UPDATE FEB 19 2020 READ ASAP - General Office of National Health Committee Office of State Administration of traditional Chinese Medicine
Wednesday, February 19, 2020
OPEN LINK TO FULL BLOG ABOVE, CLICK TITLE>>> Above >>>>>UPDATE FEB 19 2020 READ ASAP - General Office of National Health Committee Office of State Administration of traditional Chinese MedicineGuo Wei ban Yi Han c2020145Diagnosis and treatment novel coronavirus pneumoniaNotice of (trial version 6)Health and Health Committee and administration of traditional Chinese medicine of all provinces, autonomous regions, municipalities directly under the central government and Xinjiang production and Construction Corps:Page 1Translation best we could do. quickly done >>>>>>
General Office of National Health Committee Office of State Administration of traditional Chinese MedicineGuo Wei ban Yi Han c2020145Diagnosis and treatment novel coronavirus pneumoniaNotice of (trial version 6)Health and Health Committee and administration of traditional Chinese medicine of all provinces, autonomous regions, municipalities directly under the central government and Xinjiang production and Construction Corps:In order to novel coronavirus pneumonia novel coronavirus diagnosis and medical treatment work, we organized experts to make a revision of the diagnosis and treatment plan based on the analysis, judgement and summary of the early medical treatment work, and formed the new diagnosis and treatment plan of coronavirus pneumonia (trial version sixth). It is hereby printed and distributed to you. Please refer to it for 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, establish a joint consultation system of traditional Chinese and Western medicine, and achieve good results in medical treatmentSheng Hui runLejia administration of traditional Chinese medicine SuFebruary 16, 2022(form of information disclosure: active disclosure)Family Health CommitteeOffice of administration of traditional Chinese MedicinePage 1Diagnosis and treatment of novel coronavirus pneumonia(trial version 6)Many novel coronavirus pneumonia patients have been found in Wuhan, Hubei since December 2019. With the spread of the epidemic, other cases in China and other regions have also been found. The novel coronavirus novel coronavirus pneumonia has been included in the infectious diseases of class B as stipulated in the infectious disease prevention and control law of the People's Republic of China. As a result of the deepening of the understanding of diseases and the accumulation of experience in diagnosis and treatment, we revised the new coronavirus pneumonia diagnosis and treatment plan (revised version fifth), forming a new diagnostic and therapeutic plan for coronavirus pneumonia (trial version sixth).Characteristics of etiologyThe novel coronavirus belongs to the coronavirus of B genus, with capsule and round or oval shape. The diameter is 60-140nm, and its gene characteristics are significantly different from those of SARSr -Cov and MERSr -Cov. At present, the homology with bat SL covzc 45 is more than 85%. In vitro isolation and culture, 2019-ncov can be found in human respiratory epithelial cells in about 96 hours, while in Vero 6 and Huh-7 cell lines isolation and culture takes about 6 daysThe understanding of the physical and chemical characteristics of coronavirus mostly comes from the study of SARS CoV and mersr cov. The virus is sensitive to ultraviolet and heat. The fat solvents such as 56 ℃ for 30 minutes, ether, 75% ethanol, chlorine containing disinfectant, peracetic acid and chloroform can effectively inactivate the virus, while chlorhexidine can not effectively inactivate the virusPage 22、 Epidemiological characteristics（1） Source of infectionThe novel coronavirus infection is the main source of infection.