新型冠状病毒肺炎药物预防、诊断、治疗与出院管理循证临床实践指南(更新版)  

Chemoprophylaxis,diagnosis,treatments,and discharge management of COVID-19:An evidencebased clinical practice guideline(updated version)

作　　者：靳英辉 詹庆元[2,3] 彭志勇 任学群[6] 尹训涛[7] 蔡林 袁玉峰 岳冀蓉[10,11] 张笑春 杨启文[13] 纪建光[14] 夏剑 李一荣[4,16] 周福祥 高亚东 余追[18] 徐峰 涂明利[20] 谭力铭[21] 杨旻[22] 陈芳[23] 张晓菊[24] 曾玫[25] 朱渝 刘新灿[27] 杨简[28] 赵东赤[29] 丁玉峰 侯宁[31] 汪付兵[16] 陈昊 张永刚[10,33] 李玮 陈文 施月仙[36] 杨秀芝[37] 王学军[38] 钟燕军[39] 赵明娟 李柄辉 马琳璐 訾豪[1,6] 王娜 王云云 余绍福 李路遥[1,6] 黄桥 翁鸿 任相颖[1,6,42] 罗丽莎 范曼如 黄笛 薛竑飏 余临心 高锦萍 邓通 曾宪涛 李宏军 程真顺 姚晓梅 王行环 无 Jin Ying-Hui;Zhan Qing-Yuan;Peng Zhi-Yong;Ren Xue-Qun;Yin Xun-Tao;Cai Lin;Yuan Yu-Feng;Yue JiRong;Zhang Xiao-Chun;Yang Qi-Wen;Ji Jian-Guang;Xia Jian;Li Yi-Rong;Zhou Fu-Xiang;Gao YaDong;Yu Zhui;Xu Feng;Tu Ming-Li;Tan Li-Ming;Yang Min;Chen Fang;Zhang Xiao-Ju;Zeng Mei;ZhuYu;Liu Xin-Can;Yang Jian;Zhao Dong-Chi;Ding Yu-Feng;Hou Ning;Wang Fu-Bing;Chen Hao;Zhang Yong-Gang;Li Wei;Chen Wen;Shi Yue-Xian;Yang Xiu-Zhi;Wang Xue-Jun;Zhong Yan-Jun;Zhao MingJuan;Li Bing-Hui;Ma Lin-Lu;Zi Hao;Wang Na;Wang Yun-Yun;Yu Shao-Fu;Li Lu-Yao;Huang Qiao;Weng Hong;Ren Xiang-Ying;Luo Li-Sha;Fan Man-Ru;Huang Di;Xue Hong-Yang;Yu Lin-Xin;Gao JinPing;Deng Tong;Zeng Xian-Tao;Li Hong-Jun;Cheng Zhen-Shun;Yao Xiao-Mei;Wang Xing-Huan;无(Center for Evidence-Based and Translational Medicine;National Clinical Research Center for Respiratory Diseases;3Department of Pulmonary and Critical Care Medicine,China-Japan Friendship Hospital,Beijing 10029,China;Leishenshan Hospital in Wuhan,Wuhan 430200,China;Department of Critical Care Medicine;Institutes of Evidence-Based Medicine and Knowledge Translation,Henan University,Kaifeng,Henan 475000,China;Department of Medical Imaging,Guizhou Provincial People’s Hospital,Guiyang 550002,China;Department of Orthopedics;Department of Hepatobiliary Surgery;National Clinical Research Center for Geriatrics;Department of Geriatrics;Department of Radiology;Department of Clinical Laboratory,Peking Union Medical College Hospital(PUMCH),Peking Union Medical College,Chinese Academy of Medical Sciences(CAMS),Beijing 100730,China;Center for Primary Health Care Research,Lund University and Region Skane,Malmo 25002,Sweden;Emergency Center;Department of Allergology;Department of Radiation and Medical Oncology;Department of Critical Care Medicine,Renmin Hospital of Wuhan University,Wuhan 430060,China;Department of Emergency Medicine and Chest Pain Center,Qilu Hospital of Shandong University,Jinan 250002,China;Department of Respiratory and Critical Care Medicine,Suizhou Central Hospital,Hubei University of Medicine,Suizhou,Hubei 441

