新冠肺炎患者的最后时刻，是什么样的？

admin · 发表于 2020-10-14 12:51:01

                  <section data-role="paragraph" data-color="rgb(182, 228, 253)" data-custom="rgb(182, 228, 253)"><section><section><section><section powered-by="gulangu"><section><section><section><section powered-by="gulangu"><section><section><section><section powered-by="gulangu"><section><section><section><section powered-by="gulangu"><section><section><section><section><p><p><img src="image/20201014/86b79d371e9862b01189f0252a03b2cd_1.png" /></p></p></section><section><section><span><strong></strong></span></section><p><span>医疗器械媒体报道先锋</span></p><p><span>分享专业医疗器械知识</span></p></section><section><section><section><span>关注</span></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section><p><br  /></p><section><span>网传一位一线医生的内心话，内文直言，目前治疗新冠肺炎是采“安慰治疗”（支持性治疗），暂时还无真正的特效药，死亡感受超极痛苦，“像淹死一样”。</span></section><section><br  /></section><section><p><img src="image/20201014/0083ce42f2a2ee1bc0c00c1be9792733_2.jpg" /></p></section><section><br  /></section><section><span><strong>1、病人去世前的感受</strong><strong></strong></span></section><section><br  /><span>一直呼吸困难，直到最后几分钟，病人全程清醒。病人会呼救，会哭着喊着说医生你救救我……伴随着剧烈地挣扎，直到呼出最后一口气。</span><br  /><br  /><span>死因：本质上和淹死一个道理。大量的水，进到了肺里面之后，氧进不去。肺被病毒导致的果冻状的分泌物给占满了，换气功能完全丧失。再浓的氧也进不去血里面。而吸痰，做过气管镜的都知道，靠气管镜到达不了那个终末端的地方。另外，没有特效药。</span><br  /><br  /><span><strong>2、开始，把纯氧输送给病人，不经口插管。</strong><strong></strong></span></section><section><br  /><span>维持大概三五天之后，如果他的血氧“饱和度”能上升到正常范围，他也就挺过了呼吸衰竭这一关。</span></section><section><br  /></section><section><span><strong>3、挺不过，就要上无创呼吸机，或者切开气管，插管接有创呼吸机。</strong><strong></strong></span></section><section><br  /></section><section><span>无创呼吸机，最后病人易产生呼吸肌疲劳。</span></section><section><br  /></section><section><span><strong>4、治疗分为四个步骤：</strong><strong></strong></span></section><section><br  /><span>（1）高流氧治疗；</span></section><section><span>（2）不行的话就上无创呼吸机；</span></section><section><span>（3）如果上无创呼吸机两个小时无效，就要气管插管。</span></section><section><span>（4）到最后，如果有条件，就上ECMO（人工心肺机）。李文亮医生最后一晚在抢救的时候，就用ECMO，但还是没能救过来。</span><br  /><br  /><span><strong>5、为什么不给危重病人气管插管？</strong><strong></strong></span></section><section><br  /></section><section><span>每一步都是有前置条件和相应标准的。</span></section><section><br  /></section><section><span>从硬件配套看，进行气管插管的前提条件是要有层流病房，插管之后医护比要达到1:2—3。现状是，医院没有那么多层流病房，综合icu或者部分急诊icu配备了，就算都有也不可能按规范配置人力。</span></section><section><br  /></section><section><p><img src="image/20201014/2140996e3e505ec8a9ad98cc6543e880_3.png" /></p></section><section><br  /></section><section><span><strong>6、如果你说没有这些装置硬上呢？</strong><strong></strong></span></section><section><br  /></section><section><span>我们所有的医生、护士都会中枪。吸痰过程中病人受到刺激，一咳嗽飞沫就直接喷出来了。</span></section><section><br  /></section><section><span>插管之后，就是24小时不间断地喷新冠病毒飞沫，整个房间的空气会被污染。所以，这种高风险、高暴露操作，在一般的病房或者急诊ICU条件稍差的是不允许的，非典留给我们血的教训也不是没有试过～</span></section><section><br  /></section><section><span><strong>7、效果</strong><strong></strong></span></section><section><br  /></section><section><span>重症之后再住院抢救，医院的治疗呼吸机已经没有大的帮助。无论是上无创和上有创呼吸机（插管），对这种病最后的逆转都没有太大的帮助。能救活的，不到10%。只要上了气管插管（有创呼吸机）就不乐观了。</span></section><section><br  /></section><section><span>因为气管插管一方面会增加病人的痛苦，增加机体的刺激，还导致合并呼吸细菌感染。几家专门收重症的定点医院，抢救成功率很低。目前，能高流氧就高流氧，能不插管就不插管。</span></section><section><br  /></section><section><span><strong>8、ECMO是人工心肺</strong><strong></strong></span></section><section><br  /></section><section><span>就是病人的肺坏了，我就搞一个人工肺来代替。肺已经不行了，通过ECMO，只是一天一天的撑下去。</span></section><section><br  /></section><section><span><strong>9、肺“白”了</strong><strong></strong></span></section><section><br  /></section><section><span>肺白了，之后就容易纤维化。纤维化不能逆转，除非肺移植。</span></section><section><br  /></section><section><span><strong><span>10、新冠肺炎的厉害</span></strong><strong><span></span></strong></span></section><section><br  /></section><section><span>一是高传染性，二是目前没有特效药。</span></section><section><br  /></section><section><span><strong>11、如何做好预防：</strong><strong></strong></span><br  /></section><section><br  /><span>1）不要去超市挤长队，不要去楼下抢白菜。</span><br  /><span>2）勤洗手，正确佩戴口罩。</span><br  /><span>3）多吃水果蔬菜，多喝水，适量运动，保证充足睡眠。每天开窗通风两次，每次半小时以上。</span><br  /><span>4）早诊早治，不要把轻症拖成重症。</span><br  /><span>5）保持积极乐观的心态，过度焦虑会影响疗效。</span><br  /><span>6）轻症需要定期复查，排除残留纤维化，避免不可逆。</span></section><section><br  /></section><section><span>最后，国家派了几万医护人员去武汉，说明这个病不好治，也说明国家很重视。但在没特效药的情况下，现在所有的治疗，就是安慰性治疗。</span></section><section><br  /></section><section><p><img src="image/20201014/ec6dc9ae9d7f673d4f02962fcb046ef8_4.jpg" /></p></section><section><br  /></section><section><span>大家还是听钟南山和一线医护人员的话，最近还是少扎堆，疫情会过去的……</span></section><p><br  /></p><section data-role="outer" label="Powered by gulangu"><section 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