（2） Transmission channelsThe main route of transmission is through respiratory droplets and close contact. It is possible to transmit through aerosols in relatively closed environment when exposed to high concentration aerosols for a long time（3） Susceptible populationGeneral susceptibility3、 Clinical characteristics）Clinical manifestationsBased on the current epidemiological survey, the incubation period is 1-14 days, mostly 3-7 daysFever, dry cough and asthenia were the main manifestations. A few patients were accompanied with nasal obstruction, runny nose, sore throat, myalgia and diarrhea. Severe patients often have dyspnea and / or hypoxemia one week after the onset of the disease. Severe patients can rapidly progress to acute respiratory distress syndrome, septic shock, metabolic acidosis, coagulation dysfunction and multiple organ failure. It is worth noting that the course of severe and critical patients can be moderate to low fever, or even no obvious feverMild patients only showed low fever and slight asthenia, without pneumoniaAccording to the current cases, the prognosis of most patients is good, a few patients are critically ill, the prognosis of the elderly and those with chronic basic diseases is poor, and the symptoms of children are relatively mildThe infected may also become a source of infectionPage 3（2） Laboratory examinationIn the early stage of the disease, the total number of leukocytes in peripheral blood was normal or decreased, the lymphocyte count was decreased, some patients could have the increase of liver enzyme, lactate dehydrogenase (LDH), muscle enzyme and myoglobin, and some critical patients could see the increase of troponin. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were increased in most patients, D-dimer was increased in patients with normal and severe procalcitonin, and inflammatory factors were increased in patients with progressive decrease of peripheral blood lymphocytesA novel coronavirus nucleic acid can be detected in nasopharyngeal swabs, sputum and other lower respiratory tract secretions, blood and feces.In order to improve the positive rate of nucleic acid test, it is suggested to take sputum as much as possible, collect the secretion of lower respiratory tract from patients with endotracheal intubation, and send the samples for examination as soon as possible after collection（3） Chest imagingIn the early stage, there were multiple small spot shadow and interstitial changes. The extrapulmonary zone developed into multiple ground glass shadow and infiltrative shadow. In severe cases, lung consolidation and pleural effusion were rare4、 Diagnostic criteria（1） Suspected cases.Combined with the comprehensive analysis of the following epidemiological history and clinical manifestations:1. Epidemiological history(1) Within 14 days before the onset of the disease, there were travel or residence histories of Wuhan and its surrounding areas, or other communities with case reports;(2) novel coronavirus infected persons (positive for nucleic acid detection) had a history of contact within 14 days before onset.Page 4(3) Within 14 days before the onset of the disease, the patients from Wuhan city and surrounding areas, or from the community with case reports of fever or respiratory symptoms were contacted;(4) Agglomerative disease2. Clinical manifestations(1) Fever and / or respiratory symptoms;(2) novel coronavirus pneumonia imaging features.(3) In the early stage of the disease, the total number of leukocytes was normal or decreased, and the lymphocyte count was decreasedThere is any one in the epidemiological history, and it is consistent with any two in the clinical manifestations.No clear epidemiological history, in line with the three clinical manifestations（2） Confirmed cases.Suspected cases with one of the following pathogenic evidences:The novel coronavirus nucleic acid was detected by real-time fluorescence RT-PCR 1..2. the novel coronavirus is highly homologous to the virus gene.5、 Clinical typing（1） Light duty.The clinical symptoms were mild, and there was no sign of pneumonia on imaging.（2） Common type.With fever, respiratory tract and other symptoms, imaging can be seen pneumonia.（3） Heavy duty.Comply with any of the following:1. Dyspnea, RR > 30 times / min;2. In the resting state, the oxygen saturation is less than 93%;3. PaO2 / FiO2 < 300MMHGPage 51mmHg-0 .133kPa )PaO2 / FiO2 should be corrected in high altitude (over 1000m) area according to the following formula: PaO2 / fio2x [atmospheric pressure (MMG) / 760Pulmonary imaging showed that the lesions progressed more than 50% within 24-48 hours, and the patients were managed according to heavy duty（4） Severe.One of the following:1. Respiratory failure occurs and mechanical ventilation is required;2. Shock;3. Patients with other organ failure need ICU monitoring and treatment6、 Differential diagnosisA novel coronavirus infection is characterized by mild manifestations of upper respiratory tract infection.