼吸与危重症医学科主治医师胡展维说在武汉疫情暴发早期，也出现过药物短缺的情况，一些基础性治疗药物，例如心脑血管和糖尿病的药物，库存不足。但这种情况随着全国各地援鄂医疗队的抵达和资源调配，很快得到了缓解。 胡医生说，虽然新冠肺炎目前没有特效药物，但辅助性药物对于患者的治疗非常重要，例如抗生素、糖皮质激素等，都是不可或缺的，需要及时补足。 抗凝问题也是目前各国医学专家、医务人员都非常关注的问题。来自同一研究所的呼吸、麻醉、危重症医学部主任吉列尔莫•多明格斯（Guillermo Dominguez）提出，希望中方医生介绍一下在治疗中使用的预防性或者治疗性抗凝剂都有哪些。 北大一院心内科主治医师翁浩宇说，目前很多研究发现危重症新冠肺炎患者中很多出现了肺部和心脏的微小静脉血栓，也有D二聚体升高的现象，这些都是导致患者死亡的原因。他建议在治疗中关注患者的病情发展，如出血的时间等。他提到，中方医生治疗中最常用到的是低子肝素，剂量标准会根据患者病情进行调整。翁浩宇医生在武汉同济医院中法新城院区病房 北大一院副院长李海潮补充说，低分子肝素对于治疗患者出现的血氧不足等症状非常重要。 The use of anticoagulant therapy Carlos Torruco, critical care medicine specialist and attending physician from Mexico, asked about the use of anticoagulant therapy, or treatment plans for patients with blood clots, and which type of prophylactic and therapeutic anticoagulation drug should be used. Weng Haoyu, attending physician at the Department of Cardiology, Peking University First Hospital, answered that studies have found that many critically ill COVID-19 patients develop tiny venous thrombosis in the lungs and heart, as well as elevated D-Dimer levels, which are the causes of death. He suggests focusing on the patient's conditions such as the timing of bleeding, noting that low-molecule-weight heparin is most commonly used by Chinese doctors, and the dosage should be adjusted according to the patient's condition. The shortage of drugs Juan Gutierrez Mejia from the Disaster Reaction Planning Department at the National Institute of Medical Sciences and Nutrition Salvador Zubirán mentioned the shortage of drugs in many Mexican hospitals, some of which were even difficult to obtain in the market. He asked Chinese doctors whether they experienced similar situations and what their solutions were. Chinese attending physician Hu Zhanwei said there was also a shortage of drugs in the early stages of the outbreak in Wuhan. Some basic medications including cardiovascular and cerebrovascular drugs and diabetes drugs were low in stock. However, this situation was soon alleviated with the arrival of medical teams and equipment from all over the country. Dr. Hu said that although there are no specific drugs for COVID-19, drugs such as antibiotics and glucocorticoids are very important for the treatment of patients and should be timely supplemented. 无创正压通气（NPPV）效果如何？ 梅西亚医生提到了负压通风房间内使用高流量鼻氧，以及无创正压通气，并希望中方医生介绍一下患者救治过程中的通气策略。 李海潮副院长介绍，将无创正压通气应用于新冠肺炎治疗也是基于2003年SARS的救治经验，而在使用中，医生们也总结了与有创通气相比，NPPV的一些明显的优势。例如，在治疗过程中，患者可以保持清醒，和医生进行直接交流，而医生也可以观察到患者的基本病情和反应。 除此之外，李海潮说，有些患者血氧过低，此时如果进行插管，容易引起患者的猝死，而无创正压通气可以避免这一点。无创正压通气还可以在普通病房中使用，更加方便。 The effect of noninvasive positive-pressure ventilation (NPPV) Li Haichao, vice president of Peking University First Hospital, director of internal medicine, mentioned the advantages of using noninvasive positive-pressure ventilation compared with invasive mechanical ventilation. For instance, during the NPPV treatment, the patient can stay awake and have direct communication with the doctor, who can observe the patient's basic condition and reaction. In addition, Li said some patients have severe hypoxemia, and intubation at this time is likely to cause sudden death, which can also be avoided by using NPPV. 俯卧位治疗需要注意什么问题？ 墨西哥的医生们提到，在当地医院的ICU，有60%-70%的患者使用俯卧位氧疗，其中一部分患者即使没有接受氧疗，也采用了俯卧位治疗，他们希望中方医生介绍一下这一手段的使用情况。 胡医生介绍，在治疗中，应用俯卧位治疗的患者通常是急性呼吸窘迫综合征（ARDS）患者，以及一些肺部后方有病灶的患者。不是所有患者都能够适应俯卧位治疗的。主持人邹韵主持“全球疫情会诊室” 他对于俯卧位治疗表示赞同，但同时也指出，在中国采用俯卧位治疗的患者，通常需要4名医护人员看护，每4-8小时要帮助患者翻一次身，最长时间不超过12小时；同时，要密切观察患者的呼吸频率，看哪些患者需要回到俯卧位。 李海潮补充说，是否采取俯卧位治疗也要根据患者病情来决定，如果患者肺部磨玻璃阴影较多，患者可能会感到不适。 About prone positioning ventilation The Mexican doctors mentioned that 60 to 70 percent of the patients in the ICU of local hospitals use prone position combined with oxygen therapy. Dr. Hu said in Chinese hospitals, the prone position is usually used in patients with acute respiratory distress syndrome (ARDS) and some patients with lesions in the rear of the lungs. Not all patients are able to adapt to the treatment. At least four staff members are needed to safely position the patient and the duration for proning is no longer than 12 hours. The patient's breathing rate should also be closely monitored. 给墨西哥同行们的建议 在直播节目的最后，萨尔瓦多•祖比兰研究所的医生们还希望中方医生为墨西哥同行们多提一些建议，帮助他们抗击疫情。 胡医生说，希望墨西哥同行们能尽最大可能保护自己，做好个人防护的每一个步骤，他表示，只有做好自我保护，才能救治更多的患者。在治疗建议方面，他的建议是，为患者提供呼吸支持，不要放弃病人，只要坚持足够长时间的治疗，大部分患者都能够好起来。 李海潮副院长说，他知道西方许多国家关于是否应该戴口罩的争议。他说，湖北省最初疫情暴发时，许多医护人员都是在对该疾病不了解，没有做好个人防护的情况下感染的，这也导致武汉市的新冠肺炎病亡率明显高于其他地区。个人防护做得比较好的省份，病亡率一直维持在一个较低的水平。 李海潮说，在北京刚刚结束的这一轮疫情中，由于人们重视了日常防护，只有300多例感染者，疫情很快得到控制。 Advice for Mexican medics Doctors from Mexico's National Institute of Medical Sciences and Nutrition Salvador Zubiran also asked about the advice on fighting COVID-19. Dr. Hu said Mexican doctors to do their best to protect themselves, saying only by doing so could more patients be saved. In terms of treatment, he suggested to provide patients with respiratory support, not to give up on them, as long as the treatment lasts long enough, most patients will get better. Li Haichao mentioned the importance of wearing masks, saying it can significantly reduce the proportion of critically ill patients. In later episodes of "COVID-19 Frontline," more frontline doctors and experts from China 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.