zh-cn	第二部分 诊疗经验  
en-us	Part Two Diagnosis and Treatment 

zh-cn	一. 多学科协作个性化治疗 
en-us	I. Personalized, Collaborative and Multidisciplinary Management 

zh-cn	浙大一院收治的主要是重型及危重型COVID-19患者，病情变化快，常累及多器官，需要多学科协助，医院整合感染科、呼吸内科、ICU、检验科、放射科、超声医学科、药学部、中医科、精神卫生科、呼吸治疗科、康复医学科、营养科、护理部等各专科力量组成COVID-19专家团队。 
en-us	FAHZU is a designated hospital for COVID-19 patients, especially severe and critically ill individuals whose condition changes rapidly, often with multiple organs infected and requiring the support from the multidisciplinary team (MDT). Since the outbreak, FAHZU established an expert team composed of doctors from the Departments of Infectious Diseases, Respiratory Medicine, ICU, Laboratory Medicine, Radiology, Ultrasound, Pharmacy, Traditional Chinese Medicine, Psychology, Respirator Therapy, Rehabilitation, Nutrition, Nursing, etc. 

zh-cn	建立完善的多学科协作诊疗（MDT）机制，每日进行研讨，隔离病区医生通过互联网视频参与一起讨论，协同诊治
en-us	A comprehensive multidisciplinary diagnosis and treatment mechanism has been established in which doctors both inside and outside the isolation wards can discuss patients’ conditions every day via video conference. 

zh-cn	为每位重型、危重型患者制订科学、系统、个性化的治疗方案。
en-us	This allows for them to determine scientific, integrated and customized treatment strategies for every severe and critically ill patient. 

zh-cn	科学决策是MDT的核心。
en-us	Sound decision-making is the key to MDT discussion. 

zh-cn	讨论中既要发挥各学科专家的领域优势，又需集中和聚焦诊疗中的关键问题，出现多种意见与建议时，需要能把控全局、经验丰富的专家进行整合，确定最终治疗方案。 
en-us	During the discussion, experts from different departments focus on issues from their specialized fields as well as critical issues to diagnoses and treatment. The final treatment solution is determined by experienced experts through various discussions of different opinions and advice. 

zh-cn	系统分析是MDT的关键。
en-us	Systematic analysis is at the core of MDT discussion. 

zh-cn	高龄的、存在基础疾病的患者容易进展为危重症。
en-us	Elderly patients with underlying health conditions are prone to becoming critically ill. 

zh-cn	在关注COVID-19疾病演化同时，患者的基础状况、合并症、并发症、每日的检验检查结果要做综合分析，研判病情趋势，做好提前干预，阻断疾病进展，抗病毒、氧 疗、营养支持等措施要积极。 
en-us	While closely monitoring the progression of COVID-19, the patient's basic status, complications and daily examination result s should be analyzed comprehensively to see how the disease will progress. It is necessary to intervene in advance to stop the disease from deteriorating and to take proactive measures such as antivirals, oxygen therapy, and nutritional support. 

zh-cn	个性化诊治是MDT的结果。
en-us	The goal of MDT discussion is to achieve personalized treatment. 

zh-cn	治疗方案要做到因人施策、精准施策，充分考虑不同个体、不同病程、不同类型的患者治疗上的差异性。 
en-us	The treatment plan should be adjusted to each person when considering the differences among individuals, courses of disease, and patient types. 

zh-cn	我们的经验是多学科协作诊治机制可以有效提高COVID-19的诊治效果。 
en-us	Our experience is that MDT collaboration can greatly improve the effectiveness of the diagnosis and treatment of COVID-19.  

zh-cn	二. 病原学与炎症指标检查  
en-us	II. Etiology and Inflammation Indicators 

zh-cn	SARS-CoV-2核酸检测 
en-us	Detection of SARS-CoV-2 Nucleic Acid 

zh-cn	1.1标本采集 
en-us	1.1 Specimen Collection 

zh-cn	选择合适的标本类型、正确的采集方法和时机对提高检测灵敏度十分重要。
en-us	Appropriate specimens, collection methods and collection timing are important to improve detection sensitivity. 

zh-cn	标本类型包括：上呼吸道标本（咽拭子、鼻拭子、鼻咽抽取物）、下呼吸道标本（痰液、气道抽取物、肺泡灌洗液）、血液、粪便、尿液和结膜分泌物等。
en-us	Specimen t types include upper air way specimens (pharyngeal swabs, nasal swabs, nasopharyngeal secretions), lower air way specimens (sputum, air way secretions, bronchoalveolar lavage fluid), blood, feces, urine and conjunctival secretions. 

zh-cn	痰等下呼吸道标本检出核酸阳性率高，应优先采集。
en-us	Sputum and other lower Respiratory tract specimens have a high positive rate of nucleic acids and should be collected preferentially. 

zh-cn	SARS-CoV-2在II型肺泡细胞（AT2）中增殖，其释放峰值（peak of viral shedding）出现在发病后3~5d。
en-us	SARS-CoV-2 preferentially proliferates in t type II alveolar cell s (AT2) and peak of viral shedding appears 3 to 5 days after the onset of disease. 

zh-cn	因此，发病初期如核酸检测阴性，应连续随访采样检测，核酸阳性率会明显提高。 
en-us	Therefore, if the nucleic acid test is negative at the beginning, samples should continue to be collected and tested on subsequent days. 

zh-cn	1.2核酸检测 
en-us	1. 2 Nucleic Acid Detection 

zh-cn	核酸检测是诊断SARS-CoV-2感染的首选方法。
en-us	Nucleic acid testing is the preferred method for diagnosing SARS-CoV-2 infection. 

zh-cn	根据试剂盒说明书进行，一般过程：痰标本等经过前处理，并裂解病毒提取核酸，再用实时（real-time）荧光定量PCR技术扩增SARS-CoV-2的3个特异性基因：开放读码框架1a/b（ORF1a/b）、核壳蛋白 （N）及包膜蛋白（E）基因，检测扩增后荧光强度获得结果。
en-us	The testing process according to the kit instructions is as follows: Specimens are pre-processed, and the virus is lysed to extract nucleic acids. The three specific genes of SARS-CoV-2, namely the Open Reading Frame 1a/b (ORF1a/b), nucleocapsid protein (N), and envelope protein (E) genes, are then amplified by real-time quantitative PCR technology. The amplified genes are detected by fluorescence intensity. 

zh-cn	核酸阳性判断标准： 
en-us	Criteria of positive nucleic acid result s are:

zh-cn	ORF1a/b基因阳性，和/或N基因、E基因阳性。 
en-us	ORF1a/b gene is positive, and/or N gene/E gene are positive. 

zh-cn	多种类型标本联合检测核酸有利于提高诊断阳性率。
en-us	The combined detection of nucleic acids from multiple types of specimens can improve the diagnostic accuracy. 

zh-cn	在呼吸道标本核酸阳性的确诊患者中，约30%-40%的患者可在其血液中检测到病毒核酸；约50%-60%的患者可在粪便中检测到病毒核酸；尿液标本核酸检出阳性率很低。
en-us	Among patients with confirmed positive nucleic acid in Respiratory tract, about 30% - 40% of these patients have detected viral nucleic acid in the blood and about 50% - 60% of patients have detected viral nucleic acid in feces. However, the positive rate of nucleic acid testing in urine samples is quite low. 

zh-cn	呼吸道标本、粪便、血液等多种 类型标本联合检测有利于提高疑似病例的诊断灵敏度、患者疗效观察和制定合理的出院后隔离管理措施。 
en-us	Combined testing with specimens from Respiratory tract, feces, blood and other types of specimens is helpful for improving the diagnostic sensitivity of suspected cases, monitoring treatment efficacy and the management of post-discharge isolation measures. 

zh-cn	病毒分离培养 
en-us	Virus Isolation and Culture  

zh-cn	病毒培养必须在获得资格的生物安全三级（BSL-3）实验室开展。
en-us	Virus culture must be per formed in a laboratory with qualified Biosafety Level 3 (BSL-3). 

zh-cn	简要过程：留取患者痰液、粪便等新鲜标本，接种于Vero-E6细胞进行病毒培养，96h后观察细胞病变效应（CPE），并检测培养液病毒核酸阳性即提示培养成功。
en-us	The process is briefly described as follows: Fresh samples of the patient's sputum, feces, etc. are obtained and inoculated on Vero-E6 cell s for virus culture. The cytopathic effect (CPE) is observed after 96 hours. Detection of viral nucleic acid in the culture medium indicates a successful culture. 

zh-cn	病毒滴度测定：将病毒原液按10倍系列稀释后，采用微量细胞病变法测定TCID50，或采用蚀斑试验计数蚀斑形成单位（plaque forming unit，PFU）测定病毒感染活力。
en-us	Virus titer measurement: After diluting the virus stock concentration by a factor of 10 in series, the TCID50 is determined by the micro-cytopathic method. Otherwise, viral viability is determined by plaque forming unit (PFU). 

zh-cn	血清抗体检测 
en-us	Detection of Serum Antibody 

zh-cn	SARS-CoV-2感染后会产生特异性抗体。
en-us	Specific antibodies are produced after SARS-CoV-2 infection. 

zh-cn	血清抗体测定方法有：胶体金免疫层析法、ELISA、化学发光免疫分析等。患者血清特异性IgM阳性，或恢复期特异性IgG抗体滴度较急性期升高4倍及以上，可作为核酸检测阴性疑似患者的诊断依据。
en-us	Serum antibody determination methods include colloidal gold immunochromatography, ELISA, chemiluminescence immunoassay, etc. Positive serum-specific IgM, or specific IgG antibody titer in the recover y phase ≥4 times higher than that in the acute phase, can be used as diagnostic criteria for suspected patients with negative nucleic acid detection. 

zh-cn	通过随访监测，发现在患者发病后10天可检出IgM，发病后12天检出IgG，并随着血清抗体水平升高，病毒核酸载量逐渐下降。 
en-us	During follow-up monitoring, IgM is detectable 10 days after symptom onset and IgG is detectable 12 days after symptom onset. The viral load gradually decreases with the increase of serum antibody levels. 

zh-cn	炎症反应指标的检测 
en-us	Detecting Indicators of Inflammatory Response 

zh-cn	建议开展C反应蛋白、降钙素原、铁蛋白、D-二聚体、淋巴细胞总数及亚群、IL-4、IL-6、IL-10、TNF-α、INF-γ等反应机体炎症与免疫状态的检查，有助于判断临床进程，预警重症、危重症倾向，并为治疗策略制订提供依据。 
en-us	It is recommended to conduct test s of C-reactive protein, procalcitonin, ferritin, D-dimer, total and subpopulations of lymphocytes, IL-4, IL-6, IL-10, TNF-α, INF-γ and other indicators of inflammation and immune status, which can help evaluate clinical progress, alert severe and critical tendencies, and provide a basis for the formulation of treatment strategies. 

zh-cn	大多数新冠肺炎患者降钙素原正常，C反应蛋白显著升高，C反应蛋白迅速大幅升高提示可能出现继发感染。
en-us	Most patients with COVID-19 have a normal level of procalcitonin with significantly increased level s of C-reactive protein. A rapid and significantly elevated C-reactive protein level indicates a possibility of secondary infection. 

zh-cn	重症患者D-二聚体水平显著升高，是患者预后不良的潜在危险因素。
en-us	D-dimer level s are significantly elevated in severe cases, which is a potential risk factor for poor prognosis. 

zh-cn	发病初期淋巴细胞总数较低的患者一般预后较差，且重症患者外周血淋巴细胞数量呈进行性减少。 
en-us	Patients with a low total number of lymphocytes at the beginning of the disease generally have a poor prognosis. Severe patients have a progressively decreased number of peripheral blood lymphocytes. 

zh-cn	重症患者IL-6、IL-10表达水平显著上升，监测IL-6、IL-10水平有助于评估患者重症化风险。 
en-us	The expression level s of IL-6 and IL-10 in severe patients are increased greatly. Monitoring the level s of IL-6 and IL-10 is helpful to assess the risk of progression to a severe condition. 

zh-cn	继发细菌真菌感染的检测 
en-us	Detection of Secondary Bacterial or Fungal Infections 

zh-cn	重症、危重症患者易继发细菌、真菌感染。
en-us	Severe and critically ill patients are vulnerable to secondary bacterial or fungal infections. 

zh-cn	根据感染部位采集合格标本进行细菌、真菌培养。
en-us	Qualified specimens should be collected from the infection site for bacterial or fungal culture. 

zh-cn	怀疑肺部继发感染，宜采集深部痰标本、气管吸出物、肺泡灌洗液和毛刷标本等进行培养。
en-us	If secondary lung infection is suspected, sputum coughed from deep in the lungs, tracheal aspirates, bronchoalveolar lavage fluid, and brush specimens should be collected for culture. 

zh-cn	高热患者应及时进行血培养。
en-us	Timely blood culture should be per formed in patients with high fever. 

zh-cn	留置导管的疑似脓毒症患者，同时送检外周静脉血和导管血进行培养。
en-us	Blood cultures drawn from peripheral venous or catheters should be per formed in patients with suspected sepsis who had an indwelling catheter. 

zh-cn	怀疑真菌感染患者，除真菌培养外，还建议至少每周两次送检血液G试验和GM试验。 
en-us	It is recommended that they take blood G test and GM test at least twice a week in addition to fungal culture. 

zh-cn	实验室安全防护 
en-us	Laboratory Safety 

zh-cn	应依据不同的实验操作风险程度确定生物安全防护措施。
en-us	Biosafety protective measures should be determined based on different risk levels of experimental process. 

zh-cn	呼吸道标本采集、核酸检测和病毒培养等操作，个人防护应按照BSL-3级实验室防护要求。
en-us	Personal protection should be taken in accordance with BSL-3 laboratory protection requirements for Respiratory tract specimen collection, nucleic acid detection and virus culture operations. 

