Елена Самтынова
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Минздрав России опубликовал1 10 версию Временных методических рекомендаций «Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19)». В новой версии скорректированы разделы по этиотропному и патогенетическому лечению. В частности, в настоящее время выделены следующие препараты, которые могут быть использованы при лечении COVID-19: фавипиравир, ремдесивир, умифеновир, гидроксихлорохин, интерферон-альфа.
Включены новые препараты для противовоспалительной и антитромботической терапии. Например, для антитромботической терапии в перечень добавлен препарат дабигатрана этексилат, но при условии отсуствия ривароксабана и апиксабана. Усовершенствованы схемы лечения в амбулаторных и стационарных условиях в зависимости от тяжести течения заболевания и подходы к интенсивной терапии пациентов с острой дыхательной недостаточностью.
В новой версии рекомендаций также обращено внимание, что антибактериальная терапия должна назначаться только при наличии убедительных признаков присоединения бактериальной инфекции (повышение ПКТ более 0,5 нг/мл, появление гнойной мокроты, лейкоцитоз > 12×109/л (при отсутствии предшествующего применения глюкокортикоидов), повышение числа палочкоядерных нейтрофилов более 10%).
Все важные документы и новости о коронавирусе COVID-19 – в ежедневной рассылке Подписаться
Добавлены рекомендации по особенностям оказания медицинской помощи пациентам с онкологическими заболеваниями и хронической болезнью почек. Так, указывается, что максимальному риску подвержены пациенты, получающие противоопухолевое лекарственное лечение, получающие лучевую терапию, пациенты с лейкопенией и/или низким уровнем иммуноглобулинов, пациенты после трансплантации костного мозга, пациенты, получающие иммуносупрессивную терапию, а также пациенты с некоторыми типами опухолей кроветворной и лимфоидной тканей. Целесообразно минимизировать сроки пребывания пациента в стационаре и рассмотреть возможность проведения противоопухолевого лекарственного лечения в амбулаторных условиях, с использованием таблетированных препаратов, если это не ухудшит течение онкологического процесса. Отмечается, что необходимо избегать назначения противоопухолевых препаратов, обладающих пульмональной токсичностью, и рассмотреть возможность временного прерывания противоопухолевого лекарственного лечения, если сокращение химиотерапии не приведет к ухудшению онкологического прогноза.
Применение лекарственных препаратов для лечения COVID-19 у пациентов с хронической болезнью почек с вероятным нефротоксическим эффектом требует постоянного мониторинга функции почек (креатинин, мочевина, концентрация калия, натрия в крови). К группе особо высокого риска отнесены пациенты получающие гемодиализ в связи с невозможностью изоляции и необходимости присутствия в диализных центрах, для получения жизнеспасающей процедуры не менее чем 12 раз в месяц. Также к особой группе относятся реципиенты трансплантированных органов, получающих химиотерапию. Для таких пациентов предусмотрена строгая маршрутизация как при подозрении на COVID-19, так и при наличии его признаков.
Кроме того, определены особенности диспансерного наблюдения за пациентами, перенесшими COVID-19. Актуализирован раздел по специфической профилактике инфекции у взрослых.
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1 С Временными методическими рекомендациями «Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19)» можно ознакомиться на официальном сайте Минздрава России (https://minzdrav.gov.ru/news/2021/02/08/16027-minzdrav-rossii-opublikoval-10-versiyu-metodrekomendatsiy-po-koronavirusu).
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