(two) 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, especially for suspected cases, including detection of common respiratory pathogens by means of rapid antigen detection and multiplex PCR nucleic acid detection.（3） It should also be differentiated from non infectious diseases, such as vasculitis, dermatomyositis and organic pneumonia7、 Case finding and reportAfter finding suspected cases that meet the definition of cases, the medical staff of all kinds of medical institutions at all levels shall immediately carry out single room isolation treatment, in hospital expert consultation or chief consultant consultation, still consider suspected cases, carry out network direct report within 2 hours, and collectPage 6The novel coronavirus nucleic acid was detected and the suspected cases were transferred to designated hospitals immediately. Novel coronavirus novel coronavirus etiological tests are recommended in patients with close contact with new coronavirus.Eight, treatment（1） Determine the treatment site according to the condition.1. Suspected and confirmed cases shall be isolated in designated hospitals with effective isolation conditions and protection conditions. Suspected cases shall be isolated in a single room, and confirmed cases can be admitted in the same ward by multiple people.2. Severe cases should be treated in ICU as soon as possible（2） General treatment.1. Rest in bed, strengthen support treatment, ensure sufficient heat; pay attention to water and electrolyte balance, maintain internal environment stability; closely monitor vital signs, finger oxygen saturation, etc2. According to the condition monitoring blood routine, urine routine, CRP, biochemical indicators (liver enzyme, myocardial enzyme, renal function, etc.), coagulation function, arterial blood gas analysis, chest imaging and other conditions, cytokine detection is feasible.3. Give effective oxygen therapy measures in time, including nasal catheter, mask oxygen therapy and high flow oxygen therapy through nose4. Antiviral treatment: trial use of interferon a (5 million U or equivalent for adults, add 2M1 sterile water for injection, inhaled twice a day) lopinavir / ritonavir (200mg / 50mg / pill for adults, 2 capsules each time, twice a day, course of treatment no more than 10 days) ribavirin (recommended with interferon or lopinavir / ritona)Page 7For more than 10 days), oxyquine phosphate (500mg for adults, twice a day, and the course of treatment is no more than 10 days), abidol (200mg for adults, three times a day, and the course of treatment is no more than 10 days), attention should be paid to adverse reactions such as diarrhea, nausea, vomiting, liver function damage, etc. at the same time, attention should be paid to the interaction with other drugs. In clinical application, further evaluation of the efficacy of the drugs currently used should be made. 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 stopped5. Antibiotic treatment: avoid blind or inappropriate use of antibiotics, especially the combination of broad-spectrum antibiotics（3） Treatment of severe and critical cases.1. Treatment principle: on the basis of symptomatic treatment, actively prevent and treat complications, treat basic diseases, prevent secondary infection, and timely support organ function2. Respiratory support:(1) Oxygen therapy: severe patients should receive nasal catheter or mask for oxygen inhalation, and timely assess whether respiratory distress and / or hypoxemia are relieved(2) High flow nasal tube oxygen therapy or noninvasive mechanical ventilation: when the patient's respiratory distress and / or hypoxemia cannot be relieved after receiving standard oxygen therapy, high flow nasal tube oxygen therapy or noninvasive ventilation can be considered. If the condition does not improve or even worsen in a short time (1-2 hours), tracheal intubation and invasive mechanical ventilation should be carried out in time(3) Invasive mechanical ventilation: adopt lung protective ventilation strategy, i.e. low tidal volume (4-8ml / kg ideal body weight) and low aspiratory pressure (platform pressure < 30cm20) for mechanical ventilation, so as to reduce ventilator-related lung injury. Many patients have different human-computer effectsWei