世界針灸學會聯合會

(CN/EN)中英雙語:國際抗疫大講堂李光熙教授在線答疑整理

作者:世界針聯 來源:世界針聯 點擊:1576次 更新:2020-04-14
  

  由世界針灸學會聯合會、中華中醫藥學會、中國針灸學會主辦的「國際抗疫專家大講堂系列講座」第四講,我們邀請到了國家衛健委新冠肺炎專家組成員、中國中醫科學院廣安門醫院呼吸科主任李光熙舉行英文專場,以“治療要點——預防急性肺損傷(Preventing Acute Lung Injury-Essentials of Treatment)”為題。為發揮世界針聯的多語種優勢,本場講座還特別開通了中英雙語通道,得到了來自20多個國家的2867人參與。在答疑環節,李光熙教授解答了國內外醫生關切的問題,匯總如下:

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Q1-Dr. Deng(Medical Director of the BendheimIntegrative Medicine Center at MSKCC): What are the criteria specifically for initiating IPPV (Intermittent Positive Pressure Ventilation)? 

問題1-鄧博士(紐約斯隆腫瘤中心整合醫學中心醫務主任):啟動呼吸機間歇正壓通氣模式的特殊指標有哪些?

Dr. Li : Depends on the patient’s saturation, according to our experience, once a patient basically gets a good saturation with a high flow of nasal oxygen support, that’s very important. Usually we give the patients about 65% or 70% FiO2, the device is high nasal flow of oxygen support. But if it still did not work, after three hours, the patient is still in bad situation, never reach 93%. Also the patient usually has a very strong cough, as you know, plus the fever. We must consider to interfere the patient as early as possible. We need to pay attention to the frequency of cough when the patient rests. I believe this is strong indicator for using ventilation. After strong cough, patients usually have very bad saturation, usually maybe decrease to 75% even.

李光熙博士:根據我們的經驗,這取決于患者的血氧飽和度,重要的是在經鼻高流量氧療支持下,患者基本能達到良好的指端氧飽和度。通常我們給病人約65%或70%的氧氣,該裝置是經鼻高濃度的氧氣支持。但是如果三個小時后病人氧飽和度仍舊不好,那么狀況會繼續惡化,再也達不到93%的血氧飽和度。當病人咳嗽得很厲害,還伴有發燒時,我們必須考慮盡早對病人干預,病人休息時咳嗽的頻率也要關注。我認為這是使用呼吸機間歇正壓通氣的重要指征。劇烈咳嗽后,患者的氧飽和度通常很差,通常甚至可能下降到75%。

Q2-Dr. Deng: The second question is because in the United States, there is a shortage of hospital beds, so a lot of patients has mild symptoms, were discharged to home for quarantine, even though when they have symptoms, such as low grade fever, some cough, some fatigue. You mentioned the key factors are to watch for high fever, dry cough and dyspnea. Unfortunately a lot people do not have the ability to monitor their ox-meter at home. So when you say high fever, is there any specific number? 38, 39 or 39,5 degree Celsius, anything like that?

問題2-鄧博士:第二個問題是在美國,因為醫院床位短缺,很多癥狀較輕的患者,即使存在低燒,咳嗽,乏力等癥狀,也要出院居家隔離。您提到要特別注意發熱,干咳和呼吸困難。不幸的是,很多人不能在家使用血氧儀監測。所以,您說到的高熱是不是有具體數字?比如38、39或39.5度? 

Dr. Li: Yes, so the criteria for high fever is more than 39 Celsius, which is very bad. That’s because of disease is usually like that—on the first 1 or second day, patients only have low degree fever, for example it’s usually less than 38.3 Celsius, but maybe after 3 to 5 days, the fever suddenly goes up. The temperature can be up more than 39.5 Celsius. So this stage is very dangerous. During that stage we need (to treat) the patient as early as possible. In China, most patients have the ox meter, maybe in New York they don’t have. In that case, you need to ask the patients to watch how much they can walk? How much distance they walk? And how is the movement? How is the activity related with cough? This correlation it’s usually tightly correlated, the patients usually walk, and then they cough, so that means some very strong indicator for the crucial disease. 

