第十版诊疗方案:有哪些新变化?怎样用中医治疗更有效?——国家卫健委组织权威专家解读第十版新冠病毒感染诊疗方案******
新华社北京1月8日电题:第十版诊疗方案:有哪些新变化?怎样用中医治疗更有效?——国家卫健委组织权威专家解读第十版新冠病毒感染诊疗方案
新华社记者李恒、温竞华
国家卫生健康委、国家中医药局1月6日印发《新型冠状病毒感染诊疗方案(试行第十版)》。第十版诊疗方案有哪些新的变化?针对进一步完善中医治疗相关内容,如何用中医治疗更有效?国家卫生健康委组织首都医科大学附属北京中医医院院长刘清泉、北京大学第一医院感染科主任王贵强作出解答。
1.问:第十版诊疗方案的重要变化有哪些?
王贵强:根据奥密克戎毒株致病性特点、流行特征及新药研发进展,第十版诊疗方案重要变化主要体现在以下几个方面:
一是对疾病名称进行了调整,将疾病名称由“新型冠状病毒肺炎”更名为“新型冠状病毒感染”,包括无症状感染者,也包括有症状的轻、中、重和危重等类型。
二是针对重症高风险人群,从原来的60岁及以上调整为65岁及以上,强调65岁及以上没有完成全程疫苗接种的人群是重点关注人群。从目前国内外数据来看,疫苗接种是降低重症和死亡风险的重要因素,没有进行疫苗接种的或未完成全程疫苗接种的老年人、有基础病的高风险人群要继续加强疫苗接种。
在重症高风险人群中,除了有糖尿病、冠心病、高血压等基础疾病的患者、肿瘤患者等,又增加了持续透析人群,这类人群在疫情高峰期也是容易导致重症和死亡风险的人群。
三是不再判定“疑似病例”,“疑似病例”就是临床上有流行病学、临床表现,没有病原学证据,但现在病原学证据已经扩充为新冠病毒核酸检测阳性或者抗原检测阳性都可以作为诊断标准。绝大多数情况下,不会出现因流行病学史、临床表现符合疾病特点但病原学检测较长时间不能明确的情况。
针对老年人等有重症高风险人群明确诊断阳性以后,要及时向社区报备,给予早期干预,密切监测病情变化、进行随访等,做到“关口前移”。
四是调整“出院标准”,不再对感染者出院时核酸检测结果提出要求,由临床医生根据患者新冠病毒感染、基础疾病或其他疾病诊疗及健康恢复状况等进行综合研判。
五是完善了儿童重型病例早期预期预警指标,更关注低龄儿童,尤其是三岁以下儿童,要进行密切监测和随访,比如有神经系统并发症、拒奶等重症倾向的要及时救治。
六是将未全程接种疫苗的老年人加入重症高危人群,将生命体征监测特别是静息和活动后的指氧饱和度监测指标等加入重症早期预警指标。
2.问:第十版诊疗方案提出进一步完善中医治疗相关内容,具体体现在哪些方面?
刘清泉:第十版诊疗方案结合了近三年来,中医药进行边救治、边研究、边总结,形成了较完善的新冠病毒感染治疗方案。
其中,奥密克戎轻型感染者“邪毒疏表”表现明显,如浑身疼、乏力,针对这些症候特点,第十版诊疗方案给出了较明确的治疗方向和方法,更多体现在恢复期的治疗,如患者在恢复期出现明显咳嗽症状,从中医角度来看,即宣肺、止咳、化痰,为医疗机构和医生提供参考。
在重症和危重症救治中,坚持中西医协同救治,如出现严重高热时,西医和中医结合治疗能有效缩短病程;危重症病人出现严重腹胀时,中医称“阳明病”,及时给患者用上通腹泻办法;当患者出现循环衰竭时,西医在使用血管活性药等的同时,中医用益气扶正固脱办法,进行中西医协同救治。(新华网)
中新网评:处理核污水绝不是日本自家私事******
中新网北京1月19日电(蒋鲤)日本政府近日称,将于2023年春夏期间开始向海洋排放经过处理的福岛第一核电站核污水。日本罔顾国内民众及周边国家的屡屡反对,企图将核污水“一倒了之”,把一件关乎全球海洋生态环境和公众健康的事当成了自家私事。
2011年,福岛核电站事故发生后,大量放射性物质泄漏到大气层和太平洋,对周围环境造成了难以逆转的伤害,数十万人被迫撤离该地区。时至今日,作为日本邻国之一的韩国仍未解除福岛海鲜禁令。
日本以核污水存储能力即将达到上限为由,在2021年4月13日,正式决定将福岛第一核电站核污水排入太平洋。过去一年多,日本政府和东京电力公司一直在持续推进核污水排海计划。
日本政府辩称,这些核污水经多核素处理系统(ALPS)处理后很安全,甚至“可以喝”,这样的表态无疑在愚弄大众。
事实上,经过处理的核污水仍含有多种放射性物质,核污水一旦排放入海就无法回收,长期来看,将会给海洋生态带来难以估量的潜在威胁,最终危害人类健康。
因此,核污水排海计划推出后,遭到日本民众强烈反对。日本《朝日新闻》2022年3月公布的问卷调查显示,福岛县、宫城县和岩手县受访的42个市町村长中,约六成反对东京电力公司福岛第一核电站核污水排放入海。日本全国渔业协会联合会也多次申明立场,反对该计划。
日本政府认为,核污水排海是最便宜、最省事的解决方案,但此举却将周边国家乃至全世界置于核污染风险中。太平洋非日本一家之海,核污水会随着洋流流动,其影响势必会跨越国界,危害周边国家乃至整个国际社会的公共福祉和利益。
《韩国经济新闻》发文称,相关研究认为,福岛核污水如果排放入海,约7个月后将到达济州等韩国海域,该国水产业和旅游业将遭受相当大的损失。
德国南极海洋机构也曾发出警告,若日本将所有核污水排入海中,不到半年,整个太平洋都将面临高度辐射威胁,包括远在大洋另一端的美国。太平洋地区人民更是对日本该计划持反对意见。
日本作为《联合国海洋法公约》缔约国,有义务保护海洋环境。然而,在核污水排海方案的正当性、核污水数据的可靠性、净化装置的有效性、环境影响的不确定性等问题上,日本未能作出科学、可信的说明。
国际原子能机构技术工作组虽已三次赴日实地考察评估,但尚未就日排海方案的安全性给出结论,并且对日本提出诸多澄清要求和整改意见。在此情况下,日本仍执意推进核污水排海工程建设,这是极不负责任的行为。
太平洋不是日本的下水道,日本必须正视各方合理关切,在与周边国家等相关利益方和国际原子能机构充分协商后,制定合理的核污水处理方案。日本也要着眼长远,若只顾眼前,执意将核污水排放入海,不仅其自身,周边国家乃至全世界都将为之买单,其后果必将会危害数代人。
Fukushima water disposal by no means Japan’s own business
By John Lee
(ECNS) -- Japan has announced it will release treated wastewater from the wrecked Fukushima Daiichi Nuclear Power Plant into the Pacific Ocean this year.
Although Fukushima wastewater disposal affects global marine ecological environment protection and public health, Japan has turned a deaf ear to domestic and international opposition to dumping the contaminated water into the sea, treating the "global" matter as its own business.
The Fukushima accident in 2011 had sent large quantities of radiation into the atmosphere and the Pacific Ocean, causing irreversible damage to the surrounding environment, and hundreds of thousands of people were forced to evacuate the area. South Korea still maintains its import ban on Japanese seafood from areas affected by the Fukushima nuclear disaster.
