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霍勇：新冠肺炎背景下心血管疾病防治要点 – 四川在线

自2019年12月新型冠状病毒肺炎发生以来，经过全国各地的共同努力，目前新冠肺炎确诊病例有所下降，但防控工作不容半分松懈。与此同时，因疫情带来的一系列问题，也在一定程度影响心血管疾病患者的治疗和管理。为此，记者采访北京大学第一医院心内科霍勇教授，全面解析特殊时期心血管疾病的防治要点。

特殊形势下急性心肌梗死救治流程

霍勇教授表示，针对急性心肌梗死的救治，我们国家已经全面建立了胸痛中心救治体系。为适应新的防疫形势，由葛均波院士牵头，中国医师协会心血管内科医师分会专门就此发布了《新型冠状病毒(2019-nCoV)防控形势下急性心梗诊治流程和路径中国专家建议(第一版)》。总的原则，是既要兼顾新冠肺炎防疫大的形势，另外一方面也要兼顾像致死性的心血管疾病，如急性心肌梗死的救治;第二，强调加强防护的原则。尤其是在急性心肌梗死患者需要进行急诊PCI，或者说更紧密的医疗接触的情况下，要提升到三级医疗防护;第三，强调如果此类患者血流动力学稳定，更倾向于溶栓优先的原则;第四，强调就近的救治原则，不提倡长距离的转运;第五，强调利用远程医疗现代化的手段，实现远程会诊。这五个原则对现在胸痛中心救治流程起了重要的指导和规范作用。

霍勇教授认为，从目前数据来看，因新冠肺炎死亡的患者常合并有心脑血管疾病等基础性疾病。如果在防疫新冠肺炎的同时，做好心血管疾病的防治和救治，可能使死亡率有效地降低。这样才能真正有把握打赢新冠肺炎防疫这场没有硝烟的战争。

长处方+远程医疗，助力心血管慢病患者管理

2020年2月2日，国家医保局印发《关于优化医疗保障经办服务 推动新型冠状病毒感染的肺炎疫情防控工作的通知》表示，支持医疗机构根据患者实际情况，合理增加单次处方用药量，减少病人到医疗机构就诊配药次数;对高血压等慢性病患者，经诊治医院医生评估后，支持将处方用药量放宽至3个月。霍勇教授指出，对于心血管疾病比如冠心病，特别强调两大类药物，一个是预防血栓的抗血小板药物，主要针对急性冠脉综合征患者在发病一年以内，或者行冠心病介入治疗一年以内的患者;另外一类很重要的是他汀类药物。这两类药物必须长期使用，不能因为疫情或者不方便就自行减量甚至停药。此外，是否开具长处方需要医生根据患者情况进行判断，病情稳定的可以适当延长药物处方期限。

随着互联网医疗发展，通过网上问诊和购药也是可行的选择。在具备互联网医院牌照和处方药电子商务资质的正规渠道上，患者不仅可以足不出户与专科医生进行在线问诊，更可以直接在线上完成慢病药品续方，通过配送的方式将药品带到患者手中。霍勇教授呼吁，许多患者由于年龄较大可能对互联网医疗平台不太熟悉，子女等家庭成员应主动关心并帮助患者完成操作。中国医师协会、中国心血管健康联盟、光明网卫生频道等机构联合发起了公益性质的心血管疾病问诊和防治远程医疗平台，取得了非常满意的效果。霍勇教授希望更多心血管专科医师能够加入进来，全国人民团结一致，共同奋斗，战胜新冠肺炎。(朱秀美)

【相关阅读】

抗击疫情 心血管医生在行动——光明网卫生频道与中国心血管健康联盟发起远程线上公益问诊(内附在线问诊链接，详细就医咨询可登陆)

http://health.gmw.cn/2020-02/06/content_33531115.htm

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