李光熙博士:高熱是指腋窩溫度在39℃到40℃之間,這是非常糟糕的。那是因為新冠肺炎在第一天或第二天通常只會出現低于38.3攝氏度左右的中等度熱,但在第三天到第五天后可能突然升高到39.5℃以上。這個階段非常危險,我們需要盡早治療。在中國,大多數患者都有血氧儀,也許在紐約他們沒有。在這種情況下患者需要注意他們能不能走路?能走多遠?活動與咳嗽是否有關?這種相關性通常是緊密的,患者如果走著走著就咳嗽了,這意味著該病人進入到加重階段了。

Q3-Dr. Deng: Very few people in the United States have home-oxygen- monitoring ox-meter. There was a saying about the patients: if you can take a deep breath, and hold the breath for 5 seconds, or 10 seconds, you are alright. If you cannot hold your breath for 5 seconds or 10 seconds, you have probably desaturation or dyspnea, then you may go to the hospital. Is there any adaptability like any of that?

問題3-鄧博士:在美國,很少有人擁有家用氧氣監測血氧儀。關于測試有個方法說是:如果您可以深呼吸,屏住呼吸5秒鐘或10秒鐘,您就沒事了;如果您無法屏住呼吸5秒鐘或10秒鐘,則您的血氧飽和度低或有呼吸困難,需要醫院治療。這些適用嗎?

Dr. Li: I think that the problem is at that stage, it’s little bit late. I still think you need to ask patients to do some activities, for example, to go to the restroom, if they go to restroom, and cough will increase, that’s the dangerous sign. 

李光熙博士:我認為到了那個階段會有些晚了,活動時候咳嗽增加,例如去洗手間咳嗽增加就是很危險的信號。

Dr. Deng: That’s very helpful. To summarize high temperature of people in home quarantine is about 37.3 Celsius.

鄧博士:非常有幫助,歸納一下,在家隔離的發熱程度大約是37.3℃。

Dr. Deng: Dry cough especially when induced activities, or in short time dyspnea upon light activities, these are indications for acute phase and they should go to the hospital, are they all correct?

鄧博士:干咳,特別是在活動時誘發咳嗽,或在輕微活動中出現短暫的呼吸困難,這些都是疾病急性加重的征兆,應該去醫院,對嗎?

Dr. Li: I think so, correct. 

李光熙博士:我是這樣認為的。

Q4-Dr. Deng: The last question I have is about protection of medical personnel both in the intervention setting and more importantly in the regular care of the patients. I know in China, all these COVID-19 patients are coordinated into the hospital or floor. While here we are unable to do that, so patients still stay in the rooms, so they exercise droplet precaution basically mask, face shield and very light gown. And I see in China, people wear health mask like overall from top to the bottom, from head to shoes. Do you think that kind of protection is overdo or appropriate, or should be done?

問題4-鄧博士:我最后一個問題關于醫護人員防護程度,包括在呼吸介入環境中的防護,以及更重要的對患者的日常護理的防護。所有這些新冠肺炎患者在中國都安排進入醫院或(隔離)樓層。在這里我們無法做到這一點,所以病人仍在普通病房里,醫護人員對飛沫的防護基本上是口罩、面罩和薄薄的防護服。我看到在中國使用的是從頭到腳的全身防護服。您認為這樣的防護措施是過度的,適當的,還是應該采取的?

Dr.Li: I think you know regarding intervention situation is very dangerous procedure, and you must protect yourself very strictly, even though you know whereas in China, we still have physicians in Tianjin, he’s got infected right after the intervention. After intervention of 30 patients, he’s got infected. So that’s right now, probably we still need some kind of positive air, you know some of devices with mask like some small pipe machine. That’s very important for dangerous procedure like intervention bronchoscope,you need to be really careful. And you know regarding the regular people, when you do regular care of patients , you still need to wears the gowns, wear the masks, and also the face shield, to protect yourself from the droplet, and probably from the aerosol. Nobody confirm the aerosol for these patients, but I still think is very dangerous too. In China, all the nurses and physicians in Wuhan, nobody’s got infected, it’s zero. So that means all protection is appropriate, but I’m not sure in New York and other city in the United States, what’s percentage of the infection of health worker? I think if don’t do this kind of protection, the infection rate is still high. Because right now, as we are not sure what’s kind of transmission exactly? So in that case, we need to more be prepared, that’s better than unprepared.

