Trail Version 7 - March 03, 2020
See Trial Version 5 and 6 previous documents General Office of National Health Commission Office of the State Administration of Traditional Chinese Medicine National Health Office Medical Letter (2020) No. 184 About the diagnosis and treatment of new coronavirus pneumonia ( Trial version 7 ) Notice Provinces, autonomous regions, municipalities, and Xinjiang Production and Construction Corps Health and Health Committee, Chinese Medicine Administration Bureau of Management In order to further improve the diagnosis and medical treatment of new coronavirus pneumonia, We organize experts to analyze, judge and summarize the preliminary medical treatment work. In the past, the diagnosis and treatment plan was revised to form the "New Coronavirus Pneumonia Diagnosis and Treatment Plan ( Trial Line seventh edition ) . Is now issued to you, please refer to the implementation. All relevant medical institutions should Actively play the role of traditional Chinese medicine in medical treatment, strengthen the integration of traditional Chinese and western medicine, and improve the traditional Chinese and western medicine The medical consultation system promotes good results in medical treatment. ( Information disclosure is proactively disclosed ) New coronavirus pneumonia diagnosis and treatment plan ( Trial version 7 ) 2019 Nian 12 since January, Wuhan, Hubei appeared novel coronavirus pneumonia The epidemic situation, with the spread of the epidemic situation, other regions of China and many countries abroad Such cases were found. The disease has been included in the Chinese Class B infectious diseases under the Law of the Republic of China on Infectious Diseases Prevention and Control Management. By adopting a series of preventive control and medical treatment measures, the epidemic situation in our country The upward momentum has been contained to a certain extent. The epidemic has eased in most provinces, but The number of outbreaks is increasing. With the understanding of the clinical manifestations and pathology of the disease, In-depth and accumulated experience in diagnosis and treatment, in order to further strengthen the early diagnosis and early treatment of the disease, High cure rate, reduce mortality, avoid hospital infection as much as possible The spread and spread of imported cases outside of context The pneumonia diagnosis and treatment plan (the sixth edition ) was revised to form a new type of coronary disease Diagnosis and treatment plan of toxic pneumonia ( trial version 7 ) . I. Etiology characteristics The new coronavirus belongs to the coronavirus of genus 0. It has an envelope and round particles Or oval, often polymorphic, 60-140nm in diameter . Genetic characteristics and SARS-Cov And MERS-Cov are apparently different. Current research shows SARS -like coronary disease with bats The virus (bat-SL-CoVZC45) has a homology of more than 85% . When cultured in vitro, new Coronavirus can be found in human epithelial cells in about 96 hours, and It takes about 6 days to isolate and culture in Vero E6 and Huh-7 cell lines . 2 Most of the knowledge about the physical and chemical properties of coronavirus comes from the knowledge of SARS-Cov and RS-Cov Research. The virus is sensitive to UV and heat, 56 ℃ for 30 minutes, ether, 75% ethyl Fatty solvents such as alcohols, chlorine-containing disinfectants, peracetic acid, and chloroform can effectively inactivate the virus. Chlorhexidine has not been effective in inactivating the virus. I. Epidemiological characteristics ( 1 ) Source of infection. The sources of infection seen so far are mainly patients with new coronavirus infections. Asymptomatic Infected people can also become a source of infection. ( B ) the way of transmission. Respiratory droplets and close contact transmission are the main routes of transmission. In relative Aerosols present in closed environments for prolonged exposure to high concentrations of aerosols The possibility of transmission. Since new coronaviruses can be isolated in feces and urine, Stools and urine cause environmental aerosol or contact transmission. ( 3 ) Susceptible people. The crowd is generally susceptible. Third, pathological changes Based on the current limited autopsy and puncture histopathological observations are summarized below. ( A ) The lungs. The lungs showed consolidation to varying degrees. Serum, fibrinous exudate, and transparent membrane exudation are seen in the alveolar cavity The cells are mainly monocytes and macrophages, and multinucleated giant cells are easily seen. Type II alveolar epithelium Cells proliferated significantly and some cells shed. Type II alveolar epithelial cells and macrophages 3 Visible inclusions. Alveolar septal vascular congestion and edema, monocyte and lymphocytic infiltration and intravascular clear thrombosis can be seen. Focal hemorrhage and necrosis of lung tissue may occur with hemorrhagic infarction. Partial alveolar exudate mechanization and pulmonary interstitial fibrosis. The epithelium of the bronchial mucosa in the lungs fell off, and the formation of mucus and mucus plugs was visible in the cavity. A small number of alveoli are over-inflated, the alveolar septum is broken, or the cysts are formed. Coronavirus particles can be seen in the cytoplasm of bronchial mucosal epithelium and type II alveolar epithelial cells under electron microscope . Immunohistochemical staining showed that some alveolar epithelium and macrophages were positive for new coronavirus antigens, and RT-PCR was positive for new coronavirus nucleic acids. ( 2 ) Spleen, hilar lymph nodes and bone marrow. The spleen was significantly reduced. The number of lymphocytes was significantly reduced, focal hemorrhage and necrosis, macrophage proliferation in the spleen, and phagocytosis were visible; the number of lymph nodes in lymph nodes was small, and necrosis was visible. Immunohistochemical staining showed that CD4 + T and CD8 + T cells were reduced in the spleen and lymph nodes . Bone marrow three-line cells decreased. ( Three ) the heart and blood vessels. Cardiomyocytes visible degeneration, necrosis, interstitial seen few monocytes, lymphocytes, and ( or ) neutrophil infiltration. Partial vascular endothelial shedding, endometritis and celebrities Disease and thrombosis. ( D ) liver and gallbladder. Increased volume, dark red. Hepatocyte degeneration, focal necrosis with neutrophil infiltration of hepatic sinus congestion, lymphocyte and monocyte infiltration in the manifold area, microthrombosis. The gallbladder is highly filled. 