●Use of dexamethasone – We recommend dexamethasone for severely ill patients with COVID-19 who are on supplemental oxygen or ventilatory support (algorithm 2). We use dexamethasone at a dose of 6 mg daily for 10 days or until discharge, whichever is shorter. If dexamethasone is not available, it is reasonable to use other glucocorticoids at equivalent doses (eg, total daily doses of hydrocortisone 150 mg, methylprednisolone 32 mg, or prednisone 40 mg), although data supporting use of these alternatives are more limited than those for dexamethasone. In contrast, we recommend that dexamethasone (or other glucocorticoids) not be used for either prevention or treatment of mild to moderate COVID-19 (patients not on oxygen). These recommendations are largely consistent with those of other expert and governmental groups [2,41-44]. (See 'Patients with oxygen requirement/severe disease' above.)
一位90岁老人在北京感染新冠,服用抗病毒药效果不明显,症状加重,住进三甲医院,使用激素治疗后明显好转,但医生说根据治疗规程,激素治疗不能超过七天,所以必须停药。
当然,无法操控医院的治疗,只是好奇,世界卫生组织建议的激素治疗是十天,美国的新冠激素治疗有没有天数限制?
https://www.uptodate.com/contents/covid-19-management-in-hospitalized-adults#:~:text=In%20a%20meta%2Danalysis%20of,severe%20adverse%20events%20%5B45%5D.
Dexamethasone and other glucocorticoids
●Use of dexamethasone – We recommend dexamethasone for severely ill patients with COVID-19 who are on supplemental oxygen or ventilatory support (algorithm 2). We use dexamethasone at a dose of 6 mg daily for 10 days or until discharge, whichever is shorter. If dexamethasone is not available, it is reasonable to use other glucocorticoids at equivalent doses (eg, total daily doses of hydrocortisone 150 mg, methylprednisolone 32 mg, or prednisone 40 mg), although data supporting use of these alternatives are more limited than those for dexamethasone. In contrast, we recommend that dexamethasone (or other glucocorticoids) not be used for either prevention or treatment of mild to moderate COVID-19 (patients not on oxygen). These recommendations are largely consistent with those of other expert and governmental groups [2,41-44]. (See 'Patients with oxygen requirement/severe disease' above.)
Glucocorticoids may also have a role in the management of refractory shock in critically ill patients with COVID-19. These issues are discussed elsewhere. (See "COVID-19: Management of the intubated adult", section on 'Use of glucocorticoids for non-COVID-19 reasons'.)
临床用激素要慢慢taper停药。
也见过很多一次性10毫克用的。
呼吸科好像用的也很多。
http://www.fsxsj.net/ch/reader/pdf.aspx?file_no=20050520
这个冠状病毒对人体的破坏绝对不止于呼吸系统,炎症反应是全身的,这个好像蛮多文献的。