combined application, adults 500mg / time, intravenous infusion 2 to 3 times a day, treatment course is notPage 8The sedative and muscle relaxant should be used in time() rescue treatment: for patients with severe ads, it is recommended to have lung re expansion. Under the condition of sufficient human resources, more than 12 hours of ventilation in prone position should be carried out every day. If the ventilation effect in prone position is not good, ECMO should be considered as soon as possible if conditions permit3. Circulation support: on the basis of full fluid resuscitation, improve microcirculation, use vasoactive drugs, and conduct hemodynamic monitoring if necessaryNovel coronavirus pneumonia 4.: plasma treatment for the patients with advanced disease, severe and severe cases.5. Other treatment measuresFor patients with deterioration of oxygenation index, rapid progress of imaging and hyperactivation of inflammatory reaction, glucocorticoids should be used for a short period of time (3-5 days) as appropriate. It is suggested that the dosage should not exceed 1-2mg / kg / day of methylprednisolone. It should be noted that the elimination of coronavirus can be delayed by a large dose of glucocorticoids due to immunosuppression. Xuebijing can be given intravenously for 100M / time, Treatment twice a day; intestinal microecological regulator can be used to maintain intestinal microecological balance and prevent secondary bacterial infection; for patients with high inflammation, plasma exchange can be considered if conditions permitPatients often have anxiety and fear, so we should strengthen psychological counseling（4） TCM treatment.This disease belongs to the category of "epidemic" disease in traditional Chinese medicine. Because of the feeling of "pestilence", different regions can refer to it according to the condition, local climate characteristics and different physical conditionsIn vitro blood purification techniques such as adsorption, perfusion, blood / plasma filtration, etcPage 9Make a plan for syndrome differentiation and treatment. It should be used under the guidance of doctors when it comes to the dosage beyond Pharmacopoeia.1. Medical observation periodClinical manifestation 1: asthenia with gastrointestinal discomfortRecommended Chinese patent medicine: Huoxiang Zhengqi Capsule (pill, water, oral liquid)Clinical manifestation 2: asthenia with feverRecommended Chinese patent medicine: Jinhua Qinggan granules, Lianhua Qingwen capsules (granules), ShufengJiedu Capsule (granule)2. Clinical treatment period (confirmed cases)2.1 Qingfei Paidu DecoctionScope of application: it is suitable for light, ordinary and heavy patients, and can be reasonably used in combination with the actual situation of patients in the treatment of critical and heavy patients.Basic prescriptions: Mahuang 9g, roasted licorice 6G, almond 9g, raw gypsum 15-30g (decocting first), Guizhi 9g, Alisma 9g, Polyporus 9g, Baizhu 9g, Poria 15g, Chaihu 16g, Scutellaria 6G, jiangbanxia 9g, ginger 9g, aster 9g, Donghua 9g, Shegan 9g, asarum 6G, yam 12g, Zhishi 6G, Chenpi 6G, Huoxiang 9g.Method of administration: Traditional Chinese medicine pieces, decoction. Once a day, twice in the morning and twice in the evening (40 minutes after meals), warm clothes, three times a course of treatment.If possible, half a bowl of rice soup can be added after taking the medicine every time, and one more bowl can be taken if the tongue is dry and the body fluid is deficient. (Note: if the patient does not have fever, the dosage of raw gypsum should be small, and the dosage of raw gypsum can be increased if the patient has fever or strong fever). If the symptoms are improved but not cured, take the second course. If the patient has special conditions or other basic diseases, the second course can modify the prescription according to the actual situation. If the symptoms disappear, stop taking the medicine.Source: novel coronavirus pneumonia, recommended by the office of the State Administration of traditional Chinese medicine, the office of the national health and Health Committee.Page 10Notice on "Qingfei Paidu Decoction" (ZMD No.22 (2020)) 2.2 light(1) Syndrome of cold dampness stagnation of lungClinical manifestations: fever, fatigue, aching, coughing, expectoration, chest tightness, suffocation, stupor, nausea, vomiting, sticky stool. The tongue is light, fat and red, the moss is white, thick, rotten or greasy, and the pulse is moistened or slippery.Recommended prescription: raw ephedra 6G, raw gypsum 15g, almond 9g, Qiang Huo 15g, Tinglizi 15g, Guanzhong 9g, Dilong 15g, xuchangqing 15g, Huoxiang 15g, Peilan 9g, Atractylodes 15g, Yunling 45g, raw Atractylodes 30g, jiaosanxian 9g, Houpu 15g, jiaobinglang 9g, simmer grass fruit 9g, ginger 15gTake method: take one dose every day, fry 600m1 in water, take it three times, one time in the morning, one time in the middle and one time in the evening, take it before meals.