4 ( E ) The kidney. Proteinous exudate was seen in the glomerular cavity, and renal tubular epithelium was degenerated and shed, and a transparent cast was seen. Interstitial hyperemia, visible microthrombus and focal fibrosis. ( 6 ) Other organs. Congestion and edema of brain tissue, and degeneration of some neurons. Adrenal glands show focal necrosis. Mucosal epithelium of the esophagus, stomach, and intestine can degenerate, necrotize, and fall off to varying degrees. Fourth, clinical characteristics ( 1 ) Clinical manifestations. Based on the current epidemiological investigation, the incubation period is 1-14 days, mostly 3-7 days. The main manifestations are fever, dry cough, and fatigue. A few patients have symptoms such as nasal congestion, runny nose, sore throat, myalgia and diarrhea. Severe patients usually have dyspnea and / or hypoxemia one week after the onset of symptoms . In severe cases, they can quickly progress to acute respiratory distress syndrome, toxic shock, difficult to correct metabolic acidosis, coagulation dysfunction and multiple organ functions. Exhaustion etc. It is worth noting that in the course of severe and critically ill patients, there can be moderate to low fever, and there is no obvious fever. Some children and neonatal cases may have atypical symptoms, manifested as gastrointestinal symptoms such as vomiting and diarrhea, or only manifested as mental weakness and shortness of breath. Mild patients showed only low fever, mild fatigue, and no pneumonia. Judging from the current cases, most patients have a good prognosis, and a few patients are critically ill. The prognosis for the elderly and those with chronic underlying disease is poor. The clinical course of pregnant women with new coronavirus pneumonia is similar to that of patients of the same age. Childhood case symptoms 5 Relatively light. ( 2 ) Laboratory inspections. 1. General inspection In the early stage of the onset, the total number of white blood cells in the peripheral blood was normal or decreased, and the lymphocyte count was reduced. Some patients may have increased liver enzymes, lactate dehydrogenase (LDH) , muscle enzymes, and myoglobin. Some critically ill patients may have increased troponin. Most patients have elevated C- reactive protein (CRP) and erythrocyte sedimentation rate and normal procalcitonin. In severe cases, D- dimer increases and peripheral blood lymphocytes progressively decrease. Severe and critically ill patients often have elevated inflammatory factors. 2. Etiology and serology (1) pathologic examination using R BU PCR or / and NGS methods nasopharyngeal swabs and other lower respiratory tract secretions sputum, blood, feces and other specimens can be detected in nucleic acids novel coronavirus. Detection of lower respiratory tract specimens ( sputum or airway extracts ) is more accurate. Submit specimens for inspection as soon as possible after collection. (2) Serological examinations of new coronavirus-specific lgM antibodies mostly begin to show 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 . ( 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. Five, diagnostic criteria 6 ( A ) Suspected cases. Combined analysis of epidemiological history and clinical manifestations 1. epidemiological history (1) Travel history or residence history of Wuhan and surrounding areas, or other communities with case reports within 14 days before the onset of illness (2) History of contact with new coronavirus infected persons ( positive nucleic acid test ) within 14 days before onset (3) Patients with fever or respiratory symptoms from Wuhan and surrounding areas, or from communities with case reports, within 14 days before the onset of illness (4) clusters of disease (2 weeks in a small area such as a home, office, school classes and other places, the emergence of 2 and more cases of fever and / cases or respiratory symptoms ) . 2. Clinical manifestations (1) Fever and / or respiratory symptoms ( With the imaging features of the above-mentioned new coronavirus pneumonia (3) The total number of white blood cells is normal or decreased, and the lymphocyte count is normal or decreased in the early stage of onset. Have any one of the epidemiological history and meet any two of the clinical manifestations . If there is no clear epidemiological history, it meets 3 of the clinical manifestations . ( B ) confirmed cases. Suspected cases with one of the following etiology or serological evidence 1. Real-time fluorescence R BU PCR detection of nucleic acids novel coronavirus positive 2. Viral gene sequencing, highly homologous to known new coronaviruses 7 3. Serum novel coronavirus-specific IgM antibody and IgG antibody positive Serum novel coronavirus-specific IgG antibody changed from negative to positive or the recovery period was 4 times or more higher than the acute phase . Clinical classification ( 1 ) Lightweight. The clinical symptoms were mild, and no pneumonia manifested on imaging. ( B ) ordinary type. With fever, respiratory tract and other symptoms, imaging shows pneumonia. ( 3 ) Heavy. Adults meet any of the following 1. shortness of breath, RR more than 30 times / min 2. In the resting state, the oxygen saturation is 砭93% 3. arterial oxygen partial pressure (Pao , ) / the oxygen concentration (FIO,) acupuncture 300 Tada Hg (lmmHg-0. 