[h=1]New coronavirus-infected pneumonia diagnosis and treatment plan (trial version 3) released[/h] [h=4][/h]
January 23, 2020 13:59 Source:
People's Daily Online
-Beijing Channel
People's Daily Online, Beijing, January 23 (Reporter Bao Congying) According to the website of the National Health and Medical Commission, the General Office of the National Health and Health Commission and the Office of the State Administration of Traditional Chinese Medicine announced on the 22nd the pneumonia diagnosis and treatment plan for the new type of coronavirus infection. Version). The notice said that in order to further guide the national scientific standard to do a good job in the diagnosis and medical treatment of pneumonia cases of new coronavirus infection, we organized experts to revise the diagnosis and treatment plan, and formed the "New Coronavirus Pneumonia Diagnosis and Treatment Plan (Trial Implementation)" ".
Attachment: pneumonia diagnosis and treatment plan for new coronavirus infection (trial version 3)
Since December 2019, some hospitals in Wuhan City, Hubei Province have successively found multiple cases of unexplained pneumonia with a history of exposure to the South China Seafood Market, which have now been confirmed as an acute respiratory infection caused by a new type of coronavirus infection. The cases collected so far show that the number of cases without a history of market exposure in South China is increasing, and there are clustered cases and confirmed cases without a history of travel in Wuhan, and no clear market exposure from Wuhan has been found in many countries and regions overseas History of confirmed cases. Given that the source of the virus, the time of detoxification after infection, and the pathogenesis are not clear, in order to better control the epidemic, reduce and reduce the probability of the disease's domestic and international transmission, and further strengthen the early detection, isolation and treatment of cases, The greatest possible reduction in nosocomial infections is the key to controlling the source of infections and reducing the incidence, improving the ability to treat, and at the same time the largest possible reduction in nosocomial infections. Our "Pneumonitis Diagnosis and Treatment Program for New Coronavirus Infection (Trial Version 2)" Was revised.
I. Coronavirus characteristics
Coronavirus is a single-stranded positive-stranded RNA virus without segmentation. It belongs to the Orthocoronavirinae subfamily of the Coronaviridae family of the order Nidovirales, and is divided into α subfamilies according to serotype and genome , Β, γ and δ four genera. There are six known coronaviruses in humans, including 229E and NL63 in the alpha genus, OC43 and HPU in the beta genus, and Middle East respiratory syndrome.
Syndrome-associated coronavirus (MERSr-CoV) and severe acute respiratory syndrome-associated coronavirus (SARSr-CoV). The coronavirus isolated from the lower respiratory tract of patients with unexplained pneumonia in Wuhan is a new type of coronavirus belonging to the genus β.
Coronaviruses have an envelope, and the particles are round or oval, often polymorphic, with a diameter of 50 to 200 nm. S protein is located on the surface of the virus to form a rod-like structure. As one of the virus's major antigen proteins, S protein is the main gene used for typing. The N protein encapsulates the viral genome and can be used as a diagnostic antigen.
Most of the understanding of the physical and chemical properties of coronavirus comes from the research of SARS-CoV and MERS-CoV. The virus is sensitive to heat. Lipid solvents such as ether, 75% ethanol, chlorine-containing disinfectant, peroxyacetic acid, and chloroform can effectively inactivate the virus for 30 minutes at 56 ? C. Chlorhexidine cannot effectively inactivate the virus.
Clinical characteristics of the outbreak
(A) clinical manifestations
Main symptoms are fever, fatigue, and dry cough. Nasal congestion and runny nose are rare. About one-half of the patients develop dyspnea after one week. In severe cases, they progress rapidly to acute respiratory distress syndrome, septic shock, difficult to correct metabolic acidosis, and coagulation dysfunction. It is worth noting that in the course of severe and critically ill patients, there can be moderate to low fever, even without obvious fever.
Some patients have mild onset symptoms and no fever. They usually recover after 1 week. Most patients have a good prognosis, and a few patients are critically ill and even die.
(Two) laboratory inspection
In the early stages of the disease, the total number of white blood cells in the peripheral blood was normal or decreased, the lymphocyte count decreased, and some patients had increased liver enzymes, muscle enzymes, and myoglobin. Most patients had elevated C-reactive protein and erythrocyte sedimentation rate and normal procalcitonin. In severe cases, D-dimer increases and peripheral blood lymphocytes progressively decrease.