On April 13, 2021, Japan announced it had decided to discharge contaminated radioactive wastewater in Fukushima Prefecture into the sea due to dwindling storage space, with the Japanese government and plant operator Tokyo Electric Power Company Holdings Inc. promoting the release plan over the past year.
The Japanese government argues that the water treated by an advanced liquid processing system, or ALPS, is safe and drinkable, which is undoubtedly fooling the public.
In fact, the treated wastewater still includes a variety of radioactive substances and can’t be recycled once discharged into the sea, which will pose a great threat to marine ecology and ultimately endanger human health in the long run.
Therefore, the discharge plan has been strongly opposed in Japan. According to a questionnaire conducted by The Asahi Shimbun, nearly 60 percent of mayors of 42 municipalities in Iwate, Miyagi and Fukushima prefectures oppose the discharge plan. The National Fisheries Cooperative Federation of Japan has also repeatedly stated its opposition in public.
The Japanese government believes that dumping Fukushima wastewater into the sea is the cheapest and most convenient solution, but neighboring countries and even the whole world will be at risk of nuclear pollution.
The Pacific Ocean doesn’t belong to Japan and the wastewater flow along oceanic currents will surely break boundaries and endanger public welfare and the interests of neighboring countries and even the international community.
The Korea Economic Daily reported that related research concluded that if contaminated water from Fukushima is released into the ocean, it would only take seven months for the contaminated water to reach the shores of Jeju Island, with the country's aquaculture and tourism suffering considerable losses.
According to the calculation of a German marine scientific research institute, radioactive materials will spread to most of the Pacific Ocean within half a year from the date of discharge, and the U.S. and Canada will be affected by nuclear pollution. People in the Pacific region also oppose the discharge plan.
As a participant of the United Nations Convention on the Law of the Sea, Japan has the obligation of protecting the marine environment.
However, it hasn’t offered a full and convincing explanation on issues like the legitimacy of the discharge plan, the reliability of data on the nuclear-contaminated water, the efficacy of the treatment system or the uncertainty of environmental impact.
Though the IAEA has yet to complete a comprehensive review after three investigations in Japan, the Japanese side has been pushing through the approval process for its discharge plan and even started building facilities for the discharge. It is rather irresponsible for Japan to act against public opinion at home and concerns abroad.
The Pacific Ocean is not a private Japanese sewer. The country must seriously heed the voices of the international community and make a reasonable plan for the Fukushima wastewater disposal after full consultation with stakeholders and international agencies.
If it only seeks instant interest and insists on discharging the contaminated water into the sea, not only itself, but also its neighboring countries and the entire world will pay for the decision and several generations will be forced to bear the consequence.
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