133kpa) . At high altitudes ( above 1,000 meters ), PaOz / Fi0. Should be corrected according to the following formula Pao2 / Fi0, x [ Atmospheric pressure ( Tada Hg) / 76o] . Pulmonary imaging showed significant progression of the lesion within 24-48 hours> 50% of patients were managed as severe. Children meet any of the following 1. shortness of breath ( < 2 months of age, the RR plurality 60 times / min 2 ~ 12 months of age, the RR plurality 50 times / min 1 ~ 5 years, the RR plurality 40 times / min> 5 years of age, the RR plurality 30 times / min ) , Except for the effects of fever and crying 8 2. At rest, means oxygen saturation 砭92% 3. Assisted breathing ( groaning, nasal flap, tricuspid sign ) , cyanosis, intermittent apnea 4. Drowsiness and convulsions 5. Refuse to feed or feed, with signs of dehydration. ( 4 ) Dangerous. One of the following conditions 1. Respiratory failure occurs and requires mechanical ventilation 2. Shock appears 3 , combined with other organ failure requires ICU monitoring and treatment. Seven, heavy and critical clinical warning indicators ( A ) Adults. 1. Progressive decline in peripheral blood lymphocytes 2. Peripheral blood inflammatory factors such as IL-6 and C- reactive protein are increasing 3. Progressive elevation of lactic acid 4. Intrapulmonary disease progresses rapidly in the short term. ( B ) Children. 1. Increased respiratory rate W 2. Poor mental response, lethargy 3. Progressive elevation of lactic acid 4. Imaging shows bilateral or multilobe infiltration, pleural effusion, or short-term lesions 9 Rapid progress 5.3 baby months of age or have underlying diseases ( congenital heart disease, bronchopulmonary dysplasia, respiratory abnormalities, abnormal hemoglobin, severe malnutrition, etc. ) , immune deficiency or low ( long-term use of immunosuppressive agents ) . Differential diagnosis ( 1 ) The mild manifestations of new coronavirus infections need to be distinguished from upper respiratory tract infections caused by other viruses. ( 2 ) New coronavirus pneumonia is mainly distinguished from other known viral pneumonia and mycoplasma pneumoniae infections such as influenza virus, adenovirus, and respiratory syncytial virus, especially for suspected cases, including rapid antigen detection and multiplex PCR nucleic acid detection as far as possible And other methods to detect common respiratory pathogens. ( 3 ) It should also be distinguished from non-infectious diseases such as vasculitis, dermatomyositis, and organizing pneumonia. Finding and reporting of cases When medical personnel at various levels and various medical institutions find suspected cases that meet the definition of a case, they should immediately conduct isolation treatment in a single person. Experts in the hospital or consultation with the attending physician should still consider the suspected cases. Direct online reporting within 2 hours and Collect specimens for new coronavirus nucleic acid testing, and immediately transfer suspected cases to designated hospitals while ensuring safe transport. Patients who have close contact with the new coronavirus infection, even if the common respiratory pathogens are positive, it is recommended that the new coronavirus pathogenic test be performed in time. 10 Suspected case negative for two consecutive new coronavirus nucleic acid tests ( sampling time (At least 24 hours apart ) and 7 days after onset of novel coronavirus-specific antibody IgM And IgG are still negative to rule out a suspected case diagnosis. Ten, treatment ( 1 ) Determine the treatment place according to the condition. 1. Suspected and confirmed cases should be confirmed in the establishment of effective isolation and protection conditions. Isolation treatment at the hospital. Suspected cases should be treated in isolation. Many people were admitted in the same ward. 2. 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 electricity Dissolve mass balance, maintain internal environment stability, closely monitor vital signs, indicate oxygen saturation Wait 2. Monitor blood routine, urine routine, CRP , biochemical indicators ( liver enzymes, Myocardial enzymes, renal function, etc. ) , coagulation function, arterial blood gas analysis, chest imaging, etc. If possible, cytokine detection is feasible. 3. Give effective oxygen therapy measures in a timely manner, including nasal cannula, mask oxygen and transnasal height Flow oxygen therapy. Oxyhydrogen gas can be inhaled conditions ( day Techno 0,66. Pay Techno 33.3%) treatment. 4. Anti-viral treatment can try a- interferon ( 5 million U or more per adult When the dose, add 2m1 of sterile water for injection , aerosolized inhalation 2 times a day ) , lopina Wei / ritonavir ( adults 200 Tian g / somg / tablets, each 2 tablets daily 2 times, treatment No more than 10 days ) , ribavirin ( recommended with interferon or lopinavir / ritona 11 Wei combination ADULT 500 Tian g / twice a day 2 to . 3 intravenous infusion treatment not exceeding 10 days ) , chloroquine phosphate (18 years -65 years old adults. Weigh more than 50 kg or per 500 mg of daily 2 , treatment . 7 days weighing less than 50 kg or, first, two days per SOOmg , day 2 , third to seventh day per SOOmg , twice daily ) , Abidor ( adults 200 mg of , daily 3 times, the course of treatment does not exceed 10 days ) . Attention should be paid to the adverse reactions of the above drugs, contraindications ( such as chloroquine forbidden in patients with heart disease ) , and interaction with other drugs. To further evaluate the efficacy of the currently tested drugs in clinical applications. It is not recommended to use 3 or more antiviral drugs at the same time, and the use of related drugs should be stopped when there are intolerable side effects. For the treatment of pregnant women, the number of weeks of pregnancy should be considered, and as far as possible, drugs that have a small impact on the fetus, and whether to treat after termination of pregnancy should be informed and informed. 