李光熙博士:您知道,呼吸介入操作感染風險很高,您必須非常嚴格地保護自己。在中國天津有醫生在給30位患者做呼吸介入后被感染了?,F在我們也許仍然需要提供正壓氣流的裝置,您知道有一些帶有管道的電動口罩,這對插管和支氣管鏡這樣的危險操作非常重要。至于日常護理,您仍然需要穿防護服,戴口罩以及面罩,以保護自己免受飛沫和氣溶膠的侵害。雖然目前氣溶膠傳播途徑尚未確鑿,但我仍然認為這也是非常危險的。在中國,支援武漢的所有醫護人員,沒有人被感染,即感染率為零。因此,這意味著所有保護措施都是適當的,但是我不確定在紐約和美國的其他城市,醫護人員的感染率是多少?如果不采取這種保護措施,我認為感染率仍然會很高。因為現在,我們不確定所有確切的傳播途徑?因此,在這種情況下,我們需要做更多的準備,這總比沒有準備的好。

Q5-Dr. Deng: Thank you, I think that it’s too early to know, right now in New York and the States, we are still in the early stage, in care of regular COVID-19 patients, not doing invasive procedures, do we need N95 mask or just a regular surgical mask, face shield and gown will be in enough?

問題5-鄧博士:謝謝,我認為現在對這個(感染率)的了解還為時過早,目前在紐約和美國,我們仍處于早期階段,還在處理普通病人,沒有采取侵入性程序治療,我們是否需要N95口罩,或者普通的醫用手術口罩、面罩和防護服就足夠了?

Dr. Li:In China, a lot of physicians initially just wear like that with surgical mask, but actually quite a lot of physicians and nurses have got infected, so I think N95 is very necessary for health workers, and face shield. It’s very very very important.

李光熙博士:在中國很多醫生開始也只是戴普通醫用外科口罩,但實際上很多醫生和護士都被感染了,我認為N95還有防護面屏對于醫護人員還是非常必要的,非常重要。

Dr.Deng: Thank you. Right now there is a shortage of N95 mask, so we try to strike fight the use of them in the efficient way.

鄧博士:謝謝。目前N95口罩短缺,因此我們努力以有效的方式爭取能用上。

Q6-Marek Kalmus: Are any special advices how to treat SARS-Cov-2 infected pregnant women?

問題6-Marek Kalmus:請問對如何治療SARS-Cov-2感染孕婦有什么特別的建議嗎?

Dr. Li: We do have several cases of pregnant women got infected, I saw one patient, one pregnant women at the age of 27, and she died from Covid-19. I think if you are pregnant, you really should be very careful. You know, nobody has immunity of this virus basically, so everyone is vulnerable to this virus, especially for the pregnant women, they may need some kind of more lung capacity, so they really need be taken care of, greatly than other people.

李光熙教授:我們確實有幾例孕婦被感染,我看到其中一名27歲的孕婦,她死于新冠肺炎。我認為,一旦懷孕應該非常小心。要知道基本上沒有人對此病毒具有免疫力,因此每個人都容易感染該病毒,特別是孕婦,她們需要比普通人更大的肺通氣容量(肺活量),因此需要對感染新冠肺炎的孕婦患者更加重視。

Q7-Marek Kalmus:How many asymptomatic COVID-19 carriers are estimated?

問題7-Marek Kalmus:估計有多少無癥狀COVID-19攜帶者?

Dr.Li: We don’t have the exact data for those asymptomatic patients, but we know, even for people with mild symptom, they don’t think they got infected. Actually, they just have some diarrhea, some fatigue. They never think they got infected, so we don’t have the exact data for that. There is quite a large population for those people, especially for children, young persons, young adults, they really don’t have bad symptoms, you know, they even don’t have any fever, they just have very mild fatigue, mild cough and mild diarrhea. We don’t know exactly how many got it, because they didn’t do the test for that. That’s we don’t have exact data for this question. 

李光熙博士:我們目前沒有無癥狀感染者的確切數據,一些癥狀較輕的人,他們只有輕微的腹瀉和乏力癥狀,認為自己沒有被感染。這樣的人很多,尤其是兒童和年輕人,他們沒有嚴重癥狀,甚至沒有發燒,只是非常輕度的乏力、咳嗽和腹瀉。這部分人通常沒有做病毒檢測。我們沒有確切數據。

Q8-Marek Kalmus:I have also question from medical doctors, she is TCM practitioner, she would ask could you describe the nature of corona virus according to TCM and penetration of this pathogen according to Wen Bing Lun or Shang Han Lun?