(Three) chest imaging
Multiple small patchy shadows and interstitial changes appeared early, and the extrapulmonary bands were obvious. Furthermore, it develops multiple ground glass infiltration and infiltrates in both lungs. In severe cases, pulmonary consolidation and pleural effusion are rare.
Case definition
(I) Suspected cases (original observation cases)
Meet the following 2 at the same time:
Epidemiological history
Patients with a history of travel or residence in Wuhan within two weeks before the onset of illness or who had been exposed to fever from Wuhan with respiratory symptoms within 14 days before the onset of illness, or had clustered onset.
Clinical manifestations
(1) Fever ﹔
(2) With the above imaging characteristics of pneumonia ﹔
(3) The total number of white blood cells is normal or decreased, or the lymphocyte count is decreased in the early stage of onset.
(B) confirmed cases
On the basis of meeting the criteria for suspected cases, sputum, throat swabs, lower respiratory tract secretions, and other specimens were tested by real-time fluorescent RT-PCR to detect novel coronavirus-positive nucleic acids or viral gene sequencing, which is highly homologous to known new coronaviruses.
(Three) severe cases
Meet any of the following:
1. Increased breathing rate (≧ 30 beats / min), difficulty breathing, cyanosis of lips
2. When inhaling, it means oxygen saturation ≦ 93% ﹔
3. Arterial blood oxygen partial pressure (PaO2) / oxygen concentration (FiO2) ≦ 300mmHg (1mmHg = 0.133kPa) ﹔
4. Pulmonary imaging shows multilobular lesions or lesion progression within 50 hours> 50% ﹔
5. Combining other clinical conditions that require hospitalization.
(4) Critical cases
One of the following:
1. Respiratory failure occurs and requires mechanical ventilation ﹔
2. Shock appears
3. Combining other organ failures requires ICU monitoring and treatment.
Fourth, differential diagnosis
It is mainly distinguished from other known viral pneumonias such as influenza virus, parainfluenza virus, adenovirus, respiratory syncytial virus, rhinovirus, human metapneumovirus, SARS coronavirus, and mycoplasma pneumoniae, chlamydia pneumonia, and bacterial pneumonia. In addition, it should be distinguished from non-infectious diseases such as vasculitis, dermatomyositis, and organizing pneumonia.
V. Case Discovery and Reporting
When medical staff at all levels and types of medical institutions find suspected cases that meet the definition of a case, they should immediately conduct isolation and treatment and report to the relevant departments of the medical institution and the disease control center under their jurisdiction. The medical institution will organize the hospital or district (county) within 2 hours. Relevant expert consultation, if it is not diagnosed with viral pneumonia caused by common respiratory pathogens, specimens should be collected in time for pathogen detection.
Suspected cases can be ruled out after two consecutive negative tests for respiratory pathogenic nucleic acid (sampling interval of at least 1 day).
Treatment
(1) Determine the treatment place according to the severity of the disease
Suspected and confirmed cases should be isolated and treated in designated hospitals with effective isolation and protection conditions. Suspected cases should be treated in isolation and in a single room. Confirmed cases can be admitted to the same ward. Critical cases should be admitted to ICU as soon as possible.
(B) general treatment
1. Rest in bed, strengthen supportive treatment, ensure sufficient heat, pay attention to water and electrolyte balance, maintain internal environment stability, closely monitor vital signs, oxygen saturation, etc.
2. Monitor blood routine, urine routine, C-reactive protein (CRP), biochemical indicators (liver enzyme, myocardial enzyme, renal function, etc.), coagulation function according to the condition, and perform arterial blood gas analysis if necessary, and review chest imaging
3. According to the change of oxygen saturation, timely provide effective oxygen therapy measures, including nasal catheter, mask oxygen, nasal high-flow oxygen therapy if necessary, non-invasive or invasive mechanical ventilation, etc.
4. Antiviral treatment: There are no effective antiviral drugs. Try aerosol interferon inhalation (5 million U each time for adults, add 2ml of sterile water for injection, 2 times a day) ﹔ lopinavir / ritonavir 2 times a day, twice a day.
5. Antibacterial drug treatment: Avoid blind or inappropriate use of antibacterial drugs, especially the combination of broad-spectrum antibacterial drugs. Strengthen bacteriological surveillance, and timely apply antibacterial drugs when there is evidence of secondary bacterial infection.