5. Antibacterial drug treatment Avoid blind or inappropriate use of antibacterial drugs, especially in combination with broad-spectrum antibacterial drugs. ( 3 ) Treatment of severe and critical cases. 1. The principle of treatment 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 (1) Patients with severe oxygen therapy should receive oxygen from a nasal cannula or a mask, and promptly evaluate whether respiratory distress and / or hypoxemia is relieved. (2) High-flow nasal catheter oxygen therapy or non-invasive mechanical ventilation. When patients have respiratory distress and / or hypoxemia cannot be relieved after receiving standard oxygen therapy, high-flow can be considered. 12 Nasal catheter oxygen therapy or non-invasive ventilation. If the condition does not improve within a short time (1-2 hours ) To worsen, tracheal intubation and invasive mechanical ventilation should be performed in time. (3) Invasive mechanical ventilation adopts lung protective ventilation strategy, that is, small tidal volume (6-8mL / kg ideal body weight ) and low level airway platform pressure ( ミ30cmH, O) . Perform mechanical ventilation to reduce ventilator-related lung injury. Airway platform pressure At 35cmH, O , high PEEP can be used appropriately to keep the airway warm and humid, avoiding long time Sedation was sedated, patients were awakened early and pulmonary rehabilitation was performed. Human-computer presence in many patients Out of sync, sedation and muscle relaxants should be used in a timely manner. According to the airway secretions, Select closed sputum suction, and perform bronchoscopy if necessary. (4) Salvage treatment For patients with severe ARDS , it is recommended to perform lung expansion. With sufficient human resources, the prone position should be performed for more than 12 hours per day Ventilation. Prone position mechanical ventilation is not effective, if conditions permit, should be tested as soon as possible Consider outer membrane lung oxygenation (ECM0) . The relevant indication ® in FI0 ,> 90% , the radon Bonding index of less than 80 fields mHg, , duration 3-4 hours or more internet Park airway pressure Mi 35cmH, 0 . For patients with simple respiratory failure, W - ECM0 mode is preferred If supported, select VA-ECM0 mode. Cardiopulmonary function under control of underlying diseases When there are signs of recovery, we can start the withdrawal test. 3. Circulation support improves microcirculation on the basis of adequate fluid resuscitation Use vasoactive drugs to closely monitor changes in patients' blood pressure, heart rate, and urine output. And lactic acid and alkali remaining in arterial blood gas analysis, non-invasive or invasive blood flow if necessary Kinetic monitoring, such as echo Doppler, echocardiography, invasive blood pressure or continuous 13 Cardiac output (PICCO) monitoring. In the treatment process, pay attention to the fluid balance strategy, Avoid excess and deficiency. If the patient's sudden increase in heart rate is found to be greater than 20% of the baseline value or blood pressure drops Above about 20% of the basal value , if accompanied by signs of poor skin perfusion and decreased urine output Patients should be closely monitored for septic shock, gastrointestinal bleeding, or cardiac function Can fail and other conditions. 4. Renal failure in renal failure and renal replacement therapy Actively look for factors that cause kidney damage, such as hypoperfusion and medication. Correct Treatment of patients with renal failure should focus on fluid balance, acid-base balance and electrolytes Balance, pay attention to nitrogen balance, calories and trace elements in nutrition support treatment supplement. Alternatively patients with severe CRRT (continuous renal replacement therapy (CRRT) . The indications include ® hyperkalemia Park Acidosis Pulmonary edema or fluid overload @ Fluids with multiple organ dysfunction management. 5. Plasma therapy for rehabilitated patients is suitable for fast progression, severe and critical illness patient. For usage and dosage, please refer to "Plasma clinical treatment method for recovering patients with new coronary pneumonia." Case ( trial version 2 ) . 6. Blood purification treatment blood purification system includes plasma exchange, adsorption, irrigation Flow, blood / plasma filtration, etc., can clear inflammatory factors and block. Cytokine storm. , In order to reduce the damage to the body caused by the inflammatory response, it can be used for patients with severe and critical illness. Treatment of Cytokine Storms in Early and Middle Stages. 14 use 1. Medical observation period Clinical manifestations 1 fatigue with gastrointestinal discomfort Recommended Chinese patent medicine Huoxiangzhengqi capsule ( pill, water, oral solution ) Clinical manifestations 2 fatigue and fever Recommended Chinese patent medicine Jinhua Qinggan granules, Lianhua Qingwen capsules ( granules ) , Shufengjiedu capsules ( granules ) 2. Clinical treatment period ( confirmed cases ) 2.1 Qingfei Detox Soup Scope of application Combined with the clinical observations of doctors in various places, it is suitable for light, ordinary and heavy patients. It can be used reasonably in combination with the actual situation of patients in the treatment of critically ill patients. Basic prescription ephedra 9g , licorice 6g , almonds 9g , gypsum 15 ~ 30g ( Xian Jian ) , Guizhi 9g , Alisma 9g , Polyporus 9g , Atractylodes 9g , Poria 15g , bupleurum 16G , skullcap 6g , ginger Pinellia 9g , ginger 9g , purple flower 9g , winter flower 9g , shoot dry 9g , asarum 6g , yam 12g , coriander fruit 6g , tangerine peel 6g , aquila 9g. Take traditional Chinese medicine decoction pieces, decoction. One payment per day, one morning and one evening ( forty minutes after a meal ) , warm service, three treatments. If conditions permit, you can take half a bowl of rice soup each time you take the medicine, and you can take up to one bowl if you have a dry tongue and fluid. ( Note that if the patient does not have fever, the amount of gypsum should be small, and fever or strong heat can increase the amount of gypsum ) . If the symptoms improve but do not heal, then take a second course of treatment. If the patient has special conditions or other underlying diseases, the second course of treatment can be based on 16 The actual situation changed the prescription, and the drug was discontinued when the symptoms disappeared. The source of the prescription is the Office of the State Administration of Traditional Chinese Medicine of the General Office of the National Health and Health Commission. Qingfei detox soup. Notice " ( Guo Han Han Zheng Zheng Han (2020) No. 22 ) . 