問題8-Marek Kalmus:我還有位中醫的問題,她問您能描述冠狀病毒的性質嗎?您能根據中醫描述這種冠狀病毒的性質嗎,依據《溫病論》和/或《傷寒論》描述這種病原體(侵入)的滲透性嗎? 

Dr. Li: I see. According to the first question, how we describe this pathogen in Chinese medicine, we think this coronavirus belongs to the cold, and belongs to the wet. So basically is the cold and wet, that means we need some medicine to expel the cold and dry the wet, so that’s how we describe the principle. 

Regarding the second question, what kind of book we need to use, actually you know, both books are good for this disease, you know we have different success with Chinese doctors, they tried different combinations, some doctors used Shang Han, some physicians used Wen Bing, so they all work. But I think regarding this disease I prefer Wen Bing, because this disease changed rapidly, you can see how fast the patients can deteriorate. So just you know, you can count after 5 days they may become acute lung injury, and they die after 10 days. So it’s very dangerous disease and very rapidly changed disease. Thank you.

李光熙博士:

  第一個問題:我們如何用中醫描述這種疾?。ú≡w),在中醫里這屬于濕毒疫,大多數以寒濕為主,我們需要祛寒和祛濕的藥(來治療這種病毒),這就是我們的開方原則。

  第二個問題:我們需要依據哪本書來指導?實際上《溫病論》和《傷寒論》兩本書都對這種疾病都有效。中醫醫生們嘗試了不同組合,有些醫生用《傷寒論》,有些用《溫病論》,都取得了療效。我個人對于這種疾病傾向于用《溫病論》。因為疾病傳變迅速,患者惡化的速度很快,僅僅5天后就可能會變成急性肺損傷,而10天后患者可能死亡。因此,這是非常危險傳變非??斓募膊?。

Q9-Reginaldo(Director of Brazilian School of Chinese Medicine):My question is as now in Brazil the number of cases are increasing, and we are suggested to do quarantine. Actually in some states and cities, we are also enforced to quarantine right now. Do you recommend to people at home they can do something to improve their immunity, such as moxibustion, what’s your opinion on that?

問題9-Reginaldo(巴西中醫學院院長):我的問題是由于當前巴西的感染人數正在增加,大多數人被建議進行隔離。您是否可以對艾灸的自我使用提出一些建議,幫助大家改善健康狀況并扶助正氣?

Dr. Li: Regarding the early quarantine, certainly it is very important, it’s the cause of infection of the majors. I think another thing is regarding moxibustion, it’s very good. But even after you do that, it doesn’t mean that you will not have this virus. You still can get it. So there is nothing really prevent us from this virus. Only thing we can do is we try to develop the vaccination of the disease. So it will not happen soon, I think it takes probably after 18 months. Even 18 months is very early, it’s a long way to go. But nothing can really work for prevention virus. Everyone is vulnerable to that. You certainly need to use some kind of Chinese Medicine to make yourself. Even you get it, you can make your symptom very mild, you don’t fall into the very severe stage, and very severe time. We are still suggest for people who had cold and wet in their stomach, you know, according to Chinese theories, so they still need moxibustion, they need do some acupuncture, they need to take some Chinese herbs. To have some for themselves. For the obesity patients, they need lose weight, I don’t know how they can lose weight within a week, what we saw most people are really having some kind of problems for obesity, this is one most of population they can fall into the stage of danger, so these patients need to take care of themselves even now.

李光熙博士:關于早期隔離,當然這很重要,大多數人都是因為沒有隔離感染的。另外艾灸是非常好的,但是艾灸了不代表您不會感染此病毒,沒有什么能真正阻止我們感染這種病毒。我們唯一能做的就是嘗試開發這種疾病的疫苗,但它不會很快投入使用,我認為大概至少需要18個月,還有很長的路要走。目前沒有能真正有效預防病毒的方法,每個人都可能感染。但是,即使感染了,您可以使用一些中藥,可以使癥狀非常輕微,不會發展到非常嚴重的階段。根據中醫的理論,我們建議那些脾胃寒濕的人做艾灸、針刺,服用中藥。對于肥胖癥患者,他們需要減肥,我不知道他們如何在一周內減肥,我們看到大多數人的確患有肥胖癥,他們是一群容易發展到危重癥的人群,因此這些患者現在就要格外注意。

Q10-Reginaldo: My point is I totally agree and understand there is no such thing to avoid virus. The idea of moxibustion more to improve the health, so as be in good health could be a little bit stronger for body to fight virus, to contact with them. Right?