6. Others: According to the patient's dyspnea and chest imaging progress, glucocorticoids should be used within a short period (3 to 5 days) as appropriate. The recommended dose is not to exceed 1 to 2 mg / kg ? d of methylprednisolone.
(III) Treatment of severe and critical cases
1. Treatment principle: Based on symptomatic treatment, actively prevent complications, treat basic diseases, prevent secondary infections, and provide organ function support in a timely manner.
2. Respiratory support: Non-invasive mechanical ventilation for 2 hours, no improvement in the condition, or the patient cannot tolerate non-invasive ventilation, increased airway secretions, severe cough, or hemodynamic instability, and should be promptly transitioned to invasive mechanical ventilation.
Invasive mechanical ventilation uses a small tidal volume "pulmonary protective ventilation strategy" to reduce ventilator-related lung injury.
If necessary, prone ventilation, lung retension, or extracorporeal membrane oxygenation (ECMO) are used.
3. Circulation support: based on adequate fluid resuscitation, improve microcirculation, use vasoactive drugs, and monitor hemodynamics if necessary.
(IV) Traditional Chinese Medicine Treatment
The disease belongs to the category of traditional Chinese medicine epidemic disease. The disease is caused by the epidemic disease, and the disease is located in the lungs. The basic pathogenesis is "wet, hot, poisonous, and stasis." The following schemes are used for dialectical treatment (this scheme cannot be used for prevention).
Wet evil depression lung
Clinical manifestations: low fever or no fever, dry cough, less phlegm, dry throat, sore throat, fatigue, chest tightness, nausea, or vomiting, diarrhea. The tongue is pale or red, the fur is white or greasy, and the veins are pulsating.
Governing law: detoxification and detoxification, declaring lungs through evil.
Recommended prescription: Ma Xing Zhi Gan Decoction, Lifting and Falling Powder, Dayuan Drink.
Basic prescriptions: ephedra, almond, grass fruit, betel nut, cicada weeping, forsythia, atractylodes, Chinese bellflower, scutellaria baicalensis, burdock, raw licorice
2. Fever heat and lungs
Clinical manifestations: fever, thirst, do not want to drink, chest tightness, dry throat and less phlegm, poor appetite, poor stool or loose stools. Red tongue, yellow fur, floating pulse.
Governing Law: clearing away heat and detoxifying, declaring the lungs and demonstrating evil.
Recommended prescription: Ma Xing Shi Gan Tang, Yin Qiao San.
Basic prescriptions: ephedra, almond, gypsum, mulberry peel, honeysuckle, forsythia, scutellaria baicalensis, Fritillaria cirrhosa, raw licorice.
3. The evil poison closes the lungs
Clinical manifestations: high fever, no sputum cough, or yellow sputum, chest tightness, shortness of breath, bloating and constipation. Red tongue, yellow greasy or yellow dry fur, slippery pulses.
Governing Law: Xuanfei detoxification, Tongxie fever.
Recommended prescriptions: Xuanbai Chengqi Decoction, Huanglian Jiedu Decoction, Jiedu Huoxue Decoction.
Basic prescriptions: almond, gypsum, melon, rhubarb, ephedra, gardenia, peach kernel, red scallion, raw licorice.
4. Closed out
Clinical manifestations: dizziness, irritability, burning of chest and abdomen, coldness of hands and feet, shortness of breath or need for auxiliary ventilation. Tongue quality Aster, moss yellow-brown or dry, veins floating large without roots.
Governing Law: Open and close Gutu, detoxification and rescue.
Recommended prescription: Sini plus ginseng soup, An Gong Niuhuang Wan, Zixue San.
Basic prescription: ginseng, aconite, dogwood, take An Gong Niu Huang Wan or Zi Xue San.
Seventh, lift the isolation and discharge standards
The body temperature returned to normal for more than 3 days, the respiratory symptoms improved significantly, the lung imaging showed obvious absorption of inflammation, and two consecutive consecutive respiratory pathogen nucleic acid tests were negative (sampling interval of at least 1 day). The patient can be released from isolation or transferred to the appropriate department for treatment according to the condition. other illnesses.
Eight, the principle of transshipment
Patients should be transported in special vehicles, and personal protection and vehicle disinfection of transporters should be done.
Nine, hospital infection control
In accordance with the requirements of the "Guidelines for the Prevention and Control of New Coronavirus Infection in Medical Institutions (First Edition)".
Issued by the General Office of the National Health Commission on January 22, 2020
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