zh-cn	血常规、生化、免疫检验等常规检验操作，个人防护应按照BSL-2级实验室防护要求。
en-us	Personal protection in accordance with BSL-2 laboratory protection requirement should be carried out for biochemical, immunological tests and other routine laboratory tests. 

zh-cn	标本运送应采用符合生物安全要求的专用运输罐和运输箱。
en-us	Specimens should be transported in special transport tanks and boxes that meet biosafety requirements. 

zh-cn	所有实验室废弃物均应严格高压消毒处理。 
en-us	All laboratory waste should be strictly autoclaved.  

zh-cn	三. COVID-19患者肺部影像学表现 
en-us	III. Imaging Findings of COVID-19 Patients 

zh-cn	肺部影像学检查在COVID-19诊断、疗效监测及出院评估中具有重要价值。
en-us	Thoracic imaging is of great value in the diagnosis of COVID-19, monitoring of therapeutic efficacy, and patient discharge assessment. 

zh-cn	检查方法首选肺部高分辨率CT；对于不便搬动的危重型患者，可选择床旁X线检查。
en-us	A high-resolution CT is highly preferable. Portable chest X-rays are helpful for critically ill patients who are immobile. 

zh-cn	一般于入院当日行基线肺部CT检查，若治疗后疗效不理想，2~3d后可复查肺部CT；治疗后症状稳定或好转，可5~7d后复查
en-us	CT for baseline evaluation of patients with COVID-19 is usually performed on the day of admission, or if ideal therapeutic efficacy is not reached, it can be re-performed after 2 to 3 days. If symptoms are stable or improved after treatment, the chest CT scan can be reviewed after 5 to 7 days. 

zh-cn	危重型患者须每日复查床边胸片。 
en-us	Daily routine portable chest X-rays are recommended for critically ill patients. 

zh-cn	COVID-19患者肺部CT早期多表现为位于肺外带、胸膜下、下叶分布的多发性斑片状磨玻璃阴影，病灶长轴多与胸膜平行；
en-us	COVID-19 at the early stage often presents with multifocal patchy shadows or ground glass opacities located in the lung periphery, subpleural area, and both lower lobes on chest CT scans. The long axis of the lesion is mostly parallel to the pleura. 

zh-cn	部分磨玻璃样病灶内可见小叶间隔增厚和小叶内间隔增厚，呈细小网格状，为“铺路石征“；
en-us	Interlobular septal thickening and intralobular interstitial thickening, displaying as subpleural reticulation namely a "crazy paving" pattern, is observed in some ground glass opacities. 

zh-cn	少数病例可表现为单发、局部病变，或表现为沿支气管分布、伴周边磨玻璃样改变的结节/斑片状病灶。
en-us	A small number of cases may show solitary, local lesions, or nodular/ patchy lesion distributed consistent with bronchus with peripheral ground glass opacities changes. 

zh-cn	病情进展多发生在病程7-10天，可表现为病灶范围扩大，大片肺实变，内可见支气管充气征。
en-us	Disease progression mostly occurs in the course of 7-10 days, with enlarged and increased density of the lesions compared with previous images, and consolidated lesions with air bronchogram sign. 

zh-cn	危重症患者可表现为实变范围进一步扩大，全肺密度增高实变，呈“白肺”征像。
en-us	Critical cases may show further expanded consolidation, with the whole lung density showing increased opacity, sometimes known as a "white lung". 

zh-cn	病情缓解后，磨玻璃样阴影可完全吸收，部分实变病灶会遗留条索样或网格样纤维化病灶。 
en-us	After the condition is relieved, the ground glass opacities can be completely absorbed, and some consolidation lesions will leave fibrotic stripes or subpleural reticulation. 

zh-cn	对于病变累及多叶，尤其是动态观察发现病灶范围增大者，须警惕疾病加重。
en-us	Patients with multiple lobular involvement, especially those with expanded lesions should be observed for disease exacerbation. 

zh-cn	具备典型肺部CT表现者，即使核酸检测阴性，亦应隔离并连续行核酸检测(见图1-6）。 
en-us	Those with typical CT pulmonary manifestations should be isolated and undergo continuous nucleic acid tests even if the nucleic acid test of SAR-CoV-2 is negative. 

zh-cn	COVID-19肺CT典型表现：
en-us	Typical CT features of COVID-19 : 

zh-cn	图1、图2 磨玻璃渗出；
en-us	Figure 1, Figure 2: patchy ground glass opacities;

zh-cn	图3 结节及斑片状渗出；
en-us	Figure 3: nodules and patchy exudation; 

zh-cn	图4、图5 肺实变；
en-us	Figure 4, Figure 5: multifocal consolidation lesions; 

zh-cn	图6 广泛实变，表现为“白肺 
en-us	Figure 6: diffuse consolidation, "white lung". 

zh-cn	四. COVID-19患者诊治中支气管镜技术的应用 
en-us	IV. Application of Bronchoscopy in the Diagnosis and Management of COVID-19 Patients 

zh-cn	支气管镜技术在COVID-19患者诊治中具有以下价值： 
en-us	Flexible bronchoscopy is versatile, easy to use, and well tolerated in mechanically ventilated COVID-19 patients. Its applications include: 

zh-cn	1）留取深部气道标本，提升病毒核酸检出阳性率及病原体培养准确率，合理指导抗菌药物应用； 
en-us	(1) Collection of Respiratory specimens from the lower Respiratory tract (i.e. sputum, endotracheal aspirate, bronchoalveolar lavage) for SARS-CoV-2 or other pathogens guides the selection of appropriate antimicrobials, which may lead to clinical benefits. Our experience indicates that lower respiratory specimens are more likely to be positive for SAR-CoV-2 than upper Respiratory specimens. 

zh-cn	2）吸痰，清除血痂，解除气道梗阻； 
en-us	(2) Can be used for localization of the site of bleeding, cessation of hemoptysis, sputum or blood clots removal; if the site of bleeding is identified by bronchoscopy, local injection of cold saline, epinephrine, vasopressin, or fibrin as well as laser treatment can be per formed via the bronchoscope. 

zh-cn	3）协助建立人工气道，引导气管插管或经皮气管切开； 
en-us	(3) Assist in the establishment of artificial airways; guide tracheal intubation or percutaneous tracheotomy. 

zh-cn	4）气道内给药，如滴注α-干扰素、N-乙酰半胱氨酸。 
en-us	(4) Drugs such as infusion of α-interferon and N-acetylcysteine can be administrated via the bronchoscope. 

zh-cn	危重症患者气管镜下可见支气管粘膜广泛充血肿胀，管腔内大量粘液样分泌物潴留，严重者可见粘稠胶冻样痰液堵塞气道，见图7。 
en-us	Bronchoscopic views of extensive bronchial mucosal hyperemia, swelling, mucus-like secretions in the lumen and jelly-like sputum blocking the air way in critically ill patients. (Figure 7). 

zh-cn	图7 COVID-19气管镜下表现：支气管粘膜肿胀充血；管腔内见大量粘液样分泌物 
en-us	Figure 7: Bronchoscopic manifestations of COVID-19: bronchial mucosa swelling and congestion; large amounts of mucus secretions in the lumen  

zh-cn	五. COVID-19诊断与临床分型 
en-us	V. Diagnosis and Clinical Classification of COVID-19 

zh-cn	临床上应做到早诊断、早治疗、早隔离。
en-us	Early diagnosis, treatment and isolation should be carried out whenever possible. 

zh-cn	动态观察肺部影像、氧合指数、细胞因子水平，早期发现有重症、危重症倾向的患者。 
en-us	Dynamic monitoring of lung imaging, oxygenation index and cytokine levels are helpful for early identification of patients who may develop into severe and critical cases. 

zh-cn	SARS-CoV-2核酸阳性是COVID-19确诊的金标准，但核酸检测存在假阴性现象，因此对于肺部CT高度疑似COVID-19者，即使核酸检测阴性，可先按临床诊断病例处理，进行隔离治疗并连续进行标本联合送检。 
en-us	A positive result of the nucleic acid of SARS-CoV-2 is the gold standard for the diagnosis of COVID-19. However, considering the possibility of false negatives in nucleic acid detection, suspected cases characteristic manifestations in CT scans can be treated as confirmed cases even if the nucleic acid test is negative. Isolation and continuous tests of multiple specimens should be carried out in such cases. 

zh-cn	COVID-19诊断标准遵循我国新冠病毒肺炎诊疗方案，综合流行病学史（包括聚集性发病）、临床症状（发热和呼吸道症状）、肺部影像、SARS-CoV-2核酸检测、血清特异性抗体等因素来明确诊断。 
en-us	The diagnostic criteria follow Protocol s for the Diagnosis and Treatment of COVID-2019. A confirmed case is based on epidemiological history (including cluster transmission), clinical manifestations (fever and Respiratory symptoms), lung imaging, and result s of SARS-CoV-2 nucleic acid detection and serum-specific antibodies. 

zh-cn	临床上分为： 
en-us	Clinical Classifications:  

zh-cn	轻型，临床症状轻微，影像学未见肺炎表现; 
en-us	Mild Cases The clinical symptoms are mild and no pneumonia manifestations can be found in imaging. 

zh-cn	普通型，具有发热、呼吸道等症状，影像学可见肺炎表现; 
en-us	Moderate Cases Patients have symptoms such as fever and Respiratory tract symptoms, etc. and pneumonia manifestations can be seen in imaging. 

zh-cn	重型，成人符合下述任何一条者：呼吸频率≥30次/min；或静息状态下指氧饱和度≤ 
en-us	Severe Cases Adult s who meet any of the following criteria: Respiratory rate ≥ 30 breaths/min; 

zh-cn	93%；或者动脉血氧分压（PaO2）/吸氧浓度（FiO2）≤300mmHg；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; 
en-us	oxygen saturation ≤ 93% at a rest state; arterial partial pressure of oxygen (PaO2)/oxygen concentration (FiO2) ≤ 300 mmHg. Patients with > 50% lesions progression within 24 to 48 hours in lung imaging should be treated as severe cases. 

zh-cn	危重型，符合以下情况之一者：出现呼吸衰竭且需要机械通气；或者出现休克；或者合并其他器官功能衰竭需ICU监护治疗。 
en-us	Critical Cases Meeting any of the following criteria: occurrence of Respiratory failure requiring mechanical ventilation; presence of shock; other organ failure that requires monitoring and treatment in the ICU. 

zh-cn	针对危重型，我们根据氧合指数、呼吸系统顺应性等情况，进一步分为早期、中期、晚期。 
en-us	Critical cases are further divided into early, middle and late stages according to the oxygenation index and compliance of Respiratory system. 

zh-cn	●早期：100mmHg<氧合指数≤150mmHg，呼吸系统顺应性≥30mL/cmH2O，未合并肺以外脏器功能衰竭的，通过积极抗病毒、抗细胞因子风暴、对症支持处理，恢复机会较大。 
en-us	● Early stage: 100 mmHg <oxygenation index ≤150 mmHg; compliance of Respiratory system ≥30 mL / cmH2O; without organ failure other than the lungs. The patient has a great chance of recovery through active antiviral, anti-cytokine storm, and supportive treatment. 

zh-cn	●中期：指氧合指数60mmHg<氧合指数≤100mmHg，30mL/cmH2O>呼吸系统顺应性≥15mL/cmH2O，可同时合并其他脏器功能轻中度受损。 
en-us	● Middle stage: 60 mmHg < oxygenation index ≤100 mmHg; 30 mL/cmH2O > compliance of Respiratory system ≥15 mL/cmH2O; may be complicated by other mild or moderate dysfunction of other organs. 

zh-cn	●晚期：指氧合指数≤60mmHg，呼吸系统顺应性<15mL/cmH2O两肺弥漫性实变，需要人工膜肺支持，或出现其他重要脏器功能衰竭的，死亡风险显著提高。 
en-us	● Late stage: oxygenation index ≤ 60 mmHg; compliance of Respiratory system <15 mL/cmH2O; diffuse consolidation of both lungs that requires the use of ECMO; or failure of other vital organs. The mortality risk is significantly increased. 

zh-cn	六. 抗病毒治疗及时消除病原体
en-us	VI. Antiviral Treatment for Timely Elimination of Pathogens

zh-cn	抗病毒治疗越早越好，可以减少重症、危重症的发生。
en-us	An early antiviral treatment can reduce the incidence of severe and critical cases. 

zh-cn	COVID-19虽然缺乏有明确临床证据的有效抗病毒药物，根据我国新冠病毒肺炎诊疗方案，结合冠状病毒结构特征，现阶段我们采取的抗病毒策略如下： 
en-us	Although there is no clinical evidence for effective antiviral drugs, currently the antiviral strategies based on the characteristics of SAR-CoV-2 are adopted according to Protocols for Diagnosis and Treatment of COVID-19: Prevention, Control, Diagnosis and Management. 

zh-cn	抗病毒方案 
en-us	Antiviral Treatment 

zh-cn	我们以洛匹那韦/利托那韦片2片po q12h联合阿比多尔片200mg po tid作为基础方案；使用该方案，49例患者出现第一次病毒核酸检测阴性平均时间为12d（95%可信 
en-us	At FAHZU, lopinavir/ritonavir (2 capsules, po q12h) combined with arbidol (200 mg poq12h) were applied as the basic regimen. From the treatment experience of 49 patients in our hospital, the average time to achieve negative viral nucleic acid test for the first time was 12 days (95% CI: 8-15 days). 

zh-cn	区间8～15d），持续病毒核酸检测阴性时间（持续2次以上病毒核酸检测阴性且两次 间隔24h）为13.5d（95%可信区间9.5～17.5d）。 
en-us	The duration of negative nucleic acid test result (negative for more than 2 times consecutively with interval ≥ 24h) was 13. 5 days (95% CI: 9.5 - 17.5 days). 

