（CN/EN）中英双语：国际抗疫大讲堂李光熙教授在线答疑整理

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

问题1-邓博士（纽约斯隆肿瘤中心整合医学中心医务主任）：启动呼吸机间歇正压通气模式的特殊指标有哪些？

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：根据我们的经验，这取决于患者的血氧饱和度，重要的是在经鼻高流量氧疗支持下，患者基本能达到良好的指端氧饱和度。通常我们给病人约65%或70%的氧气，该装置是经鼻高浓度的氧气支持。但是如果三个小时后病人氧饱和度仍旧不好，那么状况会继续恶化，再也达不到93%的血氧饱和度。当病人咳嗽得很厉害，还伴有发烧时，我们必须考虑尽早对病人干预，病人休息时咳嗽的频率也要关注。我认为这是使用呼吸机间歇正压通气的重要指征。剧烈咳嗽后，患者的氧饱和度通常很差，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？

问题2-邓博士：第二个问题是在美国，因为医院床位短缺，很多症状较轻的患者，即使存在低烧，咳嗽，乏力等症状，也要出院居家隔离。您提到要特别注意发热，干咳和呼吸困难。不幸的是，很多人不能在家使用血氧仪监测。所以，您说到的高热是不是有具体数字？比如38、39或39.5度？

Dr. Li: Yes, so the criteria for high fever is more than 39 Celsius, which is verybad. 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 beup 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：高热是指腋窝温度在39℃到40℃之间，这是非常糟糕的。那是因为新冠肺炎在第一天或第二天通常只会出现低于38.3摄氏度左右的中等度热，但在第三天到第五天后可能突然升高到39.5℃以上。这个阶段非常危险，我们需要尽早治疗。在中国，大多数患者都有血氧仪，也许在纽约他们没有。在这种情况下患者需要注意他们能不能走路？能走多远？活动与咳嗽是否有关？这种相关性通常是紧密的，患者如果走着走着就咳嗽了，这意味着该病人进入到加重阶段了。

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?

问题3-邓博士：在美国，很少有人拥有家用氧气监测血氧仪。关于测试有个方法说是：如果您可以深呼吸，屏住呼吸5秒钟或10秒钟，您就没事了；如果您无法屏住呼吸5秒钟或10秒钟，则您的血氧饱和度低或有呼吸困难，需要医院治疗。这些适用吗？

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：我认为到了那个阶段会有些晚了，活动时候咳嗽增加，例如去洗手间咳嗽增加就是很危险的信号。

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

邓博士：非常有帮助，归纳一下，在家隔离的发热程度大约是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?

邓博士：干咳，特别是在活动时诱发咳嗽，或在轻微活动中出现短暂的呼吸困难，这些都是疾病急性加重的征兆，应该去医院，对吗？

Dr. Li: I think so, correct.

李光熙博士：我是这样认为的。

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?

问题4-邓博士：我最后一个问题关于医护人员防护程度，包括在呼吸介入环境中的防护，以及更重要的对患者的日常护理的防护。所有这些新冠肺炎患者在中国都安排进入医院或（隔离）楼层。在这里我们无法做到这一点，所以病人仍在普通病房里，医护人员对飞沫的防护基本上是口罩、面罩和薄薄的防护服。我看到在中国使用的是从头到脚的全身防护服。您认为这样的防护措施是过度的，适当的，还是应该采取的？

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 physiciansin 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，呼吸介入操作感染风险很高，您必须非常严格地保护自己。在中国天津有医生在给30位患者做呼吸介入后被感染了。现在我们也许仍然需要提供正压气流的装置，您知道有一些带有管道的电动口罩，这对插管和支气管镜这样的危险操作非常重要。至于日常护理，您仍然需要穿防护服，戴口罩以及面罩，以保护自己免受飞沫和气溶胶的侵害。虽然目前气溶胶传播途径尚未确凿，但我仍然认为这也是非常危险的。在中国，支援武汉的所有医护人员，没有人被感染，即感染率为零。因此，这意味着所有保护措施都是适当的，但是我不确定在纽约和美国的其他城市，医护人员的感染率是多少？如果不采取这种保护措施，我认为感染率仍然会很高。因为现在，我们不确定所有确切的传播途径？因此，在这种情况下，我们需要做更多的准备，这总比没有准备的好。

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?

问题5-邓博士：谢谢，我认为现在对这个（感染率）的了解还为时过早，目前在纽约和美国，我们仍处于早期阶段，还在处理普通病人，没有采取侵入性程序治疗，我们是否需要N95口罩，或者普通的医用手术口罩、面罩和防护服就足够了？

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：在中国很多医生开始也只是戴普通医用外科口罩，但实际上很多医生和护士都被感染了，我认为N95还有防护面屏对于医护人员还是非常必要的，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.

邓博士：谢谢。目前N95口罩短缺，因此我们努力以有效的方式争取能用上。

Q6-Marek Kalmus: