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Interpretation of "New Coronavirus Pneumonia Diagnosis and Treatment Scheme (Trial Version 7)"
Published: 2020-03-04 Source : Medical Administration and Hospital Authority
On March 3, 2020, the National Health and Health Commission issued the "Diagnosis and Treatment of New Coronavirus Pneumonia (Trial Version 7)" (hereinafter referred to as "Seventh Version"), which is now read as follows.
I. Foreword:
In the foreword, add "Through the adoption of a series of preventive control and medical treatment measures, the rise of the epidemic situation in China has been contained to a certain degree, and the epidemic situation has eased in most provinces, but the number of cases outside the country has been increasing.
" With the deepening of the clinical manifestations and pathological understanding of the disease and the accumulation of experience in diagnosis and treatment, in order to further strengthen the early diagnosis and early treatment of the disease, improve the cure rate, reduce the mortality rate, and avoid hospital infections, it is also necessary to pay attention to overseas input. Transmission and spread caused by sexual cases. "
2.
Increasing transmission routes. " Because new coronavirus can be isolated in feces and urine, attention should be paid to aerosol or contact transmission caused by fecal and urine pollution to the environment. "
3. Add" pathological changes " "
Describe the organs such as the lungs, spleen and hilar lymph nodes, heart and blood vessels, liver and gallbladder, kidneys, brain tissue, adrenal glands, esophagus, stomach, and intestines according to the general and microscopic views." Mainly lung and immune system damage. Other organs are different due to different underlying diseases, and most of them are secondary damage.
4. Clinical manifestations
(1) Added descriptions of clinical manifestations of pregnant women and children.
For example, "the clinical course of pregnant women is close to that of patients of the same age." "Some children and neonatal cases may have atypical symptoms, manifested as gastrointestinal symptoms such as vomiting, diarrhea, or only manifested as mental weakness and shortness of breath."
(2) Etiological testing.
Delete "To increase the positive rate of nucleic acid detection, it is recommended to take sputum as much as possible and implement tracheal intubation to collect lower respiratory tract secretions", add "using RT-PCR or / and NGS methods" for nucleic acid detection, and emphasize "the detection of Respiratory specimens (sputum or airway extracts) are more accurate. "
(3) Serological tests were added.
Most of the new coronavirus-specific IgM antibodies are positive after 3-5 days of onset, and the recovery period of IgG antibody titers is 4 times or more higher than that of the acute phase.
V. Diagnostic Criteria
(1) Explain the "aggregative onset" in the epidemiological history, that is, "two cases of fever and / or respiratory tract in a small area such as home, office, school class, etc. within 2 weeks Symptoms. "
(B) The" lymphocyte count reduction "in clinical manifestations was changed to" normal or decreased lymphocyte count ".
(3) In the confirmed cases, a “serological test” was added as a basis on the basis of the original nucleic acid detection and sequencing, that is, “new coronavirus-specific IgM antibodies and IgG positive” or “new coronavirus-specific IgG antibodies changed from negative to positive or "The recovery period is 4 times higher than that of the acute period."
6. The clinical classification is
still divided into "light, ordinary, heavy and critical."
Heavy is defined separately as "adult" and "child".
Adult heavy standard has not changed, the increase in childhood Heavy criteria:
1. Shortness of breath (<2 months of age, RR≥60 beats / min; 2 to 12 months of age, RR≥50 beats / min; 1 to 5 years old, RR≥40 beats / min;> 5 years old, RR≥30 beats / min Points), except for the effects of fever and crying;
2. Oxygen saturation ≤ 92% in resting state;
3. Assisted breathing (groaning, nasal fan movement , triple concave sign), cyanosis, intermittent apnea;
4. Lethargy Convulsions;
5. Refuse to feed or feed, with signs of dehydration.
7. Increase the "Critical and Critical Clinical Warning Indicators" for adults and children, respectively.
(I) Adults
1. Peripheral blood lymphocytes have progressively decreased;
2. Peripheral blood inflammatory factors such as IL-6 and C-reactive protein have progressively increased;
3. Progressive elevation of lactic acid;
4. Intrapulmonary disease progresses rapidly in the short term.
(2) Children
1. Increased breathing rate;
2. Poor mental response and drowsiness;
3. Progressive increase in lactic acid;
4. Imaging showing bilateral or multilobe infiltration, pleural effusion, or rapid progression of lesions in the short term;
5.3 Infants under the age of one month may have underlying diseases (congenital heart disease, bronchopulmonary dysplasia, respiratory malformations, abnormal hemoglobin, severe malnutrition, etc.), and immunodeficiency or low (prolonged use of immunosuppressive agents)
8. Increase the exclusion criteria for suspected cases.
The exclusion of suspected cases should meet the following requirements: two consecutive tests of the novel coronavirus nucleic acid test are negative (sampling time interval of at least 24 hours), and the new coronavirus-specific antibodies IgM and IgG are still negative 7 days after the onset of illness.
Nine, treatment
(1) Oxygen therapy measures in general treatment, adding "Hydrogen-oxygen mixed inhalation gas (H [SUB]2[/SUB] / O [SUB]2[/SUB] : 66.6% / 33.3%) can be used for treatment if possible."
(2) Antiviral treatment.
Delete "Lipinavir / ritonavir-related diarrhea, nausea, vomiting, liver damage and other adverse reactions", and replace it with "note the problems of adverse reactions, contraindications, and interactions with other drugs." Add "The treatment of pregnant women should consider the number of weeks of pregnancy, choose medicines that have less impact on the fetus as much as possible, and whether to treat after termination of pregnancy, and inform them."
(3) In severe and critical cases treatment.
1. According to the pathological airway visible mucus and mucus plug formation, in order to improve ventilation, invasive mechanical ventilation increases "choose closed sputum suction according to airway secretions, if necessary, bronchoscopy to take appropriate treatment."
2. increase "ECMO-related indications": ① in FiO[SUB]2[/SUB] > 90%, the oxygenation index is less than 80mmHg, lasting more than 3-4 hours; ② airway plateau pressure ≥35cmH [SUB]2[/SUB] O.
3. Circulation support emphasizes "perform non-invasive or invasive hemodynamic monitoring, and pay attention to fluid balance strategies during treatment to avoid overdose and inadequacy."
4. Add "renal failure and renal replacement therapy": In addition to finding kidneys In addition to the causes of functional impairment, continuous renal replacement therapy (CRRT) can be selected for severe patients with renal failure, and treatment indications are given.
5. For severe and critically ill patients with cytokine storms, in order to remove inflammatory factors, block "cytokine storms" and increase "blood purification treatment".
6. Add "tocilizumab" for immunotherapy: the indication is "those with extensive lung disease and severe patients, and those with elevated IL-6 levels detected by the laboratory". The specific usage and dosage are given. Pay attention to allergic reactions, and those with active infection such as tuberculosis are prohibited.
7. The addition of other treatment measures "Intravenous infusion of gamma globulin may be considered in children with severe and critical cases as appropriate. Patients with pregnancy or severe or severe cases should actively terminate pregnancy, and cesarean delivery is preferred."
(4) TCM treatment has increased the criticality Type of Chinese medicine with mechanical ventilation accompanied by abdominal distension, constipation or poor stool, and human-machine synchronization.
X. "Release quarantine standards" changed to "discharge standards"
(1) Discharge standards are still four, the first three remain unchanged. Article 4 added "sputum, nasopharyngeal swabs, etc." airway nucleic acid test for two consecutive negative, the sampling time was at least "interval of 1 day", changed to "at least 24 hours".
(2) Precautions after discharge. In view of the fact that a small number of discharged patients have positive nucleic acid test retest results, in order to strengthen the health management and isolation of discharged patients, the "should continue to monitor the self-health condition for 14 days" was changed to "the 14-day isolation management and health should continue "Condition monitoring", while wearing a mask, conditionally living in a well-ventilated single room, reducing close contact with family members, sharing meals, doing good hand hygiene, and avoiding outing activities.
Related Links:
Notice on Issuing a New Coronavirus Pneumonia Diagnosis and Treatment Plan (Trial Version 7)
http://www.nhc.gov.cn/yzygj/s7652m/2...79d5af95.shtml