zh-cn	基础方案效果不佳，可以尝试使用磷酸氯喹（18岁-65岁成人。体重>50公斤者，每次500mg bid；体重<50公斤者，第一、二天每次500mg bid，第三至第七天每次500mg qd）。 
en-us	If the basic regimen is not effective, chloroquine phosphate can be used on adults between 18- 65 years old (weight ≥ 50 kg: 500 mg bid; weight ≤ 50 kg: 500 mg bid for first two days, 500 mg qd for following five days). 

zh-cn	我国新冠病毒肺炎诊疗方案推荐使用干扰素雾化吸入治疗，我们建议在负压病房进行。因雾化易诱发气溶胶播散，不建议普通病房内开展雾化吸入治疗。 
en-us	Interferon nebulization is recommended in Protocols for Diagnosis and Treatment of COVID-19. We recommend that it should be performed in negative-pressure wards rather than general wards due to the possibility of aerosol transmission. 

zh-cn	根据艾滋病患者用药经验，达芦那韦/考比司他的不良反应相对较轻，体外病毒抑制试验具有一定程度抗病毒活性，对不耐受洛匹那韦/利 
en-us	Darunavir/cobicistat has some degree of antiviral activity in viral suppression test in vitro, based on the treatment experience of AIDS patients, and the adverse events are relatively mild. 

zh-cn	托那韦的患者，在通过伦理审查后可考虑口服达芦那韦/考比司他（1片 qd）或者法匹那韦（首剂1600mg，后续600mg tid）代替。 
en-us	For patients who are intolerant to lopinavir/ritonavir, darunavir/cobicistat (1 tablet qd) or favipiravir (star ting dose of 1600 mg followed by 600 mg tid) is an alternative option after the ethical review. 

zh-cn	不建议同时应用3种及以上抗病毒药物。 
en-us	Simultaneous use of three or more antiviral drugs is not recommended. 

zh-cn	疗程 
en-us	Course of Treatment 

zh-cn	磷酸氯喹疗程≤7天；其他方案的疗程尚未确定，一般为2周，或痰液病毒核酸检测结果持续3次以上阴性可考虑停用抗病毒药物。 
en-us	The treatment course of chloroquine phosphate should be no more than 7 days. The treatment course of other regimens has not been determined and are usually around 2 weeks. Antiviral drugs should be stopped if nucleic acid test results from sputum specimens remain negative for more than 3 times.  

zh-cn	七. 抗休克及抗低氧血症维持生命体征 
en-us	VII. Anti-shock and Anti-hypoxemia Treatment 

zh-cn	COVID-19从重型向危重型发展时，患者可出现严重低氧血症、细胞因子风暴、继发重型感染，进而发生休克，出现组织灌注障碍，甚至多器官功能衰竭，治疗上以纠正诱发因素和液体复苏为主。
en-us	During the progression from the severe to critically ill stage, patients may develop severe hypoxemia, cytokine cascade and severe infections that might develop into shock, tissue per fusion disorders, and even multiple organ failure. Treatment is aimed at incentive removal and fluid recovery. 

zh-cn	人工肝血液净化系统可迅速清除炎症介质，消除细胞因子风暴，可阻断休克和低氧血症、呼吸窘迫的发生。 
en-us	The artificial liver support system (ALSS) and blood purification can effectively diminish inflammatory mediators and cytokine cascade and prevent the incidence of shock, hypoxemia and Respiratory distress syndrome.  

zh-cn	酌情使用糖皮质激素
en-us	Usage of Glucocorticoids when Necessary  

zh-cn	对于重型、危重型，早期、适量、短程糖皮质激素治疗既有利于控制细胞因子炎症风暴，阻止病情进展，缩短病程，又可避免长期大量使用糖皮质激素导致的不良反应和并发症。 
en-us	Appropriate and short-term use of corticosteroids to inhibit cytokine cascade and to prevent disease progression should be considered for patients with severe COVID-19 pneumonia as early as possible. However, a high dose of glucocorticoids should be avoided due to adverse event s and complications. 

zh-cn	1.1适应证 
en-us	1.1 Indication for Corticosteroids 

zh-cn	①符合重型、危重型诊断者可早期使用；
en-us	① for those in severe and critically ill stage; 

zh-cn	②高热（体温超过39°C）持续不退；
en-us	② for those with persistent high fever (temperature above 39°C); 

zh-cn	③影像学提示受累肺叶面积大（30%以上肺叶受累），有磨玻璃渗出；
en-us	③ for those whose computerized tomography (CT) demonstrated patchy ground-glass attenuation or more than 30% area of the lungs are involved; 

zh-cn	④肺部影像学表现进展迅速且受累面积明显增多（48h复查肺部CT提示进展超过50%）；
en-us	④ for those whose CT demonstrated rapid progression (more than 50% area involved in pulmonary C T images within 48 hours); 

zh-cn	⑤IL-6≥5倍正常值上限。 
en-us	⑤ for those whose IL-6 is above ≥ 5 ULN. 

zh-cn	1.2使用方法 
en-us	1.2 Application of Corticosteroids 

zh-cn	根据炎症损伤程度，甲泼尼龙琥珀酸钠（甲强龙）常规起始剂量每天0.75~1.5mg/kg分1~2次静脉注射；对于常规剂量不能控制体温，或者细胞因子仍然显著升高的重症患者可以考虑40mg q12h，危重症患者可以使用40mg-80mg q12h。
en-us	Initial routine methylprednisolone at a dose of 0.75~1.5 mg/kg intravenously once a day (nearly 40 mg once or twice a day) is recommended. However, methylprednisolone at a dose of 40 mg q12h can be considered for patients with falling body temperature or for patients with significantly increased cytokines under routine doses of steroid. Even methylprednisolone at a dose of 40 mg-80 mg q12h can be considered for critical cases. 

zh-cn	治疗期间，密切监测体温、血氧饱和度，每隔2~3d复查血常规、C反应蛋白、细胞因子、生化指标、血糖、肺部CT等评估病情及疗效。
en-us	Closely monitor body temperature, blood oxygen saturation, blood routine, C-reactive protein, cytokines, biochemical profile and lung CT every 2 to 3 days during the treatment as necessary. 

zh-cn	如病情改善，体温正常，或肺部影像有吸收，则每3~5d激素减半，减至每日20mg/d后序贯甲泼尼龙（美卓乐）口服,根据病情确定疗程。 
en-us	The dosage of methylprednisolone should be halved every 3 to 5 days if medical conditions of patients are improved, the body temperature normalizes, or involved lesions on CT are significantly absorbed. Oral methylprednisolone (Medrol) once a day is recommended when the intravenous dose is reduced to 20 mg per day. The course of corticosteroids in not defined; some expert s have suggesting ceasing corticosteroids treatment when patients are nearly recovered. 

zh-cn	1.3治疗期间注意事项 
en-us	1.3 Special Consideration during Treatment 

zh-cn	①治疗前完善结核菌感染T细胞斑点（T-SPOT）试验、乙型肝炎病毒和丙型肝炎病毒标志物等检测，避免在激素治疗过程中激活潜在感染；
en-us	① screening of TB by T-SPOT assay, HBV and HCV by antibody assay should be performed before corticosteroid therapy;

zh-cn	②根据情况应用质子泵抑制剂、钙剂预防并发症；
en-us	 ② proton pump inhibitors could be considered to prevent complications; 

zh-cn	③监测血糖，一旦出现血糖升高，皮下注射胰岛素控制血糖；
en-us	③ blood glucose should be monitored. High blood glucose should be treated with insulin when necessary; 

zh-cn	④监测血钾，纠正低钾血症；
en-us	④ low serum potassium should be corrected; 

zh-cn	⑤监测肝功能，及时进行护肝治疗；
en-us	⑤ liver function should be monitored closely; 

zh-cn	⑥出现多汗、自汗者，可试用中药；
en-us	⑥ traditional Chinese herbal medicine may be considered for patients who are sweating; 

zh-cn	⑦出现兴奋、睡眠障碍者，临时给予镇静催眠药。 
en-us	⑦ sedative-hypnotics can be administered temporarily for patients with sleep disorder.  

zh-cn	人工肝治疗消除细胞因子风暴
en-us	Artificial Liver Treatment for Suppression of Cytokine Cascade 

zh-cn	人工肝系统集成血浆置换、吸附、灌流，血液/血浆滤过等技术，用于清除炎症介质、内毒素及中小分子有毒有害物质，补充白蛋白、凝血因子等有益物质，调节水电解质、酸碱平衡；能阻断“细胞因子风暴”，纠正休克，减轻肺部炎症，改善呼吸功能；同时有助于恢复机体免疫稳态、改善体内代谢紊乱状态、有利于容量精准管理、改善肝、肾等多器官功能，以提高重型、危重型患者的救治成功率，降低病死率。 
en-us	The artificial liver support system (ALSS) can conduct plasma exchange, adsorption, per fusion, and filtration of inflammatory mediators such as endotoxins and harmful metabolic substances of small or medium molecular weight. It can also provide serum albumin, coagulation factors, balance fluid volume, electrolytes and acid-base ratio, and manifest anti-cytokine storms, shock, lung inflammation, et al. In doing so it can also help to improve multiple organ functions including the liver and kidney. Thus, it can increase treatment success and reduce the mortality of severe patients. 

zh-cn	2.1适应证 
en-us	2.1 Indication for ALSS 

zh-cn	①血炎症因子（如IL-6等）浓度≥正常上限5倍，或每日上升速度≥1倍； 
en-us	① serum inflammatory indicator (such as IL-6) level rises to ≥ 5 ULN, or rising rate is ≥1 time per day; 

zh-cn	②肺部影像学快速进展，CT或X线提示肺受累百分比每天进展10%或以上； 
en-us	② involved area of pulmonary C T or X-ray images ≥10% progression per day; 

zh-cn	③基础疾病需要人工肝治疗患者； 
en-us	③ artificial liver support system is required for the treatment of underlying diseases. 

zh-cn	符合①+②的患者，或符合③的患者。 
en-us	Patients meeting ① + ②, or patients meeting ③. 

zh-cn	2.2相对禁忌证 
en-us	2.2 Contraindications 

zh-cn	在危重型患者抢救中，无绝对禁忌证，但出现以下情况须谨慎使用： 
en-us	There is no absolute contraindication in the treatment of critically ill patients. However, ALSS should be avoided in the following situations: 

zh-cn	①严重活动性出血或弥漫性血管内凝血者；
en-us	①Severe bleeding disease or disseminated intravascular coagulation; 

zh-cn	②对治疗过程中所用血制品或药品如血浆、肝素和鱼精蛋白等严重过敏者；
en-us	② Those who are highly allergic to blood component s or drugs used in the treatment process such as plasma, heparin and protamine; 

zh-cn	③急性脑血管意外或严重颅脑损伤者；
en-us	③ Acute cerebrovascular diseases or severe head injury; 

zh-cn	④慢性心功能不全，心功能分级为III级及以上者；
en-us	④ Chronic cardiac failure, cardiac functional classification ≥ grade III; 

zh-cn	⑤尚未纠正的低血压、休克；
en-us	⑤ Uncontrolled hypotension and shock; 

zh-cn	⑥严重的心律失常。 
en-us	⑥ Severe arrhythmia. 

zh-cn	建议进行血浆置换联合血浆吸附或双重血浆分子吸附、灌流及滤过，血浆置换量建议2000mL以上。
en-us	Plasma exchange combined with plasma adsorption or dual plasma molecular adsorption, per fusion, and filtration is recommended according to the patients’ situation. 2000 mL of plasma should be exchanged when ALSS is per formed. 

zh-cn	具体操作方案请参考《人工肝血液净化系统应用于重型、危重型新型冠状病毒肺炎治疗的专家共识》。 
en-us	Detailed operating procedures can be found in the Expert Consensus on the Application of Artificial Liver Blood Purification System in the Treatment of Severe and Critical Novel Coronavirus Pneumonia. 

zh-cn	我院经过人工肝治疗的危重型患者，ICU住院时间明显缩短；血清细胞因子IL-2/IL-4/IL-6/TNF-α水平显著下降，呼吸改善，氧饱和度提升。
en-us	ALSS significantly reduces the time that critically ill patients stay in the ICU in our hospital. Typically, the level s of serum cytokines such as IL-2/IL-4/IL-6/TNF-α are remarkably decreased, and oxygen saturation is significantly improved after ALSS.  

zh-cn	氧疗纠正低氧血症
en-us	Oxygen Therapy for Hypoxemia 

zh-cn	COVID-19呼吸功能受损以低氧血症最为突出。
en-us	Hypoxemia can present due to impaired Respiratory functions by COVID-19. 

zh-cn	如何及时、有效地纠正低氧血症、缓解患者呼吸窘迫和缺氧导致的继发器官损伤和功能障碍对改善患者预后具有重要意义。 
en-us	Oxygen supplementation treatment can correct hypoxemia, relieving secondary organ damage caused by Respiratory distress and hypoxemia. 

zh-cn	3.1氧疗 
en-us	3.1 Oxygen therapy 

zh-cn	1）氧疗同时持续指氧饱和度监测 
en-us	(1) Continual oxygen saturation monitoring during oxygen therapy 

zh-cn	大多数患者初期氧合并不差，但部分患者氧合功能可能快速恶化。
en-us	Some patients do not necessarily have impaired oxygenation functions at the onset of infection but may manifest rapid deterioration in oxygenation over time. 

zh-cn	因此，氧疗同时建议持续指氧饱和度监测。 
en-us	Therefore, continual monitoring of oxygen saturation is recommended, before and during oxygen therapy. 

zh-cn	2）氧疗时机 
en-us	(2) Oxygen therapy as soon as possible 

zh-cn	不吸氧情况下指氧饱和度（SpO2）>93%，且无明显呼吸窘迫症状时，可不给予氧疗。
en-us	Oxygen therapy is not necessary for patients with oxygen saturation (SpO2) of more than 93% or for patients without obvious symptoms of Respiratory distress without oxygen treatment. 