2.2 Lightweight (1) cold and dampness lung syndrome Clinical manifestations include fever, fatigue, sore body, cough, expectoration, tightening of belching, appetite, nausea, vomiting, and sticky stools. The tongue is pale, with thick tooth marks or red, moss white, thick, rotten or greasy, and the pulses are slippery or slippery. The recommended prescribed raw ephedra 6g , gypsum 15g , almonds 9g , Notopterygium 15g, Tinglizi 15g , Guanzhong 9g , earthworm 15g , Xu Changqing 15g , Agastache 15g , Perrin 9g , herb 15g , Yun Ling 45g , Atractylodes 30g , coke Sansen each 9g , Magnolia 15g. coke betel nut 9g , simmer grass fruit 9g , ginger 15g. Take 1 dose daily , decoction 60001 , 3 times a day, 1 time each morning, night and evening , before meals. (2) Damp heat syndrome Clinical manifestations: low fever or no fever, slight chills, fatigue, heavy head and body, muscle aches, dry cough, less phlegm, sore throat, dry mouth, do not want to drink more, or accompanied by chest tightness, no sweat or sweating. Or see vomiting and dullness, diarrhea or sticky stool. The tongue is reddish, the white fur is thick and greasy or thin yellow, and the pulse is slippery or sloppy. Recommended prescription betel nut 10g , grass fruit 10g , Magnolia 10g , Zhimu 10g , yellow 17 芩10g , Bupleurum 10g , Red Radix 10g , Forsythia 15g , Artemisia annua 10g ( back ) , Cang Surgery 10g , Folium 10g , raw licorice 5g. Take 1 dose daily , decoct 400 ol , and take 2 times, one morning and one night . 2.3 ordinary type (1) damp toxin and lung syndrome Clinical manifestations of fever, low cough and sputum, or yellow sputum, tightness, shortness of breath, abdominal distension, Constipation. The tongue is dark red, the tongue is fat, the coating is greasy or yellow, and the pulse is slippery or stringy. Recommended prescription: raw ephedra 6g , bitter almond 15g , raw plaster 30g , raw coix seed 30g , Maocao 10g , patchouli 15g , artemisia annua grass 12g , Polygonum cuspidatum 20g , verbena 30g , Qianlu root 308 , gardenia 15g , orange tangerine 15g , raw licorice 10g. Take 1 dose daily , decoct 400 fields 1 , and take it 2 times, one morning and one night. (2) cold dampness lung syndrome Clinical manifestations: low fever, low body temperature, or no fever, dry cough, less sputum, burnout Fatigue, chest tightness, nausea, or nausea. Pale or red tongue, white or white fur Tired and pulsed. Recommended prescriptions are Cangzhu 15g , Chenpi 10g , Magnolia officinalis 10g , Huoxiang 10g , grass 6g fruit, 6g raw ephedra , 10g loquat , 10g ginger, 10g betel nut . Dosage daily 1 , decoction 4001 , divided 2 doses, sooner or later each 1 times. 2.4 Heavy (1) Epidemic alcohol lung certificate Clinical manifestations: fever, flushing, cough, yellowish phlegm, or blood in sputum, asthma 18 Shortness of breath, tiredness, dry mouth, stickiness, nausea, poor stool, short urine red. Red tongue, yellow greasy fur, slippery pulses. Recommended prescriptions Basic prescription raw ephedra 6g , almond 9g , raw gypsum 15g , licorice 3g , tincture Incense 10g ( after the next ) , Magnolia 10g , herb 15g , grass and fruit 10g , France Pinellia 9g , Fu Ling Ling 15g , raw rhubarb 5g ( behind the bottom ) , raw astragalus 10g , gardenia 10g , red scallion 10g. Take 1 to 2 doses daily , decoction, 100 fields 1 to 200 fields 1 each time , 2 to 1 day 4 times, orally or nasally. (2) Two dialectics of air camp Clinical manifestations of fever, thirst, shortness of breath, shortness of breath, slang fainting, wrong vision, They may have spotted rash, or vomiting blood, bleeding, or twitching of the limbs. Tongue scabs with little or no moss, veins Shen small numbers, or floating large numbers. The recommended prescribed gypsum 30 ~ 60g ( fry ) , altogether 30g , habitat 30 ~ 60g , buffalo horn 30g ( fried first ) , red scallion 30g , black ginseng 30g , forsythia 15g , dan Peel 15g , Coptis chinensis 6g , bamboo leaves 12g , gardenia 15g , raw licorice 6g. Take 1 dose daily , decoction, decoction gypsum and buffalo horn first, then apply medicine, 100 fields 1 to 20001 each time , 2 to 4 times a day, orally or nasally. Recommended traditional Chinese medicine Xiyanping injection, Xuebijing injection, Reduning injection Liquid, Tanreqing injection, Xingnaojing injection. Drugs with similar efficacy You can choose one kind of situation, or you can use two kinds according to clinical symptoms. Chinese medicine injection The agent can be used in combination with Chinese medicine decoction. 