問題10-Reginaldo: 我完全同意并理解,沒有一個方法可以避免病毒。艾灸助于改善健康狀況,身體強壯時抵御病毒的力量會更強一點。對嗎?

Dr. Li:Yes, absolutely. So you can regulate yourself to adapt while the virus comes into your body, basically you can regulate yourself to adapt to this the vulnerable situations, so you don’t get this inflammation storm  triggered, that’s really helpful. Patients you know, Chinese herbs, acupuncture, they all have do that. 

李光熙博士:是的,當然。當病毒進入你的身體時,你可以調節自身適應能力,不容易被感染,即使感染炎癥風暴也不會觸發,中藥和針灸對此真的很有幫助。

Reginaldo:As Brazil now it is coming into autumn from summer right now, so this year my colleague and I offered acupuncture and application of herbs, summer treatment for winter diseases. For those patients, they experienced very good health right now. So I really believe on improving quality of life, and improving the health using Chinese medicine theory, and I encourage more people from other countries to consider that even in the countries where Chinese medicine is not officially accepted, but we shall teach and expand it for our patients.

Reginaldo:由于巴西現在正從夏季進入秋季,所以今年我和同事都在提供針灸和中藥治療,進行夏病冬治。這些患者現在身體非常健康。因此,我堅信使用中醫理論可以改善生活質量和健康狀況,我鼓勵其他國家/地區的人們也考慮中醫治療,即使在那些中醫尚未被正式認可的國家中,我們也應該這樣告訴我們的病人并傳播中醫藥療法。

Dr. Li: Yeah, absolutely, I think this moxibustion and transdermal therapy you should use in this season, because that next pandemic will go to these countries like Brazil and Argentina. Right now the temperature will go like what we have in September or October, that’s very dangerous. 

李光熙博士:是的,完全正確,我認為您應該在這個季節使用這種艾灸和透皮療法,因為接下來大流行將蔓延到巴西和阿根廷等國家。(你們)現在的氣溫類似我們這兒的9月或10月,這很危險。

Q11-Amir Hooman Kazemi(Vice President of WFAS from Iran):What is the syndrome differentiations of pulmonary effusion in TCM and which herbs can be useful?

問題11-Amir Hooman(伊朗世針聯副主席):胸腔積液在中醫中的辯證分型有哪些,哪些中藥可用?

Dr.Li:Pulmonary effusion for the COVID-19 is rare, but you know that  if you have some other knowledge of effusion, then you certainly need to differentiate (it as) cold(寒), it’s from the weakness of qi and some other things. You can use some dongchouxiacao(冬蟲夏草), cordyceps sinensis, it’s very helpful. Cordyceps and chaihu(柴胡)are good herbs, for this kind of symptoms.

李光熙博士:COVID-19的胸腔積液很少見,如果您對胸腔積液有其他了解,您會把它辨為寒邪,主要由于氣虛和其他一些因素造成??梢允褂枚x夏草和柴胡,可以幫助緩解癥狀。

Q12-Amir Hooma:Which herbs are useful for prevention ( specially the herbs we can find in other countries?

問題12-Amir Hooman:哪些中藥有預防作用(特別是我們能在中國以外的其他國家/地區可以找到的草藥)?

Dr. Li: In Iran, zanghonghua(藏紅花saffron crocus)is also very good. I think it is very popular in Iran. It is good, they already took that in every meal . I bought when I was there last year. I don’t know the what kind of herbs can be used in Iran, but maybe something is we can discuss later after they are showed to us, how are they called in your country.

李光熙博士:在伊朗,紅花也很不錯,我認為它在伊朗很受歡迎,使用在日常飲食中,我去年去那兒時就買了一些。我不知道在伊朗還可以使用哪種草藥,也許再告訴我們詳細情況,都有什么草藥,我們可以進一步討論。  

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