zh-cn	部分COVID-19重型患者虽然PaO2/FiO2<300，但呼吸窘迫症状却不明显，建议氧疗。 
en-us	Oxygen therapy is strongly recommended to the patients with symptoms of Respiratory distress. It should be noted that some severe patients with PaO2/FiO2 < 300 had no obvious symptoms of Respiratory distress. 

zh-cn	3）氧疗目标 
en-us	(3) Treatment goal of oxygen therapy 

zh-cn	建议维持氧饱和度目标SpO293%-96%。若合并慢性II型呼吸衰竭，降低氧饱和度目标至SpO288%-92%；日常活动下SpO2频繁降至85%以下时，提高氧浓度至92%-95%，监测PaCO2水平。 
en-us	The treatment goal of oxygen therapy is to maintain the oxygen saturation (SpO2) at 93%-96% for patients without chronic pulmonary disease and at 88%-92% for patients with chronic type II Respiratory failure. Specially, the oxygen concentration should be increased to 92%-95% for patients whose SpO2 drops below 85% frequently during daily activities. 

zh-cn	4）控制性氧疗 
en-us	4) Control oxygen therapy 

zh-cn	PaO2 /FiO2 是比较准确的评价氧合功能指标。
en-us	PaO2/FiO2 is a sensitive and accurate indicator of oxygenation function. 

zh-cn	若病情进展、PaO2 /FiO2<300mmHg的患者，FiO2的稳定性、可监测性非常重要。
en-us	The stability and monitorability of FiO2 are very important for patients with disease progression and PaO2/FiO2 below 300 mmHg. 

zh-cn	推荐首选控制性氧疗。 
en-us	Controlled oxygen therapy is the preferred treatment. 

zh-cn	静息状态下SpO2 <93%、PaO2 /FiO2 <300mmHg（1mmHg=0.133kPa）、呼吸频率>25次/min或影像学表现进展明显时，建议给予高流量吸氧(HFNC），患者佩戴外科口罩。
en-us	High-flow nasal cannula (HFNC) oxygen therapy is recommended for patients with the following conditions: SpO2< 93%; PaO2/FiO2< 300 mmHg (1 mmHg = 0.133 kPa); Respiratory rate > 25 times per min at bed; or remarkable progression on X-ray imaging. Patients should wear a surgical mask during HFNC treatment. 

zh-cn	对于PaO2/FiO2介于200-300mmHg且患者无明显胸闷气促主诉时，HFNC的气流量应从低水平开始，逐渐达到40-60L/min。
en-us	The air flow of HFNC oxygen therapy should star t at a low level and gradually increased up to 40-60 L/min when PaO2 is between 200-300 mmHg so that patients do not feel obvious chest tightness and shortness of breath. 

zh-cn	对于明显呼吸窘迫的患者，可直接给予60L/min的初始流量。 
en-us	An initial flow of at least 60 L/min should be given immediately for patients with obvious respiratory distress. 

zh-cn	部分患者氧合指数较低（<100mmHg），但一般情况较好，对于这部分患者是否立即行气管插管，最重要的是关注原发病进展状况，综合评估患者全身状态、代偿能力及疾病发展趋势。
en-us	Tracheal intubation for patients is dependent on disease progression, systemic status and complication of patients for those with stable situation but with a low oxygenation index (<100 mmHg). Thus, detailed evaluations of the clinical condition of patients is very important before decision making. 

zh-cn	如果HFNC高流量（60L/min）高浓度吸入（>60%）1-2小时内患者氧合指数持续降低（<150mmHg）或呼吸窘迫症状明显加重或合并其他脏器功能不全，尽早气管插管。 
en-us	Tracheal intubation should be per formed as early as possible for patients with an oxygenation index less than 150 mmHg, worsening symptoms of Respiratory distress or multiple organ dysfunction within 1-2 hours after high-flow (60 L/min) and high-concentration (> 60%) HFNC oxygen therapy. 

zh-cn	对于高龄（>60岁）合并症多或PaO2/FiO2<200mmHg的患者，建议收住重症医学科。 
en-us	Older patients (> 60 years old) with more complications or PaO2/FiO2 less than 200 mmHg should be treated in ICU. 

zh-cn	3.2机械通气 
en-us	3.2 Mechanical Ventilation 

zh-cn	1）无创通气（Noninvasive Ventilation, NIV）
en-us	(1) Noninvasive Ventilation (NIV) 

zh-cn	COVID-19部分重症患者可快速进展至ARDS，过高的通气驱动和NIV可能加重肺损伤。 
en-us	Some severe patients progress to ARDS rapidly.

zh-cn	NIV导致的胃肠胀气和患者不耐受可能引起吸入性肺炎。
en-us	Excessive inflation pressure may cause gastric distension and intolerance which contribute to aspiration and worsen lung injury.

zh-cn	我们不推荐对HFNC治疗失败的患者常规使用NIV。
en-us	NIV is not strongly recommended in COVID-19 patients who fail HFNC treatment. 

zh-cn	若患者合并急性左心衰竭或慢性阻塞性肺病或免疫抑制时，可短期使用（不超过2h）并密切监测，若患者窘迫症状或PaO2/FiO2无明显改善，尽早气管插管。 
en-us	A short-term (less than 2 hours) use of NIV can be closely monitored if the patient has acute left heart failure, chronic obstructive pulmonary disease or is immunocompromised. Intubation should be per formed as early as possible if improvement of Respiratory distress symptoms or PaO2/FiO2 is not observed. 

zh-cn	NIV建议使用双回路的呼吸机；
en-us	NIV with a double circuit is recommended. 

zh-cn	使用单管路无创呼吸机时在面罩和呼出阀之间加装病毒过滤器；选择合适型号的面罩，减少漏气导致的病毒播散风险。 
en-us	A virus filter should be installed between the mask and the exhalation valve when applying NIV with a single tube. Suitable masks should be chosen to reduce the risk of virus spread through air leakage. 

zh-cn	2）有创机械通气（Invasive Mechanical Ventilation，IMV） 
en-us	(2) Invasive Mechanical Ventilation 

zh-cn	①COVID-19危重症患者有创机械通气的原则 
en-us	① Principles of invasive mechanical ventilation in critically ill patients 

zh-cn	在保障患者基本通气和氧合需求的同时如何降低机械通气相关性肺损伤在COVID-19患者治疗过程中至关重要。 
en-us	It is important to balance the ventilation and oxygenation demands and the risk of mechanical ventilation-related lung injury in the treatment of COVID-19 . 

zh-cn	●严格限定潮气量4~8mL/kg理想体重。
en-us	·Strictly set the tidal volume to 4 – 8 mL/kg. 

zh-cn	通常情况下，肺顺应性越低，预设的潮气量也应越小; 
en-us	In general, the lower the lung compliance, the smaller the preset tidal volume should be. 

zh-cn	●控制平台压<30cmH2O（1cmH2O=0.098kPa）、驱动压<15cmH2O; 
en-us	·Maintain the plat form pressure < 30 cmH2O (1 cmH2O = 0.098 kPa) and driving pressure <15 cmH2O. 

zh-cn	●根据ARDSnet规范进行PEEP设定; 
en-us	·Set PEEP according to the ARDS’s protocol. 

zh-cn	●通气频率18~25次/min，允许适度的高碳酸血症; 
en-us	·Ventilation frequency: 18-25 times per minute. Moderate hypercapnia is allowed. 

zh-cn	●潮气量过大、平台压和驱动压过高时，加强镇静镇痛、甚至给予肌肉松弛药。 
en-us	·Administer sedation, analgesia, or muscle relaxant if the tidal volume, platform pressure and driving pressure are too high. 

zh-cn	②肺复张 
en-us	② Lung Recruitment 

zh-cn	肺复张可能改善ARDS患者肺病变的不均一性，但同时存在严重的呼吸、循环并发症。 
en-us	Lung recruitment improves the heterogeneous distribution of lesions in patients with ARDS. 

zh-cn	我们不推荐常规使用肺复张手法；若要使用，首先进行肺可复张性评估。 
en-us	However, it may result in severe respiratory and circulatory complications and therefore, the lung recruitment maneuver is not routinely recommended. The assessment of lung expandability should be performed prior to the application. 

zh-cn	3）俯卧位通气 
en-us	(3) Prone Position Ventilation 

zh-cn	COVID-19危重症患者大多对俯卧位通气有良好反应，氧合和肺部力学可在短时间内得到明显改善。
en-us	Most critically ill patients with COVID-19 respond well to prone ventilation, with a rapid improvement of oxygenation and lung mechanics. 

zh-cn	我们建议对PaO2/FiO2<150mmHg或影像表现较重的患者在无禁忌的情况下常规进行俯卧位通气，每次16小时以上。
en-us	Prone ventilation is recommended as a routine strategy for patients with PaO2/FiO2 < 150 mmHg or with obvious imaging manifestations without contraindications. Time course recommended for prone ventilation is more than 16 hours each time. 

zh-cn	当仰卧位4小时以上患者PaO2/FiO2仍>150mmHg时可暂停俯卧位通气。 
en-us	The prone ventilation can be ceased once PaO2/FiO2 is greater than 150 mmHg for more than 4 hours in the supine position. 

zh-cn	对于尚未插管、无明显呼吸窘迫但氧合较差、影像学表现为明显的肺重力依赖区实变的患者，可尝试清醒俯卧位通气。
en-us	Prone ventilation while awake may be attempted for patients who have not been intubated or have no obvious respiratory distress but with impaired oxygenation or have consolidation in gravity-dependent lung zones on lung images. 

zh-cn	每次持续4小时以上，根据效果和耐受性调整，每天可以反复多次俯卧位。 
en-us	Procedures for at least 4 hours each time is recommended. Prone position can be considered several times per day depending on the effects and tolerance. 

zh-cn	4）预防返流误吸 
en-us	(4) Prevention of Regurgitation and Aspiration 

zh-cn	常规进行胃残余量和胃肠功能评估，
en-us	Gastric residual volume and gastrointestinal function should be routinely evaluated.

zh-cn	尽早给予适量的肠内营养。
en-us	Appropriate enteral nutrition is recommended to be given as earlier as possible.

zh-cn	推荐留置鼻肠管进行空肠内营养、留置胃管进行持续减压；
en-us	Nasointestinal feeding and continuous nasogastric decompression are recommended. 

zh-cn	转运前停止肠内营养，50mL空针抽吸；无禁忌时采用30°半坐位等。 
en-us	Enteral nutrition should be suspended and aspiration with 50 mL syringe be done before transfer. If no contraindication exists, a 30° semi-sitting position is recommended. 

zh-cn	5）液体管理 
en-us	(5) Fluid Management 

zh-cn	过多的液体输注常可显著加重COVID-19患者低氧血症。
en-us	Excessive fluid burden worsens hypoxemia in COVID-19 patients. 

zh-cn	在保证患者循环灌注的情况下应严格控制液体入量，对减少肺部渗出、改善氧合有积极作用。 
en-us	To reduce pulmonary exudation and improve oxygenation, the amount of fluid should be strictly controlled while ensuring the patient's perfusion. 

zh-cn	6）呼吸机相关性肺炎（VAP）预防策略 
en-us	(6) Strategies to Prevent Ventilator-Associated Pneumonia (VAP) 

zh-cn	①选择合适型号的气管插管； 
en-us	①Select appropriate type of endotracheal tube; 

zh-cn	②使用带声门下吸引的气管插管（q2h，每次20mL空针筒抽吸）； 
en-us	② Use a endotracheal tube with subglottic suction (once every 2 hours, aspirated with 20 mL empty syringe each time); 

zh-cn	③确保气管插管的位置、深浅合适，妥善固定、避免牵拉； 
en-us	③Place the endotracheal tube at the right position and correct depth, fix properly and avoid pulling; 

zh-cn	④维持气囊压力30~35cmH2O（1cmH2O=0.098kPa），q4h监测一次； 
en-us	④ Maintain the airbag pressure at 30 - 35 cmH2O (1 cmH2O = 0.098 kPa) and monitor every 4 hours; 

zh-cn	⑤涉及体位变动时进行气囊压力监测、冷凝水处理（双人配合倾倒，倒入预置含氯消毒液的加盖容器中）、气囊上分泌物处理； 
en-us	⑤ Monitor the airbag pressure and deal with water condensates when the position changes (two people cooperate in dumping and pouring the water condensates into a capped container containing a pre-made disinfectant chlorine solution); deal with secretions accumulated in the airbag; 

zh-cn	⑥及时清理患者口鼻分泌物。 
en-us	⑥ Clean up secretions from the mouth and nose timely. 

zh-cn	7）撤机拔管时机和策略 
en-us	(7) Weaning of Ventilation 

zh-cn	当患者PaO2/FiO2>150mmHg时，可积极减停镇静剂唤醒，条件允许尽早拔管；采用HFNC或NIV进行拔管后的续贯呼吸支持。 
en-us	Sedatives is reduced and discontinued before awakening when the patient’s PaO2/FiO2 is more than 150 mmHg. Intubation withdrawal should be performed as earlier as possible if permitted. HFNC or NIV is used for sequential respiratory support after withdrawal. 

zh-cn	八. 抗继发感染合理使用抗菌药物 
en-us	VIII. The Rational Use of Antibiotics to Prevent Secondary Infection 

zh-cn	COVID-19是病毒感染性疾病，轻型及普通型患者不建议预防性使用抗菌药物；
en-us	COVID-19 is a disease of viral infection, therefore antibiotics are not recommended to prevent bacterial infection in mild or ordinary patients; 

zh-cn	重型患者需要结合具体情况谨慎决定是否预防性使用抗菌药物，
en-us	it should be used carefully in severe patients based on their conditions. 