19 2.5 Dangerous Worry inside out Clinical manifestations of dyspnea, dyspnea, asthma or mechanical ventilation, accompanied by fainting, irritability, cold sweaty limbs, dark purple tongue, thick or dry moss, large pulse without roots. It is recommended to prescribe ginseng 15g , Heishun tablets 10g ( fried first ) , dogwood 15g , and take Su Hexiang Pill or An Gong Niuhuang Pill. If you have mechanical ventilation with abdominal distension, constipation or poor stool, you can use raw rhubarb 5 ~ 10g . Man-machine out-of-sync condition occurs. In the case of sedation and muscle relaxant, raw rhubarb 5 ～10g and thenardite 5 ～10g can be used. The Chinese patent medicine Xuebijing injection, Reduning injection, Tanreqing injection, Xingnaojing injection, Shenfu injection, Shengmai injection, and Shenmai injection are recommended. Drugs with similar efficacy can be selected according to individual conditions, or can be used in combination according to clinical symptoms. Traditional Chinese medicine injection can be used in combination with traditional Chinese medicine decoction. Recommended usage of injection of heavy and critical Chinese medicine The use of traditional Chinese medicine injections follows the principle of starting from a small dose and gradually adjusting the syndrome according to the instructions of the medicine. The recommended usage is as follows Viral infection or combined mild bacterial infection 0.9% sodium chloride injection 2501 plus Xiyanping injection 100mg bid , or 0.9% sodium chloride injection 25001 heated Duning injection 20ml , or 0.9% sodium chloride injection 250m1 Jiatanreqing injection 40m1 bid. High fever with unconsciousness 0.9% sodium chloride injection 250 Tian 1 plus Xingnaojing injection 20 Liquid 20m1 bid. Systemic inflammatory response syndrome or / and multiple organ failure 0.9% sodium chloride injection 250l plus Xuebijing injection tool bid. Immunosuppressive glucose injection 2501 plus Shenmai injection 1001 or Shengmai injection 20 to 601 bid. 2.6 Recovery period (1) Lung and Spleen Qi Deficiency Syndrome Clinical manifestations of shortness of breath, fatigue, fatigue, anorexia, nausea, fullness, weak stools, and uneasiness. The tongue is pale and greasy. The recommended method is Pinellia 9g , Chenpi 10g , Codonopsis 15g , Astragalus 30g. Stir-fried Atractylodes 10g , Poria 15g , Huoxiang 10g , Amomum 6g ( later ) , and 6g of licorice . Dosage Daily i , decoction 4001 , divided two doses, morning and evening 1 times. (2) Qi and Yin deficiency Clinical manifestations are fatigue, shortness of breath, dry mouth, thirst, palpitations, excessive sweating, poor appetite, low or no fever, dry cough and sputum. Dry tongue, little pulse, thin pulse or weakness. The recommended prescribed north and south Adenophora 10g , Radix 15g , American ginseng 6g , Schisandra 6g , gypsum 15g , short bamboo 10g , mulberry 10g , reed rhizome 15g , Salvia 15g, raw licorice 6g. Dosage daily 1 , decoction 40001. points 2 times daily, morning and evening 1 times. Eleven, discharge standards and precautions after discharge ( A ) discharge standards. twenty one 1. The body temperature returns to normal for more than 3 days 2. Respiratory symptoms improved significantly 3. Pulmonary imaging shows a marked improvement in acute exudative lesions 4. Negative nucleic acid test of sputum, nasopharyngeal swabs and other respiratory specimens consecutively ( sampling time interval of at least 24 hours ) . Those who meet the above conditions can be discharged. ( 2 ) Precautions after discharge. 1. The designated hospitals should make good contact with the primary medical institutions where the patients live, share medical records, and promptly push the discharged patients' information to the patient's jurisdiction or residential committees and primary medical institutions. 2. After the patient is discharged from the hospital, it is recommended to continue the isolation management and health monitoring for 14 days, wear a mask, and live in a well-ventilated single room conditionally to reduce close contact with family members. Hygiene and avoid going out. 3. It is recommended to follow up and return to the hospital in the 2nd and 4th week after discharge . Eleven, the transfer principle It was implemented in accordance with the Work Plan for Transport of Pneumonia Cases of New Coronavirus Infection ( Trial ) issued by the National Health and Health Commission . 13. Prevention and Control of Infection in Medical Institutions Strictly follow the requirements of the National Health and Health Commission's "Technical Guidelines for the Prevention and Control of New Coronavirus Infection in Medical Institutions ( First Edition ) " and "Guidelines for the Use of Common Medical Protective Products in the Pneumonia Care of New Coronavirus Infection ( Trial ) " . twenty two
国家卫生健康委员会办公厅
国家中医药管理局办公室
国卫办医函(2020)184号
关于印发新型冠状病毒肺炎诊疗方案
(试行第七版)的通知
各省、自治区、直辖市及新疆生产建设兵团卫生健康委、中医药管
理局
为进一步做好新型冠状病毒肺炎病例诊断和医疗救治工作，
我们组织专家在对前期医疗救治工作进行分析、研判、总结的基础
上，对诊疗方案进行修订，形成了《新型冠状病毒肺炎诊疗方案(试
行第七版)》。现印发给你们，请参照执行。各有关医疗机构要在
医疗救治工作中积极发挥中医药作用，加强中西医结合，完善中西
医联合会诊制度，促进医疗救治取得良好效果。
(信息公开形式主动公开)
新型冠状病毒肺炎诊疗方案
(试行第七版)
2019年12月以来，湖北省武汉市出现了新型冠状病毒肺炎
疫情，随着疫情的蔓延，我国其他地区及境外多个国家也相继
发现了此类病例。该病作为急性呼吸道传染病已纳入《中华人
民共和国传染病防治法》规定的乙类传染病，按甲类传染病管
理。通过采取一系列预防控制和医疗救治措施，我国境内疫情
上升的势头得到一定程度的遏制，大多数省份疫情缓解，但境
外的发病人数呈上升态势。随着对疾病临床表现、病理认识的
深入和诊疗经验的积累，为进一步加强对该病的早诊早治，提
高治愈率，降低病亡率，最大可能避免医院感染，同时提醒注
意境外输入性病例导致的传播和扩散，我们对《新型冠状病毒
肺炎诊疗方案(试行第六版)》进行修订，形成了《新型冠状病
毒肺炎诊疗方案(试行第七版)》。
一、病原学特点
新型冠状病毒属于0属的冠状病毒，有包膜，颗粒呈圆形
或椭圆形，常为多形性，直径60-140nm。其基因特征与SARS-Cov
和MERS-Cov有明显区别。目前研究显示与蝙蝠SARS样冠状病
毒(bat-SL-CoVZC45)同源性达85%以上。体外分离培养时，新
型冠状病毒96个小时左右即可在人呼吸遭上皮细胞内发现，而
在Vero E6和Huh-7细胞系中分离培养需约6天。
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对冠状病毒理化特性的认识多来自对SARS-Cov和肥RS-Cov
的研究。病毒对紫外线和热敏感，56℃30分钟、乙醚、75%乙
醇、含氯消毒剂、过氧乙酸和氯仿等脂溶剂均可有效灭活病毒，
氯已定不能有效灭活病毒。
一、流行病学特点
(一)传染源。
目前所见传染源主要是新型冠状病毒感染的患者。无症状
感染者也可能成为传染源。
(二)传播途径。
经呼吸道飞沫和密切接触传播是主要的传播途径。在相对
封闭的环境中长时间暴露于高浓度气溶胶情况下存在经气溶胶
传播的可能。由于在粪便及尿中可分离到新型冠状病毒，应注
意粪便及尿对环境污染造成气溶胶或接触传播。
(三)易感人群。
人群普遍易感。
三、病理改变
根据目前有限的尸检和穿刺组织病理观察结果总结如下。
(一)肺脏。
肺脏呈不同程度的实变。
肺泡腔内见浆液、纤维蛋白性渗出物及透明膜形成渗出
细胞主要为单核和巨噬细胞，易见多核巨细胞。II型肺泡上皮
细胞显著增生，部分细胞脱落。II型肺泡上皮细胞和巨噬细胞
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内可见包涵体。肺泡隔血管充血、水肿，可见单核和淋巴细胞浸润及血管内透明血栓形成。肺组织灶性出血、坏死，可出现出血性梗死。部分肺泡腔渗出物机化和肺间质纤维化。
肺内支气管黏膜部分上皮脱落，腔内可见黏液及黏液栓形成。少数肺泡过度充气、肺泡隔断裂或囊腔形成。
电镜下支气管黏膜上皮和II型肺泡上皮细胞胞质内可见冠状病毒颗粒。免疫组化染色显示部分肺泡上皮和巨噬细胞呈新型冠状病毒抗原阳性，RT-PCR检测新型冠状病毒核酸阳性。(二)脾脏、肺门淋巴结和骨髓。
脾脏明显缩小。淋巴细胞数量明显减少，灶性出血和坏死，脾脏内巨噬细胞增生并可见吞噬现象；淋巴结淋巴细胞数量较少，可见坏死。免疫组化染色显示脾脏和淋巴结内CD4+T和CD8+T细胞均减少。骨髓三系细胞数量减少。
(三)心脏和血管。
心肌细胞可见变性、坏死，间质内可见少数单核细胞、淋巴细胞和(或)中性粒细胞浸润。部分血管内皮脱落、内膜炎亡乳儿名人圳山
症及血栓形成。
(四)肝脏和胆囊。