(2) Syndrome of dampness heat accumulating in lungClinical manifestations: low fever or no fever, slight cold, fatigue, heavy head and body sleepiness, muscle ache, less dry cough and phlegm, sore throat, dry mouth and no desire to drink more, or accompanied by chest tightness and epigastric distention, no sweat or poor sweating, or nausea, loose stools or sticky stool. The tongue is light red, the moss is white and thick or thin yellow, and the veins are smooth or deep.Recommended prescription: areca 10g, Caocao 10g, Magnolia 10g, Anemarrhena 10g, Scutellaria 10g, bupleurum 10g, paeony 10g, forsythia 15g, Artemisia 10g (lower part), Atractylodes 10g, Folium Isatidis 10g, Glycyrrhiza 5gAdministration: 1 dose per day, 400ml in water, 2 times in the morning and 1 time in the evening.1) Syndrome of dampness toxin and depression of lungClinical manifestations: fever, less cough and phlegm, or yellow phlegm, suffocation and shortness of breath, abdominal distention, and constipation. The tongue is dark red, fat, greasy or dry, and the pulse is smooth or stringy.2.3 ordinary typePage 11Recommended prescription: raw ephedra 6G, bitter almond 15g, gypsum 30g, Coix 30g, Atractylodes lanceolata 10g, patchouli 15g, Artemisia 12g, Polygonum cuspidatum 20g, Verbena 30g, dried reed 30g, Tingli 15g, orange 15g, licorice 10gLian FA: 1 dose per day, 400m1 in water, 2 times in the morning and 1 time in the evening. (2) Syndrome of cold dampness blocking lungFolloClinical manifestations: low fever, low body heat, or not hot, dry cough, less phlegm, fatigue, chest tightness, wanpi, or nausea, loose stools. The tongue is light or reddish, the moss is white or greasy, and the pulse is moistening.Recommended prescription: Atractylodes lanceolata 15g, tangerine peel 10g, Magnolia officinalis 10g, Weixiang 10g, Caocao 6G, raw ephedra 6G, notopterygium 10g, ginger 10g, areca 10gaAdministration: 1 dose per day, 400m1 water, 2 times, 24 times in the morning and evening(1) Syndrome of epidemic virus closing lungClinical manifestations: fever, blushing, coughing, less phlegm, yellow and sticky, or blood in the sputum, wheezing, shortness of breath, tiredness and tiredness, dry mouth, bitter and sticky, sincere fear of not eating, poor stool, short and red urine. Red tongue, yellow and greasy fur, smooth pulseRecommended prescription: raw ephedra 6G, almond 9g, raw gypsum 15g, liquorice 3G, Huoxiang 10g (later lower), Magnolia 10g, Atractylodes rhizome 15g, Caocao 10g, faban Pinellia 9g, Poria 15g, raw rhubarb 5g (later lower), raw Astragalus 10g, Tinglizi 10g, red peony i0g.Administration: 1-2 doses per day, decoction, 100ml-200m1 each time, 2-4 times a day, oral or nasal feeding(2) Qi Ying and two burnt certificatesClinical manifestations: fever, thirst, wheezing, dyspnea, delirium, confusion, wrong vision, or rash, or hematemesis, bleeding, or limb convulsion. The tongue is crimson with little or no moss, and the veins are thick and thin, or large and numerousPage 12Recommended prescription: raw gypsum 30-60g (decocting first), Anemarrhena 30g, raw ground 30-60g, buffalo horn 30g (decocting first), red peony 30g, Xuanshen 30g, forsythia 15g, Danpi 15g, Coptis 6G, bamboo leaf 12g, Luzi 15g, raw licorice 6G.Administration: 1 dose per day, water decoction, first decoct gypsum, buffalo horn, then under the medicine, each time 100m~200ml, 2~4 times per day, oral or nasal feeding.Recommended Chinese patent medicine: Xiyanping injection, Xuebijing injection, Reduning injection, Tanreqing injection, Xingnaojing injection. One drug with similar efficacy can be selected according to individual conditions, or two drugs can be used in combination according to clinical symptoms. Traditional Chinese medicine injection can be combined