zh-cn	对于病变范围广、气道分泌物多、原有慢性气道疾病伴下呼吸道病原体定植史、使用糖皮质激素（按泼尼松计）≥20mg×7d等情况的患者可考虑酌情使用抗菌药物，可选药物包括喹诺酮类、第二或第三代头孢菌素、β-内酰胺酶抑制剂复方制剂等；
en-us	Antibiotics can be used with discretion in patients who have the following conditions: extensive lung lesions; excess bronchial secretions; chronic airway diseases with a history of pathogen colonization in the lower Respiratory tract; taking glucocorticoids with a dosage ≥ 20 mg × 7d (in terms of prednisone). The options of antibiotics include quinolones, the second or third generation cephalothins, β-lactamase inhibitor compounds, etc. 

zh-cn	危重型患者，尤其是接受有创机械通气的患者可考虑预防性使用抗菌药物，
en-us	The antibiotics should be used for the prevention of bacterial infection in critically severe patients, especially those with invasive mechanical ventilation. 

zh-cn	根据患者个体高危因素选择抗菌药物，包括碳青霉烯类、β-内酰胺酶抑制剂复方制剂、利奈唑胺、万古霉素。 
en-us	The antibiotics such as carbapenems, β-lactamase inhibitor compounds, linezolid and vancomycin can be used in critically ill patients according to the individual risk factors. 

zh-cn	在治疗期间须密切监测患者症状、体征、血常规、C反应蛋白、降钙素原等指标，出现病情变化须临床综合判断，
en-us	The patient’s symptoms, signs and indicators such as blood routine, C-reactive protein, and procalcitonin, need to be closely monitored during the treatment. When the change of a patient’s condition is detected, a comprehensive clinical judgment needs to be made. 

zh-cn	在不能排除继发感染时须第一时间留取合格标本进行涂片、培养，进行核酸、抗原抗体检测以便尽早明确感染病原体。
en-us	When the secondary infection cannot be ruled out, qualified specimen need to be collected for testing by smear preparation, cultivation, nucleic acid, antigen and antibody, in order to determine the infectious agent as early as possible. 

zh-cn	出现下述情况可经验性使用抗菌药物：①咳痰增多、痰液颜色变深，尤其是出现黄脓痰；②体温升高，且不能用原发疾病加重解释；③白细胞、中性粒细胞数显著增多；④降钙素原≥ 0.5ng/mL；⑤病毒感染无法解释的氧合指数恶化或循环障碍及其他提示细菌感染的病情改变。 
en-us	Antibiotics can be empirically used in the following conditions: ① more expectoration, darker sputum color, especially yellow pus sputum; ② the rise of body temperature which is not due to exacerbation of the original disease; ③ the marked increase of white blood cell s and/or neutrophil s; ④ procalcitonin ≥ 0.5 ng/mL; ⑤ Exacerbation of oxygenation index or circulator y disturbance that are not caused by the viral infection; and the other conditions suspiciously caused by bacteria infections. 

zh-cn	病毒感染造成细胞免疫功能下降、糖皮质激素和/或广谱抗菌药物使用等因素导致部分COVID-19患者有继发真菌感染风险，须对危重患者行呼吸道分泌物微生物监测，包括涂片、培养；对可疑患者及时检测血或支气管肺泡灌洗液D-葡聚糖（G试验）、半乳甘露聚糖（GM试验）。 
en-us	Some COVID-19 patients are at the risk of secondary fungal infections due to weakened cellular immunity caused by viral infections, the use of glucocorticoid and/or broad-spectrum antibiotics. It is necessary to do Respiratory secretions microbiological detections such as smear preparation and cultivation for critically ill patients; and provide timely D-Glucose (G-test) and galactomannan (GM-test) of blood or bronchoalveolar lavage fluid for suspected patients. 

zh-cn	以下患者须警惕侵袭性念珠菌病，可考虑给予氟康唑或棘白菌素类抗真菌治疗： 
en-us	It is necessary to be vigilant with possible invasive candidiasis infection and anti-fungal therapy. 

zh-cn	①广谱抗菌药物使用7天及以上；②胃肠外营养；③ 接受有创检查或治疗；④两个或以上部位来源的标本培养念珠菌阳性；⑤G实验明显升高。 
en-us	Fluconazole or echinocandin can be used in the following conditions: ① patients are given broad-spectrum antibiotics for seven days or more; ② patients have parenteral nutrition; ③ patients have invasive examination or treatment; ④ patients have positive candida culture in the specimen obtained from two body part s or more; ⑤ patients have significantly increased result s of G-test. 

zh-cn	以下患者须警惕侵袭性肺曲霉病，
en-us	It is necessary to be vigilant with possible invasive pulmonary aspergillosis. 

zh-cn	可考虑给予伏立康唑、泊沙康唑或棘白菌素类治疗：①糖皮质激素使用7天及以上；②粒细胞减少或缺乏；③慢性阻塞性肺病且既往气道标本培养曲霉阳性；④GM明显升高。 
en-us	Anti-fungal therapy such as voriconazole, posaconazole, or echinocandin are considered to be used in the following conditions: ① patients are given glucocorticoid for seven days or more; ② patients have agranulocytosis; ③ patients have chronic obstructive pulmonary disease and aspergillus culture are tested positive in the specimen obtained from the airway; ④ patients have significantly increased result s of GM-test. 

zh-cn	九. 肠道微生态平衡营养支持  
en-us	IX. The Balance of Intestinal Microecology and Nutritional Support 

zh-cn	COVID-19患者由于病毒直接侵犯肠道黏膜、抗病毒抗感染等治疗药物影响，部分患者合并腹痛、腹泻等消化道症状。
en-us	Some COVID-19 patients have gastrointestinal symptoms (such as abdominal pain and diarrhea) due to direct viral infection of the intestinal mucosa or antiviral and anti-infective drugs. 

zh-cn	经检测COVID-19患者存在肠道微生态失衡，表现为肠道的乳酸杆菌、双歧杆菌等有益菌明显减少。
en-us	There has been report that the intestinal microecological balance is broken in COVID-19 patients, manifesting a significant reduction of the intestinal probiotics such as lactobacillus and bifidobacterium. 

zh-cn	肠道微生态失衡可能会导致肠道细菌异位，引起继发感染，因此要重视肠道微生态调节剂和营养支持对维持微生态平衡的治疗。 
en-us	Intestinal microecological imbalance may lead to bacterial translocation and secondary infection, so it is important to maintain the balance of intestinal microecology by microecological modulator and nutritional support.  

zh-cn	微生态制剂干预 
en-us	Microecologics Intervention 

zh-cn	1）微生态调节剂可减少细菌移位与继发感染。
en-us	(1) Microecologics can reduce bacterial translocation and secondary infection. 

zh-cn	微生态调节剂增加肠道优势菌，抑制肠道有害菌，减少毒素产生，减少菌群失调导致的感染。 
en-us	It can increase dominant gut bacteria, inhibit intestinal harmful bacteria, reduce toxin production and reduce infection caused by gut microflora dysbiosis. 

zh-cn	2）微生态调节剂可改善患者消化道症状，部分患者出现消化道症状，微生态调节剂可以通过抑制肠黏膜萎缩，使粪便中水分减少，改善粪便性状和次数，减轻腹泻等症状。 
en-us	(2) Microecologics can improve the gastrointestinal symptoms of patients. It can reduce water in feces, improve fecal character and defecation frequency, and reduce diarrhea by inhibiting intestinal mucosal atrophy. 

zh-cn	3）有条件的医院可进行肠道菌群分析。
en-us	(3) The hospital with relevant resources can perform intestinal flora analysis. 

zh-cn	根据菌群分析结果，尽早发现肠道菌群紊乱，及早调整抗菌药物、给予益生菌制剂，减少肠道菌群移位和肠源性感染的发生。 
en-us	Therefore, the intestinal flora disturbance can be discovered early according to the results. Antibiotics can be adjusted timely and probiotics can be prescribed. These can reduce the chances of intestinal bacterial translocation and gut-derived infection. 

zh-cn	4）营养支持是维持肠道微生态平衡的重要手段。
en-us	(4) Nutrition support is an important means to maintain intestinal microecological balance. 

zh-cn	在有效评估营养风险、胃肠道功能以及误吸风险的基础上，及时实施肠内营养支持。 
en-us	Intestinal nutrition support should be applied timely on the basis of effective evaluations of nutritional risks, gastroenteric functions, and aspiration risks. 

zh-cn	营养支持 
en-us	Nutrition Support 

zh-cn	重型和危重型新冠肺炎病人在严重应激状态下，存在较高营养风险。 
en-us	The severe and critically ill COVID-19 patients who are in a state of severe stress are at high nutritional risks. 

zh-cn	早期营养评估、胃肠道功能评估、误吸风险评估和及时营养支持对病人的预后很重要。 
en-us	Early evaluations of nutrition risk, gastrointestinal functions and aspiration risks, and timely enteral nutritional support are important to the patient’s prognosis. 

zh-cn	1）首选经口进食：早期开通肠内营养，提供营养支持，滋养肠道，改善肠粘膜屏障及肠道免疫功能，维持肠道微生态。 
en-us	(1) Oral feeding is preferred. The early intestinal nutrition can provide nutritional support, nourish intestines, improve intestinal mucosal barrier and intestinal immunity, and maintain intestinal microecology. 

zh-cn	2）肠内营养路径：重型和危重型患者往往有急性胃肠功能损伤，表现为腹胀腹泻，甚至胃瘫。
en-us	(2) Enteral nutrition pathway. Severe and critically ill patients of ten harbor acute gastrointestinal damages, manifested as abdominal distension, diarrhea, and gastroparesis. 

zh-cn	对于气管插管病人，建议留置空肠营养管，行幽门后喂养。 
en-us	For patients with tracheal intubation, intestinal nutrition tube indwelling is recommended for post-pyloric feeding. 

zh-cn	3）营养液选择：
en-us	(3) Selection of nutrient solution. 

zh-cn	对于肠道损伤病人建议选择预消化的短肽制剂，便于肠道吸收和利用。
en-us	For patients with intestinal damage, predigested short peptide preparations, which are easy for intestinal absorption and utilization, are recommended. 

zh-cn	肠道功能较好的病人，可以选择热能较高的整蛋白制剂。
en-us	For patients with good intestinal functions, whole-protein preparations with relatively high calories can be selected. 

zh-cn	血糖高的患者，考虑选择适合控制血糖的营养制剂。 
en-us	For hyperglycemia patients, nutritional preparations which are beneficial to glycemic controlling are recommended. 

zh-cn	4）能量供应：每公斤体重25-30kcal，目标蛋白量为1.2-2.0g/kg·d。 
en-us	(4) Energy supply. 25-30 kcal per kg body weight, the target protein content is 1. 2-2.0 g/kg daily. 

zh-cn	5）营养输注方式：
en-us	(5) Means of nutritional supply. 

zh-cn	营养泵匀速输注，从小剂量开始逐步加量，有条件的可以行营养液加热，减少喂养不耐受。 
en-us	Pump infusion of nutrients can be used at a uniform speed, star ting with a low dosage and gradually increasing. When possible, the nutrients can be heated before feeding to reduce intolerance. 

zh-cn	6）对于有误吸高风险的老年病人和腹胀明显的患者，可考虑暂行肠外营养支持，待病情好转后再逐步过渡到自主饮食或肠内营养。 
en-us	(6) The elderly patients who are at high aspiration risks or patients with apparent abdominal distention can be supported by parenteral nutrition temporarily. It can be gradually replaced by independent diet or enteral nutrition after their condition improves. 

zh-cn	十. COVID-19患者的ECMO支持  
en-us	X. ECMO Support for COVID-19 Patients 

zh-cn	COVID-19是攻击肺泡为主要靶点的新型高传染性疾病，重症患者主要累及肺部，导致严重呼吸衰竭。
en-us	COVID-19 is a novel, highly infectious disease primarily targeting pulmonary alveoli, which damages primarily the lungs of critically ill patients and leads to severe Respiratory failure. 

zh-cn	体外膜肺氧合治疗（Extracorporeal membrane oxygenation，ECMO）在COVID-19的应用，需要关注：干预时机与方式、抗凝与出血、与机械通气的配合、清醒ECMO与早期康复训练、撤机标准、合并症处置等。 
en-us	For the application of extracorporeal membrane oxygenation (ECMO) in COVID-19 treatment, medical professional s need to pay close attention to the following: the time and means of intervention, anticoagulant and bleeding, coordination with mechanical ventilation, awake ECMO and the early rehabilitation training, strategy of handling for complications.  

zh-cn	ECMO干预时机 
en-us	ECMO Intervention Timing 

zh-cn	1.1挽救性ECMO 
en-us	1.1 Salvage ECMO 

zh-cn	机械通气支持状态下，72h采用保护性通气策略及俯卧位通气等措施，发生以下情况之一，需要考虑进行挽救性ECMO干预： 
en-us	In the state of mechanical ventilation support, measures such as lung protective ventilation strategy and prone position ventilation have been taken for 72 h. With the onset of one of the following conditions, salvage ECMO Intervention needs to be considered. 

zh-cn	1）PaO2/FiO2<80mmHg（不论PEEP水平）； 
en-us	(1) PaO2/FiO2 < 80 mmHg (regardless of what the PEEP level is); 

zh-cn	2）Pplat≤30，PaCO2>55mmHg； 
en-us	(2) Ppl at ≤ 30 mmHg, PaCO2 > 55 mmHg; 

zh-cn	3）出现气胸，漏气量>1/3潮气量，持续时间>48h； 
en-us	(3) The onset of pneumothorax, air leakage > 1/3 tidal volume, duration > 48 h; 

zh-cn	4）循环恶化，去甲肾上腺素剂量>1μg/(kg×min)； 
en-us	(4) Circulation deterioration, the dosage of norepinephrine > 1 μg/(kg×min); 

zh-cn	5）心肺复苏进行体外生命支持ECPR。 
en-us	(5) Cardio-pulmonary resuscitation in vitro life support ECPR. 