机构地区：[1]武汉大学中南医院循证与转化医学中心,武汉430071 [2]中日友好医院国家呼吸系统疾病临床研究中心,北京100029 [3]中日友好医院呼吸与危重症医学科,北京100029 [4]武汉雷神山医院,武汉430200 [5]武汉大学中南医院重症医学科,武汉430071 [6]河南大学循证医学与临床转化研究院,河南开封475000 [7]贵州省人民医院医学影像科,贵阳550002 [8]武汉大学中南医院骨科,武汉430071 [9]武汉大学中南医院肝胆外科,武汉430071 [10]四川大学华西医院国家老年疾病临床医学研究中心,成都610041 [11]四川大学华西医院老年医学中心,成都610041 [12]武汉大学中南医院医学影像中心,武汉430071 [13]中国医学科学院/北京协和医学院检验学系,北京协和医院检验科,北京100730 [14]瑞典隆德大学临床研究中心/斯科讷大学医院,马尔默25002 [15]武汉大学中南医院急救中心,武汉403371 [16]武汉大学中南医院过敏反应科,武汉403371 [17]武汉大学中南医院肿瘤放化疗科,武汉403371 [18]武汉大学人民医院重症医学科,武汉430060 [19]山东大学齐鲁医院急诊科与胸痛中心,济南250002 [20]湖北医药学院附属随州市中心医院呼吸与重症医学科,湖北随州441300 [21]湖南省怀化市第二人民医院药学部,湖南怀化418000 [22]安徽医科大学第二附属医院重症医学科,合肥230601 [23]郑州大学医院内科,郑州450001 [24]河南省人民医院呼吸与危重症医学科,郑州450003 [25]复旦大学附属儿科医院感染传染科,上海201102 [26]四川大学华西第二医院感染科,成都610041 [27]河南中医药大学第一附属医院心内科,郑州450000 [28]三峡大学人民医院/宜昌市第一人民医院心内科,湖北宜昌443000 [29]武汉大学中南医院儿科,武汉430071 [30]华中科技大学同济医学院附属同济医院药学部,武汉430030 [31]山东第一医科大学附属省立医院/山东省立医院药学部,济南250021 [32]南京中医药大

出　　处：《解放军医学杂志》2020年第10期1003-1031,共29页Medical Journal of Chinese People's Liberation Army

基　　金：国家重点专项研发计划项目(2020YFC0845500);湖北省突发应急专项基金(2020FCA008);湖北省第二届医学领军人才工程第一层次基金。

摘　　要：严重急性呼吸综合征冠状病毒2(SARS-CoV-2)导致的新型冠状病毒肺炎(COVID-19)自暴发以来迅速在全球蔓延,造成数以千万人感染及数十万患者死亡。基于研究证据的临床实践指南是诊治COVID-19的有力武器。在疫情早期阶段,该团队制定并发布了《新型冠状病毒(2019-nCoV)感染的肺炎诊疗快速建议指南(标准版)》。疫情暴发后大量相关临床研究陆续开展并发表,新的证据可能会改变以前的推荐意见,更新指南的时机已经成熟。因此,该团队成立了由临床专家和方法学家组成的工作组,通过咨询一线临床专家提出并确定了与COVID-19管理相关的29个临床问题。通过系统检索有关COVID-19预防及诊疗的直接证据,使用GRADE方法评估证据质量并制订推荐意见,最终形成34条建议,其中6条强推荐,14条弱推荐,3条弱不推荐,11条为基于共识的建议;共涵盖4个方面,分别为药物预防,诊断(包括临床表现、RT-PCR检测、呼吸道标本、IgM和IgG抗体检测、CT检查、胸部X线片及无症状感染的CT特征),治疗方法[包括洛匹那韦-利托那韦、阿比朵尔、法匹拉韦、干扰素、瑞德西韦、抗病毒药的组合、羟氯喹/氯喹、白介素-6抑制剂、白介素-1抑制剂、糖皮质激素、清肺排毒汤、连花清瘟胶囊/颗粒、康复者血浆、肺移植、有创或无创通气、体外膜肺氧合支持(ECMO)]以及出院管理(包括复阳患者管理及出院标准)。此外,还制订了针对推荐意见的指南实施工具流程图,以期有力支持医护人员对COVID-19患者的照护。The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnosis and treatment guidelines for clinicians caring for patients are needed.In the early stage,we have issued"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)";now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline.We formed a working group of clinical experts and methodologists.The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas:chemoprophylaxis,diagnosis,treatments,and discharge management.We searched the literature for direct evidence on the management of COVID-19,and assessed its certainty generated recommendations using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach.Recommendations were either strong or weak,or in the form of ungraded consensus-based statement.Finally,we issued 34 statements.Among them,6 were strong recommendations for,14 were weak recommendations for,3 were weak recommendations against and 11 were ungraded consensus-based statement.They covered topics of chemoprophylaxis[including agents and Traditional Chinese Medicine(TCM)agents],diagnosis[including clinical manifestations,reverse transcription-polymerase chain reaction(RT-PCR),respiratory tract specimens,IgM and IgG antibody tests,chest computed tomography,chest X-ray,and CT features of asymptomatic infections],treatments[including lopinavir-ritonavir,umifenovir,favipiravir,interferon,remdesivir,combination of antiviral drugs,hydroxychloroquine/chloroquine,interleukin-6 inhibitors,interleukin-1 inhibitors,glucocorticoid,Qingfei Paidu decoction,Lianhua Qingwen granules/capsules,convalescent plasma,lung transplantation,invasive or noninvasive ventila

关 键 词：新型冠状病毒肺炎 2019新型冠状病毒 感染性疾病 临床实践指南 循证医学 

分 类 号：R373.1[医药卫生—病原生物学]