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复旦大学附属中山医院新型冠状病毒肺炎疑似病例诊治方案(2020 v.1)

Guideline for the diagnosis and clinical management of suspected novel coronavirus pneumonia in Zhongshan Hospital, Fudan University (2020 v.1)

  • 摘要: 目前新冠肺炎的防控重点是以国家卫健委和国家中医药管理局颁发的新冠肺炎诊治指南(第五版)为依据,早发现、早诊断、早隔离、早治疗。疑似病例的管理是避免误诊、漏诊、提高救治率以及防控交叉感染的关键,此类患者的留观指标、隔离条件、入院标准、出院标准等目前尚缺乏统一的意见。在近期管理发热隔离患者的实践中发现,部分患者虽然鼻咽拭子核酸检测阴性,但临床和影像学表现不能完全排除新冠肺炎,也有报道发现病程后期核酸检测才出现阳性的病例。针对湖北以外的此类患者建议采取住院隔离观察并给予对症治疗。针对此类患者,建议加强院内核酸检测、及时隔离分诊,出院标准等同新冠肺炎确诊患者,以确保出院患者不携带病毒,达到患者和社区双重安全。

     

    Abstract: The key of novel coronavirus pneumonia (NCP) management is early detection, early diagnosis, early isolation, early treatment based on 'the diagnosis and treatment of new coronavirus pneumonia' (v5) according of National Health Commission of the People's Republic of China. The management of NCP suspected cases is to avoid missed diagnosis, improve treatment rate, avoid delay in diagnosis and prevent infection. However, observation, isolation conditions, admission criteria, discharge criteria remain unclear. Learning from practice, the clinical symptom and the ground glass changes on chest CT scan appeared earlier than the positive for RT-PCR test in some cases. Repeat testing is recommended in clinical suspected cases with an initially negative result of nasopharyngeal swab samples. And the sensitivity and specificity of RT-PCR testing need to be verified. The clinical NCP suspected cases should be admitted in hospital with isolation and management. During the stay in the hospital, we suggest to repeat testing the samples of nasopharyngeal swab, sputum, feces, blood, lower respiratory secretions and alveolar lavage fluids, if allowed. The discharge criteria of these patients are similar to the NCP confirmed cases. To ensure that discharged patients do not carry the virus, to achieve the dual safety of patients and the community.

     

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