zh-cn	1.2替代性ECMO 
en-us	1.2 Replacement ECMO 

zh-cn	对病情评估认为患者不适合长时间进行机械通气维持，无法达到预期目标，立即采用ECMO方式进行替代，出现以下情况之一，应该考虑进行ECMO替代： 
en-us	When the patient is not suitable for long-term mechanical ventilation support, i.e., the patient is not able to obtain the expected result s, ECMO Replacement needs to be adopted immediately. With the onset of one of the following conditions, ECMO Replacement needs to be considered. 

zh-cn	1）肺顺应性减退，采用肺复张干预方法后，呼吸系统顺应性<10mL/cmH2O； 
en-us	(1) Decreased lung compliance. After the pulmonary recruitment maneuver, the compliance of the Respiratory system < 10 mL/cmH2O; 

zh-cn	2）纵膈气肿或者皮下气肿持续加重，并且预期48h内无法降低机械通气支持参数； 
en-us	(2) Persistent exacerbation of pneumomediastinum or subcutaneous emphysema. And the parameters of mechanical ventilation support cannot be reduced within 48 h, according to the estimation; 

zh-cn	3）PaO2/FiO2<100mmHg，采用常规方法72h无法改善。 
en-us	(3) PaO2/FiO2 < 100 mmHg. And it cannot be improved by routine methods in 72 h. 

zh-cn	1.3早期清醒ECMO 
en-us	1.3 Early Awake ECMO 

zh-cn	部分患者经过评估，使用机械通气预期高参数维持时间>7d，且符合清醒ECMO的必要条件，可能从中获益，需要符合以下所有标准： 
en-us	Early awake ECMO can be applied to patients who have been supported by mechanical ventilation with the expected high parameters for more than 7 days and who meet the necessary conditions of awake ECMO. They might benefit from it. All the following conditions must be met: 

zh-cn	1）患者意识清醒，有充分的配合度，能够理解ECMO运行的方式和维护要求； 
en-us	(1) The patient is in a clear state of consciousness and is fully compliant. He or she understands how ECMO works and its maintenance requirements; 

zh-cn	2）没有合并神经肌肉疾病； 
en-us	(2) The patient is not complicated with neuromuscular diseases; 

zh-cn	3）肺部损伤评分Murry>2.5分； 
en-us	(3) Pulmonary damage score Murry > 2.5; 

zh-cn	4）肺部分泌物不多，人工辅助吸引间隔>4h； 
en-us	(4) Few pulmonary secretions. The time interval between the two airway suction procedures > 4 h; 

zh-cn	5）血流动力学稳定，无需血管活性药物辅助。 
en-us	(5) Stable hemodynamics. Vasoactive agents are not required for assistance.  

zh-cn	置管方式 
en-us	Cathetering Methods 

zh-cn	COVID-19多数ECMO维持时间>7d，应该尽量采用seldinger方法超声 引导下外周置管，减少切开置管带来的出血损伤与感染风险，尤其对于早期清醒ECMO的患者。
en-us	Because the ECMO supporting time for most COVID-19 patients is greater than 7 days, the seldinger method should be used as much as possible for the ultrasound guided peripheral catheter insertion, which reduces the bleeding damages and infection risks brought about by intravascular cathterization by venous angiotomy, especially for the early awake ECMO patients. 

zh-cn	血管条件差，无法通过超声方法判断选择合适插管的患者，或者seldinger方法失败的患者才考虑进行切开置管。 
en-us	Intravascular catheterization by venous angiotomy may be considered only for the patients with bad blood vessel conditions, or the patients whose catheterization cannot be identified and selected by ultrasound, or the patients whose seldinger technique failed. 

zh-cn	模式选择 
en-us	Mode Selection 

zh-cn	1）单纯呼吸功能损伤患者首选V-V模式，不应该为了可能发生的循环问题首选V-A模式； 
en-us	(1) The first choice for the patients of Respiratory impairment is the V-V mode. The V-A mode should not be the first option just because of the possible circulation problems. 

zh-cn	2）对于合并心功能损害的呼吸衰竭患者，PaO2/FiO2<100mmHg，需要采用V-A-V模式，总流量应该>6L/min，采用限流方式维持V/A=0.5/0.5； 
en-us	(2) For the Respiratory failure patients complicated with cardiac impairment, PaO2/FiO2 < 100 mmHg, the V-A-V mode ought to be selected with the total flux > 6 L/min and V/A = 0.5/0.5 is maintained by current limiting. 

zh-cn	3）COVID-19患者没有严重呼吸衰竭，但是合并严重心血管事件导致心源性休克，应该采用V-A模式ECMO辅助，但仍然需要IPPV支持，且避免进行清醒ECMO。 
en-us	(3) For the COVID-19 patients without severe Respiratory failure but complicated with serious cardiovascular outcomes leading to cardiogenic shock, the V-A assisted by ECMO mode ought to be selected. But IPPV support is still needed and the awake ECMO should be avoided. the awake ECMO should be avoided. 

zh-cn	流量设定与氧供目标 
en-us	Flux Set-value and Target Oxygen Supply 

zh-cn	1）初始流量应>80%心排量CO，且自循环比例<30%； 
en-us	(1) The initial flux > 80% cardiac output (CO) with a self-cycling ratio < 30%. 

zh-cn	2）维持过程应保持SPO2 >90%，且机械通气或其他氧疗支持FiO2<0.5；
en-us	(2) SPO2 > 90% is to be maintained. FiO2 < 0.5 is supported by mechanical ventilation or the other oxygen therapy. 

zh-cn	3）为保证目标流量，体重80kg以下患者首选22Fr静脉accesscanula，80kg以上患者选择24Fr。 
en-us	(3) To ensure the target flux, 22 Fr (24 Fr) vein access canula is the first choice for the patient with a body weight below (above) 80 kg. 

zh-cn	通气目标设定
en-us	Ventilation Setting 

zh-cn	调节sweep gas水平，维持正常通气目标： 
en-us	Normal ventilation maintenance by adjusting the sweep gas level： 

zh-cn	1）初始气流调节，Flow:sweepgas=1:1,基本目标维持PaCO2<45mmHg，对于合并COPD患者应该PaCO2<80%基础水平； 
en-us	(1) The initial air flow is set to be Flow: sweep gas = 1:1. The basic target is to maintain PaCO2 < 45mmHg. For the patients complicated with COPD, PaCO2 < 80% basal level. 

zh-cn	2）应该保留患者自主呼吸强度，自主呼吸频率respiratoryrate, 10<RR<20，患者无呼吸困难主诉； 
en-us	(2) The patient’s spontaneous Respiratory strength and Respiratory rate (RR) should be maintained, with 10 < RR < 20 and without chief complaint of breathing difficulty from the patient. 

zh-cn	3）V-A模式sweepgas设定应该保证氧合器膜后血流PH：7.35-7.45。 
en-us	(3) The sweep gas setup of the V-A mode needs to ensure the 7.35-7.45 PH value of the bloodstream out of the oxygenator membrane. 

zh-cn	抗凝与出血防范 
en-us	Anti-Coagulation and Bleeding Prevention 

zh-cn	1）初始上机肝素应用，对于无活动性出血及无内脏出血且血小板>50×10 /L，首剂负荷量推荐50IU/kg； 
en-us	(1) For the patients without active bleeding, without visceral bleeding, and with platelet count > 50×109/L, the recommended initial heparin dosage is 50 U/kg. 

zh-cn	2）合并出血风险或血小板<50×10^9/L，肝素首剂负荷量25IU/kg； 
en-us	(2) For the patients complicated with bleeding or with platelet count < 50×109/L, the recommended initial heparin dosage is 25 U/kg. 

zh-cn	3）抗凝维持剂量目标建议以aPTT(活化凝血酶原时间)40-60sec为目标，同时参考D-dimer的变化趋势； 
en-us	(3) The activated partial thromboplastin time (aPPT) being 40 —60 sec is proposed to be the target of anticoagulation maintenance dosage. The trend of D-dimer change should be considered at the same time. 

zh-cn	4）无肝素运行建议，对于出现需要控制的活动性出血，或者致命性出血，在无法停止ECMO支持的情况下，全肝素涂层环路与插管且血流量>3L/min，可以考虑进行无肝素运行，建议运行时间<24h，且需要准备替换设备与耗材； 
en-us	(4) Heparin-free operation may be per formed in the following circumstances: the ECMO support must continue but there is fatal bleeding or active bleeding that has to be controlled; whole heparin coated loop and catheterization with blood flow > 3 L/min. The recommend operation time < 24 hour. Replacement devices and consumables need to be prepared. 

zh-cn	5）关于肝素抵抗，部分肝素使用条件下，出现aPTT无法达标，且凝血发生，应该监测血浆抗凝血酶III（ATIII）活性，若出现活性降低，需要补充新鲜冰冻血浆来恢复肝素敏感性； 
en-us	(5) Heparin resistance. Under some conditions of heparin usage, aPTT is not able to reach the standard and blood coagulation happens. In this case, the activity of plasma antithrombin III (ATIII) needs to be monitored. I f the activity reduces, fresh frozen plasma needs to be supplemented to restore heparin sensitivity. 

zh-cn	6）关于肝素相关性血小板减少症，heparin induced thrombopenia（HIT）。怀疑HIT发生，建议采用血浆置换治疗，或者采用阿加曲班药物替代。 
en-us	(6) Heparin induced thrombopenia (HIT). When HIT happens, we recommend to perform plasma exchange therapy, or to replace heparin with argatroban.  

zh-cn	ECMO合并机械通气的撤离 
en-us	Weaning from ECMO and Mechanical Ventilation 

zh-cn	1）V-V ECMO合并机械通气的患者，如果符合清醒ECMO条件，建议首先尝试撤除人工气道，除非已合并ECMO相关并发症，或者预期撤除所有机械辅助时间<48h。 
en-us	(1) If a patient treated by V-V ECMO combined with mechanical ventilation satisfies the awake ECMO condition, we suggest to first tr y to remove the artificial air way, unless the patient has ECMO related complications, or the expected time of removal of all the assisting machines is less than 48 h. 

zh-cn	2）对于气道分泌物过多，需要频繁辅助人工吸引清除，且预计采用长时间机械通气的患者，符合PaO2/FiO2>150mmHg时间>48h，肺部影像表现好转稳定，机械通气压力相关损伤已经控制，可以首先撤除ECMO辅助，不建议保留ECMO插管。 
en-us	(2) For a patient who has too much air way secretions that frequent artificial suction clearance is needed, who is expected to have a long-term mechanical ventilation support , who satisfies the conditions PaO2/FiO2 > 15 0 mmHg and time > 4 8 h, whose lung image changes for the better, and whose damages related to mechanical ventilation pressure have been controlled, the ECMO assistance may be removed. It is not recommended to keep ECMO intubation. 

zh-cn	十一. 
en-us	XI. 

zh-cn	COVID-19康复者恢复期血浆治疗 
en-us	Convalescent Plasma Therapy for COVID-19 Patients 

zh-cn	自从1891年Behring及Kitasato报道白喉抗毒素血浆具有治疗效果以来，已成为急性传染病治疗的一项重要的病原体免疫治疗手段。 
en-us	Since Behring and Kitasato reported the therapeutic effect s of diphtheria antitoxin plasma in 1891, plasma therapy has become an important means of pathogen immunotherapy for acute infectious diseases. 

zh-cn	新发突发传染病重症和危重症患者病情迅速进展
en-us	The disease progression is rapid for severe and critically ill patients of an emerging infectious disease. 

zh-cn	起病早期存在病原体直接损伤靶器官，进而诱导严重的免疫病理损伤，被动免疫抗体能够高效、直接中和病原体，减少靶器官损害进而阻断随后的免疫病理损伤。
en-us	In the early phase, the pathogens damage the target organs directly and then lead to severe immuno-pathological damage. The passive immune antibodies can effectively and directly neutralize the pathogens, which reduces the damage of the target organs and then block the subsequent immune-pathological damages. 

zh-cn	WHO在多次全球重大疫情爆发期间亦曾强调“恢复期血浆位于潜在疗法列表的前端，并且曾被用于其他疾病的暴发中”。
en-us	During multiple global pandemic outbreaks, WHO also emphasized that “convalescent plasma therapy is one of the most recommended potential therapies, and it has been used during other epidemic outbreaks”. 

zh-cn	2019年新型冠状病毒（COVID-19）肺炎爆发以来，由于无特效治疗手段，初期病死率较高，全社会高度关注疫情，能有效降低其危重症病死率的临床治疗手段是避免民众发生恐慌的关键。
en-us	Since the outbreak of COVID-19, the initial mortality rate was rather high due to the lack of specific and effective treatment s. As mortality rate is an important metric that the public concerns, clinic treatment s which can reduce the fatality rate of critical cases effectively are key to avoid public panic. 

zh-cn	本院作为浙江省省级定点收治医院，承担杭州地区部分患者和全省各地市的危重症患者的临床救治工作，预期具备充足的恢复期血浆潜在供体以及需要接受治疗的危重症患者。 
en-us	As a provincial-level hospital in Zhejiang province, we have been responsible to treat the patients from Hangzhou and the critically ill patients of the province. There are abundant potential convalescent plasma donors and critically ill patients who need convalescent plasma treatment in our hospital. 

zh-cn	血浆采集 
en-us	Plasma collection 

zh-cn	除满足常规无偿献血健康要求，并遵循相应流程外，还应注意以下内容： 
en-us	In addition to the common requirement s of blood donation and procedures, the following details should be noted. 

