医生对冠状病毒持续症状的了解

: By 威廉·佩特里

感谢造访 InnerSelf.com，哪里有 20,000+ 宣传“新态度和新可能性”的改变生活的文章。所有文章均翻译为 30多种语言. 订阅每周出版的《内在自我》杂志和玛丽·T·拉塞尔的《每日灵感》。 InnerSelf杂志 自 1985 年起出版。

杰弗里·麦基洛（Geoffrey McKillop）（前）与他的搭档尼古拉·达莱特·麦科纳吉（Nicola Dallet McConaghie）离开医院，幸免于冠状病毒幸免于难。 利亚姆·麦伯尼（Liam McBurney）/ PA图片（通过Getty Images）

在美国有超过2万例 since the coronavirus pandemic began in late December, there are now many people who have recovered from COVID-19.自从XNUMX月下旬开始发生冠状病毒大流行以来，现在已有许多人从COVID-XNUMX中康复。 At the same, there have been同时，有报告继续从感染中产生长期副作用的人群。我是教授和医师 and I specialize in infectious diseases of adults.我专门研究成年人的传染病。 I not only care for patients with bacterial, parasitic and viral infections - including COVID-19 – but actively teach and perform research into diseases that infectious pathogens cause.我不仅照顾包括COVID-XNUMX在内的细菌，寄生虫和病毒感染的患者，而且还积极教授和研究传染性病原体引起的疾病。

Here I offer a summary of what is known today about recovering from COVID-19 – and where there are important gaps in our knowledge.在这里，我提供了有关从COVID-2003中恢复的已知知识的摘要，以及在我们的知识上还有重要差距的地方。 Much of this information, which has been gleaned from studies that began after the XNUMX SARS outbreak, is important for those recovering and their family and friends who should know what to anticipate.这些信息大部分是从XNUMX年SARS爆发后开始的研究中收集的，对于那些正在康复的人们以及他们的家人和朋友来说应该知道什么是重要的。

混乱或重症监护综合症

r妄的特点是混乱，难以集中注意力，对人，地点和时间的意识降低，甚至无法与他人互动。

r妄不是COVID-19的特定并发症，但不幸的是 ICU护理的常见并发症。 Risk factors in addition to being in the ICU include advanced age and pre-existing illness.除了在重症监护病房中的风险因素，还包括高龄和既往疾病。 Some studies一些研究说多达75％的患者 treated in the ICU experience delirium.在ICU经历experience妄治疗。 The problem is not only with confusion during the hospitalization, but for months after.问题不仅在于住院期间的困惑，而且在于几个月之后。 For example, at three and nine months after discharge many of those who recovered still had difficulty with short-term memory, the ability to comprehend written and spoken words and to learn new things.例如，出院后三个月和九个月，许多康复者仍然难以记忆短期记忆，理解书面和口头语言以及学习新事物的能力。 Some even had difficulty knowing where they were and what today's date was.有些人甚至很难知道他们在哪里以及今天的约会。 And, executive function scores were significantly worse in those who had suffered from delirium.而且，del妄症患者的执行功能评分明显较差。

内科医生正在竭尽全力减少ICU患者的del妄。 Approaches that may help include reducing the use of sedatives, repeated reorientation of the patient to date, time and location, early mobilization, noise reduction and cognitive stimulation.可能有帮助的方法包括减少镇静剂的使用，患者至今，时间和位置的重新定位，早期动员，降低噪音和认知刺激。

肺–会不会出现慢性呼吸急促？

最严重的COVID-19患者通常患有肺炎和急性呼吸窘迫综合征，或者急性呼吸窘迫综合征，病了。 Doctors have not followed patients who have recovered from the new coronavirus long enough to know if there will be long-term problems with breathing.医生对从新冠状病毒中恢复过来的患者的随访时间不足以知道呼吸是否会长期存在问题。

However, a study of health care workers in China who contracted SARS, caused by the SARS-CoV coronavirus which circulated during the 2003 outbreak, are reassuring.然而，一项关于中国医护人员感染SARS的研究令人放心，该人员是由XNUMX年爆发的SARS-CoV冠状病毒引起的。 Lung damage (measured by interstitial changes seen on CT scans of the lung and pulmonary function test results)肺部损伤（通过肺部CT扫描中可见的间质变化和肺功能检查结果来衡量）大部分在病后两年内he愈.

气味和味道

大多数患者 COVID-19失去味觉或气味。 Only a quarter of patients had noted some improvement in a week's time,只有四分之一的患者在一周的时间内注意到了一些改善，但是到了10天，大多数患者已经康复.

感染后疲劳综合征

再说一次可能还为时过早，在最初的SARS爆发中，几乎有一半康复三年后接受采访的幸存者抱怨疲劳.

疾病控制和预防中心诊断慢性疲劳综合征的标准符合四分之一的COVID-19患者。 It will likely be important to target mental health interventions to COVID-19 survivors to help them deal with a prolonged convalescence characterized by fatigue.将心理健康干预措施针对COVID-XNUMX幸存者可能很重要，以帮助他们应对以疲劳为特征的长期康复。

血块

可能会出现血块 in up to a fourth of critically ill COVID-19 patients.在多达四分之一的重症COVID-XNUMX患者中。 Blood clots can cause serious long-term complications if the clots break loose from blood vessels and migrate to the lung and cause a如果血块从血管中松脱并迁移到肺部并引起血栓，可能会导致严重的长期并发症。肺栓塞或去大脑引起中风。

为了防止血块凝结，医师现在正在使用血液稀释剂预防性地增加D-二聚体的浓度，D-二聚体是纤维蛋白的一种片段，一种使血液凝结的蛋白质。

胸襟

在一项研究中，观察到心肌炎称为心肌炎或心肌病。三分之一的重症COVID-19患者。 Arrhythmias – an irregular heartbeat – are also seen.心律不齐-心律不齐-还可以看到。 It is not known if this is due to direct infection of the heart or secondary to the stress caused by the inflammatory response to this infection.尚不知道这是由于心脏的直接感染还是继发于对这种感染的炎症反应引起的压力所致。

最重要的是，尚不清楚幸存者的长期后果。

糖尿病

糖尿病患者发生严重COVID-19的风险增加，这可能部分归因于免疫反应对感染的过度反应.

但是，COVID-19和糖尿病的相互作用也可能朝另一个方向发展。血糖升高 are seen in severe cases of COVID-19 in some patients who do not have a prior history of diabetes.在一些没有糖尿病史的患者中，在严重的COVID-XNUMX病例中可以看到这种现象。 Because the virus因为病毒与血管紧张素转换酶2或ACE2相互作用, on human cells, it is plausible that changes in ACE2 activity could be one cause of diabetes in patients with the new coronavirus.在人类细胞上，ACEXNUMX活性的变化可能是新冠状病毒患者患糖尿病的原因之一。 In any case, it will be important long-term to follow up.无论如何，长期随访很重要。

The bottom line is that the new coronavirus infection has profound effects on many different organ systems in the body.最重要的是，新的冠状病毒感染会对体内许多不同的器官系统产生深远的影响。 The good news is that we expect that the damage caused by COVID-19 will heal in the vast majority of patients.好消息是，我们预计由COVID-XNUMX引起的损害将在绝大多数患者中治愈。 However, it is important to appreciate that some long-term conditions can be anticipated, and prevented or managed to benefit patients.但是，很重要的一点是，可以预见并预防或设法使患者受益的一些长期病情。