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    Home > Active Ingredient News > Drugs Articles > Interpretation of the novel coronavirus pneumonia diagnosis and treatment plan (trial version sixth)

    Interpretation of the novel coronavirus pneumonia diagnosis and treatment plan (trial version sixth)

    • Last Update: 2020-02-19
    • Source: Internet
    • Author: User
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    The novel coronavirus pneumonia diagnosis and treatment plan (trial version sixth) (hereinafter referred to as the Sixth Edition) was released by the national health and Health Committee in February 19, 2020 1、 The route of transmission changed from "respiratory droplets and contact transmission are the main routes of transmission" to "respiratory droplets and close contact transmission are the main routes of transmission" Before "contact", add the word "close" It is added that "there is the possibility of aerosol propagation in relatively closed environment exposed to high concentration aerosol for a long time." 2、 In addition to the rapid progression to acute respiratory distress syndrome, septic shock, metabolic acidosis and coagulation dysfunction that are difficult to correct, multiple organ failure may also occur in patients with severe clinical manifestations Laboratory examination emphasized that "in order to improve the positive rate of nucleic acid test, it is suggested to keep sputum as much as possible, collect the secretion of lower respiratory tract from patients with tracheal intubation, and send the samples for examination as soon as possible after collection." 3、 The sixth edition of diagnostic standard cancels the difference between Hubei Province and other provinces It can be divided into "suspected cases" and "confirmed cases" There are two kinds of suspected cases One is "any one with an epidemiological history and any two with clinical manifestations (fever and / or respiratory symptoms; with the above-mentioned imaging features of pneumonia; normal or reduced total leukocytes and lymphocyte count in the early stage of the disease) The second is "no clear epidemiological history, and in line with the clinical manifestations of three (fever and / or respiratory symptoms; with the above-mentioned image characteristics of pneumonia; early onset of normal or reduced leukocyte count, lymphocyte count decreased) Novel coronavirus DNA positive novel coronavirus positive samples were detected by real-time fluorescence RT-PCR, or highly sequenced with the known new coronavirus 4、 The clinical classification is still divided into "light, ordinary, heavy and critical type" The increase of PaO2 / FiO2 ≤ 300MMHG (1mmhg = 0.133kpa) "in the area with high altitude (over 1000m), PaO2 / FiO2 should be corrected according to the following formula: PaO2 / FiO2 × [atmospheric pressure (mmHg) / 760]" The patients whose lung imaging showed that the lesions progressed more than 50% in 24-48 hours were treated as severe management Five Novel coronavirus infection and novel coronavirus pneumonia were identified as differential diagnosis The novel coronavirus infection novel coronavirus pneumonia is mainly distinguished from other known viral pneumonia and Mycoplasma pneumoniae infection, such as influenza virus, adenovirus, respiratory syncytial virus and so on It is emphasized that "for suspected cases, methods such as rapid antigen detection and multiple PCR nucleic acid detection should be adopted as far as possible to detect common respiratory pathogens." 6、 In case finding and report, delete "requirements on the treatment of clinical diagnosis cases in Hubei Province" Delete the exclusion standard of "suspected case", and the de isolation standard of suspected case is consistent with that of "de isolation standard" 7、 Treatment 1 Determine the treatment site according to the condition Delete "suspected and confirmed cases" and change to "isolation treatment should be carried out in designated hospitals with effective isolation conditions and protection conditions, and confirmed cases can be treated in the same ward by multiple people." 2 antiviral treatment novel coronavirus is not currently recognized as effective In the trial drug, chloroquine phosphate (500mg for adults, twice a day) and abidol (200mg for adults, three times a day) were added Ribavirin is recommended in combination with interferon or lopinavir / ritonavir The course of treatment of the trial drugs shall not exceed 10 days It is suggested to further evaluate the efficacy of the drug in clinical application It is not recommended to use three or more antiviral drugs at the same time In case of intolerable side effects, relevant drugs should be stopped 3 Treatment of severe and critical cases It is suggested that "plasma therapy for convalescent" should be applied to patients with rapid progress, severe and critical illness Dosage and reference novel coronavirus pneumonia rehabilitation plasma treatment plan (trial version 1) 4 Other treatment measures: for critical patients with high inflammatory response, "if possible, the use of in vitro blood purification technology can be considered." It is modified to "if conditions permit, in vitro blood purification technologies such as plasma exchange, adsorption, perfusion, blood / plasma filtration can be considered." 5 About the treatment of traditional Chinese medicine Novel coronavirus pneumonia is a novel coronavirus pneumonia The novel coronavirus pneumonia novel coronavirus pneumonia (light version and common case management standard) has been adjusted and supplemented by the new version of the coronavirus pneumonia diagnosis and treatment plan (revised version fifth of the trial version second) Continue the previous version of the whole process of disease stage, TCM treatment is divided into medical observation period and clinical treatment period (confirmed cases), clinical treatment period is divided into light, common, heavy, critical and recovery period Chinese patent medicine is recommended for medical observation Qingfei Paidu decoction, a general prescription, was recommended in the clinical treatment period The clinical manifestations, recommended prescription and dosage, and taking methods of light, common, heavy, critical and recovery period were explained respectively At the same time, the specific usage of Chinese patent medicine (including traditional Chinese medicine injection) which is suitable for heavy and dangerous type is added in the scheme According to the condition of illness, local climate characteristics and different physical conditions, we can refer to the recommended scheme for syndrome differentiation and treatment 8、 The following four conditions should be met: 1 Body temperature returned to normal for more than 3 days; 2 Respiratory symptoms improved significantly; 3 Pulmonary imaging showed that acute exudative lesions were absorbed and improved significantly; 4 Nucleic acid test of two consecutive respiratory samples was negative (sampling time interval at least 1 day) Add "notes after discharge": 1 The designated hospital should make good contact with the primary medical institutions where the patients live, share the medical record data, and timely push the discharged patients' information to the patient's jurisdiction or residence neighborhood committee and primary medical and health institutions 2 After the patient leaves the hospital, due to the low immune function of the body in the recovery period, there is a risk of infection with other pathogens It is recommended to continue to carry out self-health monitoring for 14 days, wear masks, live in a single room with good ventilation, reduce close contact with family members, eat separately, do hand hygiene and avoid going out 3 It is suggested to follow up and visit the hospital at the 2nd and 4th week after discharge.
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