zh-cn	1.1采集对象： 
en-us	1.1 Donors 

zh-cn	康复出院满2周（深部呼吸道样本新冠病毒核酸检测转阴时间≥14天）；年龄≥18周岁且≤55周岁；男性体重＞50kg，女性体重＞45kg；停用糖皮质激素≥1周；距离上一次献血＞2周。 
en-us	At least two weeks after recover y and being discharged (the nucleic acid test of the sample taken from the lower Respiratory tract remains negative≥14 days). 18 ≤ Age ≤ 55. The body weight＞50 kg (for male) or ＞45 kg (for female). At least one week since last glucocorticoid usage. More than two weeks since last blood donation. 

zh-cn	1.2采集方法： 
en-us	1. 2 Collection Method 

zh-cn	单采血浆，每次200-400mL（根据健康征询情况）。 
en-us	Plasmapheresis, 200-400 mL each time (based on medical consultation). 

zh-cn	1.3采集后检测：除外一般质量检测和血液传播疾病相关检测外，血浆样本还应当送检： 
en-us	1.3 Post-Collection Testing In addition to the general quality test and the test of blood-borne disease, the blood samples need to be tested for: 

zh-cn	1）SARS-CoV-2病毒核酸检查； 
en-us	(1) Nucleic acid testing for SARS-CoV-2; 

zh-cn	2）稀释160倍检测SARS-CoV-2特异性IgG、IgM定性试验或稀释320倍后送检总抗体定性试验，有条件的应当保留＞3mL血浆用于病毒中和试验。 
en-us	(2) 160-fold dilution for the qualitative test of SARS- CoV-2 specific IgG and IgM detection; or 320-fold dilution for the qualitative test of whole antibody detection. If possible, keep > 3 mL plasma for the viral neutralization experiments. 

zh-cn	应当注意的是，我们在比对病毒中和试验滴度和发光法IgG抗体定量检测的数据中发现目前的SARS-CoV-2特异性IgG抗体检测不能很好体现血浆实际病毒中和能力，建议首选病毒中和试验，或选择稀释320倍后的血浆总抗体水平检测。 
en-us	The following should be noted. During the comparison of virus neutralization titer and luminescent IgG antibody quantitative detection, we found that the present SARS-CoV-2 specific IgG antibody detection does not fully demonstrate the actual virus neutralization capability of the plasma. Therefore, we suggested the virus neutralization test as the first choice, or test the overall antibody level with the 320-fold dilution of the plasma.

zh-cn	恢复期血浆临床应用 
en-us	Clinical Use of the Convalescent Plasma 

zh-cn	2.1适应证 
en-us	2.1 Indication 

zh-cn	1）呼吸道病毒检测阳性的重症、危重症COVID-19患者； 
en-us	(1) Severe or critically ill COVID-19 patients tested positive in Respiratory tract test; 

zh-cn	2）非重症、危重症患者如存在免疫抑制情况，或病毒核酸检测CT值较低，且出现肺部病灶迅速进展者。 
en-us	(2) The COVID-19 patients who are not severe or critically ill, but in a state of immunity suppression; or have low CT values in the virus nucleic acid testing but with a rapid disease progression in the lungs. 

zh-cn	注：原则上恢复期血浆不建议用于病程超过3周的COVID-19患者，
en-us	Note: In principle, the convalescent plasma should not be used on COVID-19 patients with disease course exceeding three weeks. 

zh-cn	但我们实际临床应用中发现，在病程＞3周且呼吸道样本病毒核酸检测持续阳性的患者中应用恢复期血浆治疗，能起到加快病毒清除，提高患者血液淋巴细胞和NK细胞数量，降低血乳酸水平以及改善肾功能的作用。 
en-us	But in clinical applications, we found that the convalescent plasma therapy is effective for patients with a disease course exceeding three weeks and whose virus nucleic acid test s continuously to show positive from Respiratory tract s specimen. It can speed up virus clearance, increase the numbers of the plasma lymphocytes and NK cell s, reduce the level of plasma lactic acid, and improve renal functions. 

zh-cn	2.2禁忌证 
en-us	2.2 Contraindication 

zh-cn	1）既往血浆输注过敏史，枸橼酸钠、亚甲蓝过敏史； 
en-us	(1) Allergy history of plasma, sodium citrate and methylene blue; 

zh-cn	2）自身免疫性疾病病史、选择性IgA缺乏症患者应当经临床医师评估后谨慎使用。 
en-us	(2) For patients with history of autoimmune system diseases or selective IgA deficiency, the application of convalescent plasma should be evaluated cautiously by clinicians. 

zh-cn	2.3输注方案 通常给与1次输注量≥400mL，或予多次每次≥200mL的恢复期血浆治疗。 
en-us	2.3 Infusion plan in general, the dosage of convalescent plasma therapy is ≥400 mL for one infusion, or ≥ 200 mL per infusion for multiple infusions.  

zh-cn	十二. 中医分型治疗提高疗效 
en-us	XII. TCM Classification Therapy to Improve Curative Efficacy 

zh-cn	分型分期 
en-us	Classification and Stage 

zh-cn	COVID-19可分为初期、中期、重症期及恢复期。
en-us	COVID-19 can be divided into early, middle, critical and recover y stages. 

zh-cn	初期以寒湿郁肺和外寒内热两型为主；中期以寒热错杂为先；重症期为疫毒内闭多见；恢复期重在肺脾气虚。
en-us	At the early stage, the disease has two main types: “wet lungs” and “external cold and internal heat.” The middle stage is characterized by “intermit tent cold and heat.” The critical stage is characterized by “internal block of epidemic toxin.” The recovery stage is characterized by “qi deficiency in lung-spleen.” 

zh-cn	该病初期为寒湿证，因兼有发热，可以寒热并用。
en-us	The disease initially belongs to wet lung syndrome. Due to fever, both intermit tent cold and heat treatment s are recommended. 

zh-cn	中期寒湿热兼见，中医属寒热错杂，故寒热并用，调其升降。
en-us	In the middle stage, cold, dampness, and heat coexist, belonging to “cold-heat mixture” in terms of TCM. Both cold and heat therapy should be considered. 

zh-cn	中医之治则“热者寒之”，治热以寒，但寒药易伤阳，导致脾胃虚寒，出现中焦寒热错杂之象，也需寒热并用。
en-us	According to the theory of TCM, heat should be treated with cold drugs. But cold drugs impair Yang and lead to a cold spleen and stomach and cold-heat mixture in the middle-Jiao. 

zh-cn	该病寒热错杂证常见，采用寒热并用法取得了优于其他疗法的效果。 
en-us	Therefore, in this stage both cold and heat therapies should be considered. Because cold-heat symptoms are commonly seen in COVID-19 patients, the cold-heat therapy is better than other approaches. 

zh-cn	分型论治 
en-us	Therapy Based on Classification 

zh-cn	1）寒湿郁肺：治宜散寒化湿，芳香解表。药选麻黄6g、杏仁10g、薏苡仁30g、甘草6g、黄芩15g、藿香10g、芦根30g、贯众15g、茯苓20g、苍术12g、厚朴12g。 
en-us	(1) Wet lungs Ephedra Herb 6 g, Semen Armeniacae Amarumg 10 g, Coix Seed 30 g, Liquoric Root 6 g, Baical Skullcap Root 15 g, Huoxiang 10 g, Reed Rhizome 30 g, Cyrtomium Rhizome 15 g, Indian Buead 20 g, Chinese Atractylodes Rhizome 12 g, Officinal Magnolia Bark 12 g. 

zh-cn	2）外寒内热：治宜清泄肺热、辛凉解表。药选麻黄9g、生石膏30g、杏仁10g、甘草6g、黄芩15g、瓜蒌皮20g、枳壳15g、厚朴12g、肺形草20g、桑白皮15g、半夏12g、茯苓20g、桔梗9g。 
en-us	(2) External cold and internal heat Herba Ephedrae 9 g, Raw Gypsum Fibrosum 30 g, Semen Armeniacae Amarumg 10 g, Liquoric Root 6 g, Baical Skullcap Root 15 g, Pericarpium Trichosanthis 20 g, Fructus Aurantii 15 g, Officinal Magnolia Bark 12 g, Tripterospermum Cordifolium 20 g, White Mulberry Root-bark 15 g, Pinellia Tuber 12 g, Indian Buead 20 g, Platycodon Root 9 g. 

zh-cn	3）寒热错杂：治宜平调寒热、分消湿热。
en-us	(3) Intermit tent cold-heat 

zh-cn	药选半夏12g、黄芩15g、黄连6g、干姜6g、大枣15g、葛根30g、木香10g、茯苓20g、浙贝母15g、薏苡仁30g、甘草6g。 
en-us	Pinellia Tuber 12 g, Baical Skullcap Root 15 g, Golden Thread 6 g, Dried Ginger 6 g, Chinese Date 15 g, Kudzuvine Root 30 g, Costustoot 10 g, Indian Buead 20 g, Thunberg Fritillary Bulb 15 g, Coix Seed 30 g, Liquoric Root 6 g. 

zh-cn	4）疫毒内闭：治宜清热解毒，镇惊开窍。
en-us	(4) Internal block of epidemic toxin 

zh-cn	以安宫牛黄丸灌服治疗。 
en-us	Use cheongsimhwan for treatment. 

zh-cn	5）肺脾气虚：治宜健脾益肺，补气固表。
en-us	(5) Qi deficiency of lung and spleen 

zh-cn	药选黄芪30g、党参20g、炒白术15g、茯苓20g、砂仁6g、黄精15g、半夏10g、陈皮6g、山药20g、莲子15g、大枣15g。 
en-us	Membranous Milk vetch Root 30 g, Pilose Asiabell Root 20 g, Roasted Largehead Atract ylodes Rhizome 15 g, Indian Buead 20 g, Fructus Amomi 6 g, Siberian Solomonseal Rhizome 15 g, Pinellia Tuber 10 g, Tangerine Peel 6 g, Wingde Yan Rhizome 20 g, Semen Nelumbinis 15 g, Chinese Date 15 g. 

zh-cn	以上按分型选用相应处方，每日一剂，水煎两次，早晚分服。 
en-us	Patients in different stages should take different approaches. One dose per day. Boil the medicine in water. Take it every morning and evening.  

zh-cn	十三. COVID-19患者用药管理 
en-us	XIII. Drug Use Management of COVID-19 Patients 

zh-cn	COVID-19患者合并基础疾病、用药种类复杂、涉及特殊人群用药。
en-us	COVID-19 patients are often complicated with underlying diseases receiving multiple types of drugs. 

zh-cn	临床药物治疗时应关注药物不良反应和相互作用，避免药源性器官损伤，提高救治成功率。 
en-us	Therefore, we should pay more attention to the adverse drug reactions and drug interactions so as to avoid drug-induced organ damage and improve the success rate of treatment.  

zh-cn	甄别药物不良反应
en-us	Identification of adverse drug reactions 

zh-cn	研究显示，使用洛匹那韦联合阿比多尔为主的抗病毒方案，肝功能异常发生率为51.9%，多元分析显示抗病毒药物和合并用药数是引起患者肝功能异常的独立危险因素。
en-us	It has been demonstrated that the incidence of abnormal liver function is 51.9% in COVID-19 patients who have received lopinavir/ritonavir combined arbidol antiviral treatment. Multivariate analysis revealed that antiviral agent s and more concomitant medications are two independent risk factors of abnormal liver function. 

zh-cn	应加强患者不良反应的监测，减少不必要的合并用药。
en-us	Therefore, monitoring of the adverse drug reactions should be strengthened; the unnecessary drug combinations should be reduced. 

zh-cn	抗病毒药物的主要不良反应： 
en-us	The main adverse reactions of antiviral agents include: 

zh-cn	1）洛匹那韦/利托那韦他和达芦那韦/考比司他：引起腹泻、恶心、呕吐，肝酶与黄疸 升高、血脂异常，乳酸增高等不良反应，停药后可恢复。 
en-us	(1) Lopinavir /ritonavir and darunavir/cobicistat: diarrhea, nausea, vomit, the increase of serum aminotransferase, jaundice, dyslipidemia, the increase of lactic acid.Symptoms will recover after drug withdrawal. 

zh-cn	2）阿比多尔：肝酶及黄疸升高，与洛匹那韦联用时，发生率更高，停药后一般可恢复，偶可引起心率减慢，需避免与美托洛尔、普萘洛尔等β受体拮抗剂合用，心率低于60次/min时建议停药。 
en-us	(2) Arbidol：the increase of serum aminotransferase and jaundice. When combined with lopinavir, the incidence rate is even higher. The symptoms will recover after drug withdrawal . Sometimes a slowdown of the hear t could be induced; thus it is necessary to avoid the combination of arbidol with β–receptor inhibitors such as metoprolol and propranolol . We suggest to stop taking the drugs when the heart rate drops below 60/min. 

zh-cn	3）法匹拉韦：可引起血尿酸升高、腹泻、中性粒细胞降低、休克、暴发性肝炎、急性肾损伤等不良反应，尤见于老年或合并细胞因子风暴的患者。 
en-us	(3) Fapilavir: elevation of plasma uric acid, diarrhea, neutropenia, shock, fulminant hepatitis, acute kidney injury. The adverse reactions were commonly seen in elderly patients or patients complicated with cytokine storm. 

zh-cn	4）磷酸氯喹：可引起头晕、头痛、恶心、呕吐、腹泻、各种皮疹等，心脏骤停是最严重不良反应，眼部病变是最主要不良反应，用药前检查心电图，禁用于心律失常（如传导阻滞）、视网膜疾病，以及听力减退等患者。 
en-us	(4) Chloroquine phosphate: dizziness, headache, nausea, vomit, diarrhea, different kinds of skin rash. The most severe adverse reaction is cardiac arrest. The main adverse reaction is the ocular toxicity. An electrocardiogram needs to be examined before taking the drug. The drug should be prohibited for patients with arrhythmia (e.g., conduction block), retinal disease, or hearing loss. 