with traditional Chinese medicine decoction.2.5 severe (internal closure and external Dezheng)Clinical manifestations: dyspnea, frequent wheezing or mechanical ventilation, coma, irritability, cold sweating limbs, dark purple tongue, thick and greasy or dry fur, large and rootless pulse.Recommended prescription: Ginseng 15g, heishun tablet 10g (Pan Fried first), Cornus 15g, Suhexiang pill or Angong Niuhuang Pill.Recommended Chinese patent medicine: Xuebijing injection, Reduning injection, Tanreqing injection, Xingnaojing injection, Shenfu injection, Shengmai injection and Shenmai injection. One drug with similar efficacy can be selected according to individual conditions, or two drugs can be used in combination according to clinical symptoms. Traditional Chinese medicine injection can be combined with traditional Chinese medicine decoction.Note: recommended use of heavy and dangerous traditional Chinese medicine injectionVirus infection or mild bacterial infection: 0.9% sodium chloride injection 250ml plus Xiyanping injection 100mg bid, or 0.9% sodium chloride injection 250ml plus heated toxin injection 20ml, or 0.9% sodium chloride injection 250ml plus Tanreqing InjectionPage 13Jet 40ml bidHigh fever with disturbance of consciousness: 0.9% sodium chloride injection 250ml plus Xingnaojing injection 20ml bidImmunosuppression: 0.9% sodium chloride injection 250ml and Shenmai injection 100mlbidShock: recovery period of 0.9% sodium chloride injection 250ml and Shenfu Injection 100ml bid 2.6(1) Deficiency of lung and spleenClinical manifestations: shortness of breath, tiredness, nausea, fullness of ruffles, weakness of stool, loose stools. The tongue is light and fat, and the moss is white and greasy.Stir fried Atractylodes 10g, tuckahoe 15g, Xiang 10g, Amomum 6G (lower back), liquorice 6G method: 1 dose per day, water decoction 400ml, take twice, morning and evening once respectively.Clinical manifestations: fatigue, shortness of breath, dry mouth, thirst, palpitation, sweating, poor appetite, low or no heat, dry cough and less phlegm. The tongue has little body fluid, fine pulse or weak power.Recommended prescription: South and North ginseng 10g, Ophiopogon japonicus 15g, American ginseng 6G, Schisandra 6G, raw gypsum 15g, light bamboo leaf 10g, mulberry leaf 10g, reed root 15g, Salvia miltiorrhiza 15g, raw licorice 6G.Administration: 1 dose per day, 400m1 in water, 2 times in the morning and 1 time in the evening.9、 Precautions after release of isolation and discharge（1） De isolation and discharge criteria.Recommended prescription: Rhizoma Pinelliae 9g, tangerine peel 10g, dangshen 15g, roasted Astragalus 30g(2) Deficiency of Qi and YinPage 141. The body temperature returns to normal for more than 3 days;2. The symptoms of respiratory tract improved significantly;3. The pulmonary imaging showed that the acute exudative lesions were significantly improved;4. The nucleic acid test of respiratory samples is negative for two consecutive times (the sampling time interval shall be at least 1)Those who meet the above conditions can be discharged from isolation（2） Precautions after discharge.1. The designated hospitals should make good contact with the basic medical institutions where the patients live, share the medical records, and timely push the discharged patients' information to the patient's jurisdiction or residence neighborhood committee and the basic medical and health institutions2. After the patient leaves the hospital, due to the low immune function of the body and the risk of infection with other pathogens in the recovery period, 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 and drink separately, do hand hygiene well, and avoid going out3. It is recommended to follow up and visit the hospital at the 2nd and 4th week after discharge10、 Transshipment principleAccording to the novel coronavirus infection case plan for transport work (Trial Implementation) issued by the Commission.10、 Prevention and control of infection in medical institutionsNovel coronavirus novel coronavirus infection prevention and control technical guidelines (First Edition), and guidelines for the use of common medical protective articles in the protection of new coronavirus infection (Trial Implementation) are strictly implemented in accordance with the requirements of the Commission.Page 15
Comments