体积增大，暗红色。肝细胞变性、灶性坏死伴中性粒细胞浸润肝血窦充血，汇管区见淋巴细胞和单核细胞细胞浸润，微血栓形成。胆囊高度充盈。
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(五)肾脏。
肾小球球囊腔内见蛋白性渗出物，肾小管上皮变性、脱落，可见透明管型。间质充血，可见微血栓和灶性纤维化。
(六)其他器官。
脑组织充血、水肿，部分神经元变性。肾上腺见灶性坏死。食管、胃和肠管黏膜上皮不同程度变性、坏死、脱落。
四、临床特点
(一)临床表现。
基于目前的流行病学调查，潜伏期1-14天，多为3-7天。
以发热、干咳、乏力为主要表现。少数患者伴有鼻塞、流涕、咽痛、肌痛和腹泻等症状。重症患者多在发病一周后出现呼吸困难和/或低氧血症，严重者可快速进展为急性呼吸窘迫综合征、服毒症休克、难以纠正的代谢性酸中毒和出凝血功能障碍及多器官功能衰竭等。值得注意的是重型、危重型患者病程中可为中低热，客至无明显发热。
部分儿童及新生儿病例症状可不典型，表现为呕吐、腹泻等消化道症状或仅表现为精神弱、呼吸急促。
轻型患者仅表现为低热、轻微乏力等，无肺炎表现。
从目前收治的病例情况看，多数患者预后良好，少数患者病情危重。老年人和有慢性基础疾病者预后较差。患有新型冠状病毒肺炎的孕产妇临床过程与同龄患者相近。儿童病例症状
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相对较轻。
(二)实验室检查。
1.一般检查
发病早期外周血白细胞总数正常或减少，可见淋巴细胞计数减少，部分患者可出现肝酶、乳酸脱氢酶(LDH)、肌酶和肌红蛋白增高部分危重者可见肌钙蛋白增高。多数患者C反应蛋白(CRP)和血沉升高，降钙素原正常。严重者D-二聚体升高外周血淋巴细胞进行性减少。重型、危重型患者常有炎症因子升高。
2.病原学及血清学检查
(1)病原学检查采用R卜PCR或/和NGS方法在鼻咽拭子痰和其他下呼吸道分泌物、血液、粪便等标本中可检测出新型冠状病毒核酸。检测下呼吸道标本(痰或气道抽取物)更加准确。标本采集后尽快送检。
(2)血清学检查新型冠状病毒特异性lgM抗体多在发病3-5天后开始出现阳性，IgG抗体滴度恢复期较急性期有4倍及以上增高。
(三)胸部影像学。
早期呈现多发小斑片影及间质改变，以肺外带明显。进而发展为双肺多发磨玻璃影、浸润影，严重者可出现肺实变，胸腔积液少见。
五、诊断标准
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(一)疑似病例。
结合下述流行病学史和临床表现综合分析
1.流行病学史
(1)发病前14天内有武汉市及周边地区，或其他有病例报告社区的旅行史或居住史
(2)发病前14天内与新型冠状病毒感染者(核酸检测阳性者)有接触史
(3)发病前14天内曾接触过来自武汉市及周边地区，或来自有病例报告社区的发热或有呼吸道症状的患者
(4)聚集性发病(2周内在小范围如家庭、办公室、学校班级等场所，出现2例及以上发热和/或呼吸道症状的病例)。2.临床表现
(1)发热和/或呼吸道症状
(具有上述新型冠状病毒肺炎影像学特征
(3)发病早期白细胞总数正常或降低，淋巴细胞计数正常或减少。
有流行病学史中的任何一条，且符合临床表现中任意2条。无明确流行病学史的，符合临床表现中的3条。
(二)确诊病例。
疑似病例同时具备以下病原学或血清学证据之一者
1.实时荧光R卜PCR检测新型冠状病毒核酸阳性
2，病毒基因测序，与已知的新型冠状病毒高度同源
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3.血清新型冠状病毒特异性IgM抗体和IgG抗体阳性血清新型冠状病毒特异性IgG抗体由阴性转为阳性或恢复期较急性期4倍及以上升高。
六、临床分型
(一)轻型。
临床症状轻微，影像学未见肺炎表现。
(二)普通型。
具有发热、呼吸道等症状，影像学可见肺炎表现。
(三)重型。
成人符合下列任何一条
1.出现气促，RR多30次/分
2.静息状态下，指氧饱和度砭93%
3.动脉血氧分压(Pao，)/吸氧浓度(FIO,)砭300田田Hg( lmmHg-0. 133kpa ).
高海拔(海拔超过1000米)地区应根据以下公式对PaOz/Fi0.进行校正Pao2/Fi0,x[大气压(田田Hg)/76o]。
肺部影像学显示24-48小时内病灶明显进展〉50%者按重型管理。
儿童符合下列任何一条
1.出现气促(〈2月龄，RR多60次/分2～12月龄，RR多50次/分1～5岁，RR多40次/分〉5岁，RR多30次/分)，除外发热和哭闹的影响
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2.静息状态下，指氧饱和度砭92%
3.辅助呼吸(呻吟、鼻翼扇动、三凹征)，发绀，间歇性呼吸暂停
4.出现嗜睡、惊厥
5.拒食或喂养困难，有脱水征。
(四)危重型。
符合以下情况之一者
1.出现呼吸衰竭，且需要机械通气
2.出现休克
3，合并其他器官功能衰竭需ICU监护治疗。
七，重型，危重型临床预警指标
(一)成人。
1.外周血淋巴细胞进行性下降
2.外周血炎症因子如IL-6、C反应蛋白进行性上升
3.乳酸进行性升高
4.肺内病变在短期内迅速进展。
(二)儿童。
1.呼吸频率增W
2.精神反应差、嗜睡
3.乳酸进行性升高
4.影像学显示双侧或多肺叶浸润、胸腔积液或短期内病变
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快速进展
5.3月龄以下的婴儿或有基础疾病(先天性心脏病、支气管肺发育不良、呼吸道畸形、异常血红蛋白、重度营养不良等)，有免疫缺陷或低下(长期使用免疫抑制剂)。
八、鉴别诊断
(一)新型冠状病毒感染轻型表现需与其他病毒引起的上呼吸道感染相鉴别。
(二)新型冠状病毒肺炎主要与流感病毒、腺病毒、呼吸道合胞病毒等其他已知病毒性肺炎及肺炎支原体感染鉴别，尤其是对疑似病例要尽可能采取包括快速抗原检测和多重PCR核酸检测等方法，对常见呼吸道病原体进行检测。
(三)还要与非感染性疾病，如血管炎、皮肌炎和机化性肺炎等鉴别。
九，病例的发现与报告
各级各类医疗机构的医务人员发现符合病例定义的疑似病例后，应当立即进行单人间隔离治疗，院内专家会诊或主诊医师会诊，仍考虑疑似病例，在2小时内进行网络直报，并采集标本进行新型冠状病毒核酸检测，同时在确保转运安全前提下立即将疑似病例转运至定点医院。与新型冠状病毒感染者有密切接触的患者，即便常见呼吸道病原检测阳性，也建议及时进行新型冠状病毒病原学检测。
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疑似病例连续两次新型冠状病毒核酸检测阴性(采样时间
至少间隔24小时)且发病7天后新型冠状病毒特异性抗体IgM
和IgG仍为阴性可排除疑似病例诊断。
十，治疗
(一)根据病情确定治疗场所。
1.疑似及确诊病例应在具备有效隔离条件和防护条件的定
点医院隔离治疗，疑似病例应单人单间隔离治疗，确诊病例可
多人收治在同一病室。
2.危重型病例应当尽早收入ICU治疗。
(二)一般治疗。
1.卧床休息，加强支持治疗，保证充分热量注意水、电
解质平衡，维持内环境稳定密切监测生命体征、指氧饱和度
等
2.根据病情监测血常规、尿常规、CRP、生化指标(肝酶、
心肌酶、肾功能等)、凝血功能、动脉血气分析、胸部影像学等。
有条件者可行细胞因子检测。
3.及时给予有效氧疗措施，包括鼻导管、面罩给氧和经鼻高
流量氧疗。有条件可采用氢氧混合吸入气(日ノ0,66.酬ノ33.3%)治疗。
4.抗病毒治疗可试用a-干扰素(成人每次500万U或相
当剂量，加入灭菌注射用水2m1，每日2次雾化吸入)、洛匹那
韦/利托那韦(成人200田g/somg/粒，每次2粒，每日2次，疗
程不超过10天)、利巴韦林(建议与干扰素或洛匹那韦/利托那
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韦联合应用，成人500田g/次，每日2至3次静脉输注，疗程不超过10天)、磷酸氯喹(18岁-65岁成人。体重大于50公斤者，每次500mg、每日2次，疗程7天体重小于50公斤者，第一、二天每次SOOmg、每日2次，第三至第七天每次SOOmg、每日次)、阿比多尔(成人200mg，每日3次，疗程不超过10天)。要注意上述药物的不良反应、禁忌症(如患有心脏疾病者禁用氯喹)以及与其他药物的相互作用等问题。在临床应用中进一步评价目前所试用药物的疗效。不建议同时应用3种及以上抗病毒药物，出现不可耐受的毒副作用时应停止使用相关药物。对孕产妇患者的治疗应考虑妊娠周数，尽可能选择对胎儿影响较小的药物，以及是否终止妊娠后再进行治疗等问题，并知情告知。
5.抗菌药物治疗避免盲目或不恰当使用抗菌药物，尤其是联合使用广谱抗菌药物。
(三)重型、危重型病例的治疗。
1.治疗原则在对症治疗的基础上，积极防治并发症，治疗基础疾病，预防继发感染，及时进行器官功能支持。
2.呼吸支持
(1)氧疗重型患者应当接受鼻导管或面罩吸氧，并及时评估呼吸窘迫和/或低氧血症是否缓解。
(2)高流量鼻导管氧疗或无创机械通气当患者接受标准氧疗后呼吸窘迫和/或低氧血症无法缓解时，可考虑使用高流量
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鼻导管氧疗或无创通气。若短时间(1-2小时)内病情无改善甚
至恶化，应当及时进行气管插管和有创机械通气。
(3)有创机械通气采用肺保护性通气策略，即小潮气量
(6-8mL/kg理想体重)和低水平气道平台压力(ミ30cmH,O)进
行机械通气，以减少呼吸机相关肺损伤。在保证气道平台压砭
35cmH,O时，可适当采用高PEEP,保持气道温化湿化，避免长时
间镇静，早期唤醒患者并进行肺康复治疗。较多患者存在人机
不同步，应当及时使用镇静以及肌松剂。根据气道分泌物情况，
选择密闭式吸痰，必要时行支气管镜检查采取相应治疗。
(4)挽救治疗对于严重ARDS患者，建议进行肺复张。
在人力资源充足的情况下，每天应当进行12小时以上的俯卧位
通气。俯卧位机械通气效果不佳者，如条件允许，应当尽快考
虑体外膜肺氧合(ECM0)。其相关指征®在Fi0，〉90%时，氡
合指数小于80田mHg，持续3-4小时以上园气道平台压み
35cmH,0。单纯呼吸衰竭患者，首选W一ECM0模式若需要循环
支持，则选用VA-ECM0模式。在基础疾病得以控制，心肺功能
有恢复迹象时，可开始撤机试验。
3.循环支持在充分液体复苏的基础上，改善微循环，使
用血管活性药物，密切监测患者血压、心率和尿量的变化，以
及动脉血气分析中乳酸和碱剩余，必要时进行无创或有创血流
动力学监测，如超声多普勒法、超声心动图、有创血压或持续
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心排血量(PICCO)监测。在救治过程中，注意液体平衡策略，
避免过量和不足。
如果发现患者心率突发增加大于基础值的20%或血压下降
大约基础值20%以上时，若伴有皮肤灌注不良和尿量减少等表现
时，应密切观察患者是否存在脓毒症休克、消化道出血或心功
能衰竭等情况。
4.肾功能衰竭和肾替代治疗危重症患者的肾功能损伤应
积极寻找导致肾功能损伤的原因，如低灌注和药物等因素。对
于肾功能衰竭患者的治疗应注重体液平衡、酸碱平衡和电解质
平衡，在营养支持治疗方面应注意氮平衡、热量和微量元素等
补充。重症患者可选择连续性肾替代治疗(continuous renal
replacement therapy,CRRT)。其指征包括®高钾血症园
酸中毒囤肺水肿或水负荷过重@多器官功能不全时的液体
管理。
5.康复者血浆治疗适用于病情进展较快、重型和危重型
患者。用法用量参考《新冠肺炎康复者恢复期血浆临床治疗方
案(试行第二版)》。
6.血液净化治疗血液净化系统包括血浆置换、吸附、灌
流、血液/血浆滤过等，能清除炎症因子，阻断。细胞因子风暴。，
从而减轻炎症反应对机体的损伤，可用于重型、危重型患者细
胞因子风暴早中期的救治。
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使用
1.医学观察期
临床表现1乏力伴胃肠不适
推荐中成药藿香正气胶囊(丸、水、口服液)
临床表现2乏力伴发热
推荐中成药金花清感颗粒、连花清瘟胶囊(颗粒)、疏风解毒胶囊(颗粒)
2.临床治疗期(确诊病例)
2.1清肺排毒汤
适用范围结合多地医生临床观察，适用于轻型、普通型、重型患者，在危重型患者救治中可结合患者实际情况合理使用。
基础方剂麻黄9g、炙甘草6g、杏仁9g、生石膏15～30g(先煎)、桂枝9g、泽泻9g、猪苓9g、白术9g、茯苓15g、柴胡16g、黄芩6g、姜半夏9g、生姜9g、紫花9g、冬花9g、射干9g、细辛6g、山药12g、枳实6g、陈皮6g、藿香9g.
服法传统中药饮片，水煎服。每天一付，早晚各一次(饭后四十分钟)，温服，三付一个疗程。
如有条件，每次服完药可加服大米汤半碗，舌干津液亏虚者可多服至一碗。(注如患者不发热则生石膏的用量要小，发热或壮热可加大生石膏用量)。若症状好转而未痊愈则服用第二个疗程，若患者有特殊情况或其他基础病，第二疗程可以根据
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实际情况修改处方，症状消失则停药。
处方来源国家卫生健康委办公厅国家中医药管理局办公室《关于推荐在中西医结合救治新型冠状病毒感染的肺炎中使用。清肺排毒汤。的通知》(国中医药办医政函(2020)22号)。2.2轻型
(1)寒湿郁肺证
临床表现发热，乏力，周身酸痛，咳嗽，咯痰，加紧憋气，纳呆，恶心，呕吐，大便粘腻不爽。舌质淡胖齿痕或淡红，苔白厚腐腻或白腻，脉濡或滑。
推荐处方生麻黄6g、生石膏15g、杏仁9g、羌活15g,葶苈子15g、贯众9g、地龙15g、徐长卿15g、藿香15g、佩兰9g、苍术15g、云苓45g、生白术30g、焦三仙各9g、厚朴15g.焦槟榔9g、煨草果9g、生姜15g.
