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由新型冠状病毒2型(SARS-CoV-2)引起的2019冠状病毒病(COVID-19)自2019年12月底爆发以来,在全球范围内造成大规模传播[1]。近来奥密克戎毒株也呈现出普遍易感性,且有症状的患者比例高。患者可出现高热、咳嗽、全身肌肉酸痛、疲劳、恶心、胸闷、呼吸困难和低氧血症,甚至急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS),并且可同时出现凝血、心血管、消化、泌尿、免疫等系统的损伤,甚至发生速发型多器官功能障碍综合征(multiple organ dysfunction syndrome, MODS)[2]。国内研究显示奥密克戎毒株导致的重症率为0.27%~0.50%[3]。
已有研究表明[4],D-二聚体轻微升高时即进行抗凝治疗可显著改善组织灌注而保护多脏器功能,这是阻断多脏器损伤的重要策略之一。急诊新冠患者就诊时的状态可分为发病早期和发病中后期,但对急诊医生来说,患者第一次医疗接触时,无论疾病处于哪个阶段,都属于早期(疾病早期或就诊早期),应根据疾病状态进行积极合理地抗凝,以尽早阻断多脏器损伤。
本共识旨在为急诊就诊的新冠患者如何抗凝提供依据,经专家会议讨论后,证据等级被分为3级(表1)。
表1 证据水平分级标准
证据水平 | 描述 |
低水平证据 | 将来的研究很可能对目前的评估结果有重要影响,从而很可能改变当前推荐 |
中等水平证据 | 将来的研究可能对目前的评估结果有重要影响,从而可能改变当前推荐 |
高水平证据 | 将来的研究几乎不可能改变当前的评估结果 |
参 考 文 献
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