服法每日1剂，水煎60001，分3次服用，早中晚各1次，饭前服用。
(2)湿热蕴肺证
临床表现低热或不发热，微恶寒，乏力，头身困重，肌肉酸痛，干咳痰少，咽痛，口干不欲多饮，或伴有胸闷脘痞，无汗或汗出不畅，或见呕恶纳呆，便溏或大便粘滞不爽。舌淡红，苔白厚腻或薄黄，脉滑数或濡。
推荐处方槟榔10g、草果10g、厚朴10g、知母10g、黄
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芩10g、柴胡10g、赤芍10g、连翘15g、青蒿10g(后下)、苍
术10g、大青叶10g、生甘草5g.
服法每日1剂，水煎400ol，分2次服用，早晚各1次。
2.3普通型
(1)湿毒郁肺证
临床表现发热，咳嗽痰少，或有黄痰，憋闷气促，腹胀，
便秘不畅。舌质暗红，舌体胖，苔黄腻或黄燥，脉滑数或弦滑。
推荐处方生麻黄6g、苦杏仁15g、生石膏30g、生薏苡仁
30g、茅苍术10g、广藿香15g、青蒿草12g、虎杖20g、马鞭草
30g、千芦根308、葶苈子15g、化橘红15g、生甘草10g.
服法每日1剂，水煎400田1，分2次服用，早晚各1次。
(2)寒湿阻肺证
临床表现低热，身热不扬，或未热，干咳，少痰，倦怠
乏力，胸闷，脘痞，或呕恶，便溏。舌质淡或淡红，苔白或白
腻，脉濡。
推荐处方苍术15g、陈皮10g、厚朴10g、藿香10g、草
果6g、生麻黄6g、羌活10g、生姜10g、槟榔10g.
服法每日1剂，水煎4001，分2次服用，早晚各1次。
2.4重型
(1)疫毒酒肺证
临床表现发热面红，咳嗽，痰黄粘少，或痰中带血，喘
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憋气促，疲乏倦怠，口干苦粘，恶心不食，大便不畅，小便短
赤。舌红，苔黄腻，脉滑数。
推荐处方化湿败毒方
基础方剂生麻黄6g、杏仁9g、生石膏15g、甘草3g、藿
香10g(后下)、厚朴10g、苍术15g、草果10g、法半夏9g、茯
苓15g、生大黄5g(后下)、生黄芪10g、葶苈子10g、赤芍10g.
服法每日1～2剂，水煎服，每次100田1～200田1，一日2～
4次，口服或鼻饲。
(2)气营两辩证
临床表现大热烦渴，喘憋气促，谵语神昏，视物错普，
或发斑疹，或吐血、衄血，或四肢抽搐。舌绛少苔或无苔，脉
沉细数，或浮大而数。
推荐处方生石膏30～60g(先煎)、知母30g、生地30～
60g、水牛角30g(先煎)、赤芍30g、玄参30g、连翘15g、丹
皮15g、黄连6g、竹叶12g、葶苈子15g、生甘草6g.
服法每日1剂，水煎服，先煎石膏、水牛角后下诸药，
每次100田1～20001，每日2～4次，口服或鼻饲。
推荐中成药喜炎平注射液、血必净注射液、热毒宁注射
液、痰热清注射液、醒脑静注射液。功效相近的药物根据个体
情况可选择一种，也可根据临床症状联合使用两种。中药注射
剂可与中药汤剂联合使用。
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2.5危重型
内忧外脱证
临床表现呼吸困难、动辄气喘或需要机械通气，伴神昏，烦躁，汗出肢冷，舌质紫暗，苔厚腻或燥，脉浮大无根。
推荐处方人参15g、黑顺片10g(先煎)、山茱萸15g，送服苏合香丸或安宫牛黄丸。
出现机械通气伴腹胀便秘或大便不畅者，可用生大黄5～10g。出现人机不同步情况，在镇静和肌松剂使用的情况下，可用生大黄5～10g和芒硝5～10g.
推荐中成药血必净注射液、热毒宁注射液、痰热清注射液、醒脑静注射液、参附注射液、生脉注射液、参麦注射液。功效相近的药物根据个体情况可选择一种，也可根据临床症状联合使用两种。中药注射剂可与中药汤剂联合使用。
注重型和危重型中药注射剂推荐用法
中药注射剂的使用遵照药品说明书从小剂量开始、逐步辨证调整的原则，推荐用法如下
病毒感染或合并轻度细菌感染0.9%氯化钠注射液2501加喜炎平注射液100mg bid，或0.9%氯化钠注射液25001加热毒宁注射液20ml，或0.9%氯化钠注射液250m1加痰热清注射液40m1 bid.
高热伴意识障碍0.9%氯化钠注射液250田1加醒脑静注射
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液 20m1 bid.
全身炎症反应综合征或/和多脏器功能衰竭0.9%氯化钠注射液250l加血必净注射液tool bid.
免疫抑制葡萄糖注射液2501加参麦注射液1001或生脉注射液20～601 bid.
2.6恢复期
(1)肺脾气虚证
临床表现气短，倦怠乏力，纳差呕恶，痞满，大便无力，便溏不爽。舌淡胖，苔白腻。
推荐处方法半夏9g、陈皮10g、党参15g、炙黄芪30g.炒白术10g、茯苓15g、藿香10g、砂仁6g(后下)、甘草6g.
服法每日i剂，水煎4001，分2次服用，早晚各1次。(2)气阴两虚证
临床表现乏力，气短，口干，口渴，心悸，汗多，纳差，低热或不热，干咳少痰。舌干少津，脉细或虚无力。
推荐处方南北沙参各10g、麦冬15g、西洋参6g，五味子6g、生石膏15g、淡竹叶10g、桑叶10g、芦根15g、丹参15g,生甘草6g.
服法每日1剂，水煎40001.分2次服用，早晚各1次。十一、出院标准和出院后注意事项
(一)出院标准。
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1.体温恢复正常3天以上
2.呼吸道症状明显好转
3.肺部影像学显示急性渗出性病变明显改善
4.连续两次痰、鼻咽拭子等呼吸道标本核酸检测阴性(采样时间至少间隔24小时)。
满足以上条件者可出院。
(二)出院后注意事项。
1.定点医院要做好与患者居住地基层医疗机构间的联系，共享病历资料，及时将出院患者信息推送至患者辖区或居住地居委会和基层医疗卫生机构。
2.患者出院后，建议应继续进行14天的隔离管理和健康状况监测，佩戴口罩，有条件的居住在通风良好的单人房间，减少与家人的近距离密切接触，分餐饮食，做好手卫生，避免外出活动。
3.建议在出院后第2周和第4周到医院随访、复诊。
十一、转运原则
按照国家卫生健康委印发的《新型冠状病毒感染的肺炎病例转运工作方案(试行)》执行。
十三、医疗机构内感染预防与控制
严格按照国家卫生健康委《医疗机构内新型冠状病毒感染预防与控制技术指南(第一版)》、《新型冠状病毒感染的肺炎険护中常见医用防护用品使用范围指引(试行)》的要求执行。
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