zh-cn	进行血药浓度监测
en-us	Therapeutic Drug Monitoring 

zh-cn	需要治疗药物监测（therapeutic drugmonitoring，TDM）的抗病毒和抗菌药物血药 
en-us	Some antiviral and antibacterial drugs need therapeutic drug monitoring (TDM). 

zh-cn	浓度与剂量调整见表1，一旦发现血药浓度异常，应结合患者临床症状、合并用药，进行方案调整，实行个体化给药。 
en-us	Table 1 presents the plasma concentrations of such drugs and their dosage adjustment. Upon the onset of aberrations of plasma drug concentration, the treatment regimens need to be adjusted by considering the clinical symptoms and concomitant drugs. 

zh-cn	表1 COVID-19患者常见TDM药物的浓度范围及注意事项 
en-us	Table 1 The range of concentrations and points for attention of the common TDM drugs for the COVID-19 patients  

zh-cn	药品名称
en-us	Drug names 

zh-cn	 采血时间点
en-us	Time points of blood collection

zh-cn	 治疗浓度范围 剂量调整原则 
en-us	The range of concentrations Principles of dosage adjustment 

zh-cn	洛匹那韦 /利托那韦 
en-us	lopinavir/ritonavir

zh-cn	（峰）给药后30min内
en-us	(peak) 30 min after drug administration

zh-cn	（谷）给药前30min内 
en-us	 (trough) 30 min before drug administration

zh-cn	洛匹那韦：（谷）>1μg/mL（峰）<8.2μg/mL 
en-us	 lopinavir： (trough）> 1 μg/mL (peak) < 8.2 μg/mL 

zh-cn	与疗效和毒副反应相关。 
en-us	Correlated with drug efficacy and side effects. 

zh-cn	亚胺培南 
en-us	imipenem 

zh-cn	当日给药前10min内 
en-us	10 min before the drug administration 

zh-cn	1~8μg/mL 
en-us	1~8 μg/mL 

zh-cn	美罗培南 
en-us	meropenem 

zh-cn	当日给药前10min内 
en-us	10 min before the drug administration 

zh-cn	1~16μg/mL 
en-us	1~16 μg/mL 

zh-cn	需结合病原学检测的MIC解读血药浓度监测结果，进而调整用药方案。 
en-us	Interpretation and adjust the plasma drug concentration based on MIC of the pathogen testing 

zh-cn	万古霉素 
en-us	vancomycin 

zh-cn	当日给药前30min内 
en-us	30 min before the drug administration 

zh-cn	10~20mg/L（重症MRSA感染时推荐15~20mg/L） 
en-us	10~20 mg/L (15~20mg/L for the severe MRSA infection) 

zh-cn	谷浓度与感染治疗失败率和肾毒性相关，浓度过高需减少频次或单次剂量。 
en-us	The trough concentration correlates with the failure rate of anti-infective therapy and renal toxicity. When the concentration is overly high, reduction of drug frequency or single dose is required. 

zh-cn	利奈唑胺 
en-us	linezolid 

zh-cn	当日给药前30min内 
en-us	30 min before the drug administration 

zh-cn	2~7μg/mL 
en-us	2~7 μg/mL 

zh-cn	谷浓度与骨髓抑制不良反应相关，需密切监测血三系水平。 
en-us	The trough concentration correlates with myelosuppression adverse reactions. The blood routine test needs to be closely monitored. 

zh-cn	伏立康唑 
en-us	voriconazol 

zh-cn	当日给药前30min内 
en-us	30 min before the drug administration 

zh-cn	1~5.5μg/mL 
en-us	1~5.5 μg/mL 

zh-cn	谷浓度与疗效和肝功能受损等不良反应相关 
en-us	The trough concentration correlates with the therapeutic efficacy and adverse reactions such as impaired liver function.  

zh-cn	注意潜在的药物相互作用 
en-us	Paying attention to the potential drug interactions 

zh-cn	由于抗病毒药物如洛匹那韦/利托那韦经肝脏CYP3A酶代谢，如有多重用药时须仔细排查可能的药物相互作用，合理选择药物。
en-us	Antiviral drugs such as lopinavir/ritonavir are metabolized through the enzyme CYP3A in the liver. When patients receiving concomitant medications, the potential drug interactions need to be carefully screened. 

zh-cn	有关抗病毒药物与常见基础疾病用药的相互作用见表2。 
en-us	Table 2 shows interactions bet ween antiviral drugs and common drugs for underlying diseases.  

zh-cn	表2 抗病毒药物与常见基础疾病用药的相互作用 
en-us	Table 2 Interactions bet ween antiviral drugs and common drugs for underlying  

zh-cn	药品名称  
en-us	Drug names 

zh-cn	可能的相互作用  
en-us	Potential interactions 

zh-cn	联合用药禁忌 
en-us	Contraindication in combined medication 

zh-cn	洛匹那韦/利托那韦 
en-us	lopinavir/ritonavir 

zh-cn	与 CYP3A 代谢的药物 (例如他汀类、他克莫司等免疫抑制剂、伏立康唑)可导致合用药物的血浆浓度升高，导致利伐沙班AUC增加153%，阿托伐他汀AUC增加5.9倍，咪达唑仑AUC增加13倍，要注意临床症状及TDM的监测； 
en-us	When combined with drugs associated with CYP3A metabolism (e.g., statins, immunosuppressors such as tacrolimus, voriconazole), the plasma concentration of the combined drug may increase; leading to 153%, 5.9 folds, 13 folds increase of the AUC of rivaroxaban, atrovastatin, midazolam, respectively. Pay attention to clinical symptoms and apply the TDM. 

zh-cn	严禁与胺碘酮（致命性心律失常）、喹硫平（严重昏迷）、辛伐他汀（横纹肌溶解）等联合使用； 
en-us	Combined use with amiodarone (fatal arrhythmia), quetiapine (severe coma), simvastatin (rhabdomyolysis) is prohibited. 

zh-cn	达芦那韦/考比司他 
en-us	darunavir/ cobicistat 

zh-cn	与主要经由CYP3A和/或CYP2D6代谢的药品联合用药时可导致此类药品血浆浓度升高；相互作用药物参考洛匹那韦/利托那韦； 
en-us	When combined with drugs associated with CYP3A and/or CYP2D6 metabolism, the plasma concentration of the combined drugs may increase. 

zh-cn	参考洛匹那韦/利托那韦； 
en-us	See lopinavir/ ritonavir. 

zh-cn	阿比多尔 
en-us	arbidol 

zh-cn	与CYP3A4及UGT1A9底物、抑制剂和诱导剂之间存在药物相互作用 
en-us	It interacts with CYP3A4, UGT1A9 substrates, inhibitors, and inducers. 

zh-cn	法匹拉韦 
en-us	fapilavir 

zh-cn	①茶碱可使法匹拉韦生物利用度上升； 
en-us	Theophyllinum increases the bioavailability of fapilavir. 

zh-cn	②可使乙酰氨基酚生物利用度上升到1.79倍； 
en-us	It increases the bioavailability of acetaminophen by 1.79 folds. 

zh-cn	③与吡嗪酰胺联合使用可使血液中尿酸水平升高； 
en-us	Its combination with pyrazinamide increases the plasma uric acid level. 

zh-cn	④与瑞格列奈联合使用会导致瑞格列奈血药浓度升高。 
en-us	Its combination with repaglinide increases the plasma repaglinide level. 

zh-cn	磷酸氯喹 
en-us	chloroquine phosphate 

zh-cn	严禁与莫西沙星、阿奇霉素、胺碘酮等可能导致Q-T间期延长的药物合用。 
en-us	Prohibit to combine with the drugs that may lead to the prolonged Q-T interval (such as moxifloxacin, azithromycin, amiodarone, etc.). 

zh-cn	注：“—”无相关资料；TDM：治疗药物监测；AUC：药时曲线下面积； 
en-us	Note：“—”: no relevant data；TDM：therapeutic drug monitoring；AUC：area under the curve； 

zh-cn	UGT1A9：尿苷二磷酸葡萄糖苷酸基转移酶1A9 
en-us	UGT1A9：uridine diphosphate glucosidase 1A9.  

zh-cn	特殊人群避免用药损伤 
en-us	Avoiding medical damage in special populations 

zh-cn	特殊人群包括孕妇、肝肾功能不全，机械通气、连续肾脏替代治疗（Continuousrenal replacement therapy, CRRT）、体外膜肺氧合治疗（Extracorporeal membrane oxygenation，ECMO）等患者
en-us	Special populations include pregnant women, patients with hepatic and renal insufficiency, patients supported by mechanical ventilation, patients under continuous renal Replacement therapy (CRRT) or, extracorporeal membrane oxygenation (ECMO), etc.

zh-cn	在给药过程中注意以下事项： 
en-us	 The following aspect s need to be noted during drug administration. 

zh-cn	1）孕妇患者，可选用洛匹那韦/利托那韦，禁用法匹拉韦、磷酸氯喹等； 
en-us	(1) Pregnant women Lopinavir/ritonavir tablets could be used. Favipiravir and chloroquine phosphate are prohibited. 

zh-cn	2）肝功能不全患者，尽量选择原形经肾脏排泄的药物，比青霉素类、头孢菌素类等； 
en-us	(2) Patients with hepatic insufficiency Drugs that are excreted unchanged through the kidney are preferred, such as penicillin and cephalosporins, etc. 

zh-cn	3）肾功能不全患者（包括血液透析患者），尽量选择经肝脏代谢或肝肾双通道排泄的药物，比如利奈唑胺、莫西沙星、头孢曲松等； 
en-us	(3) Patients with renal insufficiency (including those on hemodialysis) Drugs that are metabolized through the liver or excreted through the liver-kidney double channels are preferred, such as linezolid, moxifloxacin, ceftriaxone, etc. 

zh-cn	4）CRRT持续24h患者，万古霉素建议负荷剂量1g，维持剂量0.5g，q12h，亚胺培南日剂量不建议超过2g。 
en-us	(4) Patients under CRRT for 24h For vancomycin, the recommended regimen is: loading dose 1 g and maintenance dose 0.5 g, q12h. For imipenem, the maximum daily dosage should not exceed 2 g. 

zh-cn	十四. COVID-19患者心理干预 
en-us	XIV. Psychological Intervention with COVID-19 Patients  

zh-cn	新冠肺炎患者的心理反应和精神症状 
en-us	The psychological stress and symptoms of COVID-19 patients 

zh-cn	新冠肺炎患者确诊后常常会表现出懊悔自责、孤独无助、悲观抑郁、焦虑恐慌、烦躁失眠等症状，部分患者会出现惊恐发作。
en-us	Confirmed COVID-19 patients often have symptoms such as regret and resentment, loneliness and helplessness, depression, Anxiety and phobia, irritation and sleep deprivation. Some patients may have panic at tacks. 

zh-cn	在隔离病房的心理评估显示，约48%的新冠肺炎确诊患者在入院初期存在心理反应，大多数是应激状态下的情绪反应。
en-us	Psychological evaluations in the isolated wards demonstrated that, about 48% of confirmed COVID-19 patients manifested psychological stress during early admission, most of which were from their emotional response to stress. 

zh-cn	危重症患者有较高 
en-us	The percentage of delirium is high among the critically ill patients. 

zh-cn	比例出现谵妄，个案报道新冠病毒所致脑炎，伴有意识不清、烦躁等精神症状。 
en-us	There is even a report of encephalitis induced by the SARS-CoV-2 leading to psychological symptoms such as unconsciousness and irritability.  

zh-cn	建立动态心理危机评估预警机制 
en-us	Establishing a dynamic mechanism for evaluation and warning of psychological crisis  

zh-cn	在入院后每周及出院前动态监测COVID-19对患者个体心理应激、情绪、睡眠、压力等精神状态的影响程度。
en-us	Patients’ mental states (individual psychological stress, mood, sleep quality, and pressure) should be monitored every week after admission and before discharge. 

zh-cn	采用自评工具：心理健康自评量表（SRQ-20）、抑郁症筛查量表（PHQ-9），广泛性焦虑筛查量表（GAD-7）。
en-us	The self-rating tools include: Self-Reporting Questionnaire 20 (SRQ-20), Patient Health Questionnaire 9 (PHQ-9）and Generalized Anxiety Disorder 7 (GAD-7). 

zh-cn	他评工具：汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表(HAMA)、阴性与阳性症状量表（PANSS）。 
en-us	The peer-rating tools include: Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Positive and Negative Syndrome Scale (PANSS). 

zh-cn	在隔离病房特殊环境下，建议患者在指导下通过手机进行问卷自评，医生可以采用面对面或语音连线下进行访谈和量表评估。在防护服穿戴下建议更多的肢体语言交流。 
en-us	In such a special environment as the isolated wards, we suggest that patients should be guided to complete the questionnaires through their cell phones. The doctors can interview and perform scale assessing through face-to-face or online discussion. 

zh-cn	基于评估结果进行相应的干预和处理 
en-us	Intervention and treatment based on the assessment 

zh-cn	3.1干预和处理原则 
en-us	3.1 Principles of Intervention and treatment 

zh-cn	对于轻症患者，建议采用非药物心理干预，自助式心理调适可采用呼吸放松训练、正念训练。
en-us	For mild patients, psychological intervention is suggested. Psychological self-adjustment includes breathing relaxation training and mindfulness training. 

zh-cn	中重症患者，建议药物联合心理干预治疗模式。
en-us	For moderate to severe patients, Intervention and treatment by combining medication and psychotherapy are suggested. 

zh-cn	可给予新型抗抑郁药、抗焦虑药以及苯二氮卓类药物等改善情绪和睡眠问题。
en-us	New antidepressants, anxiolytics, and benzodiazepines can be prescribed to improve the patients’ mood and sleep quality. 

zh-cn	第二代抗精神病药物如奥氮平、喹硫平改善幻觉、妄想等精神病性症状。 
en-us	The second generation antipsychotics such as olanzapine and quetiapine can be used to improve psychotic symptoms such as illusion and delusion. 

zh-cn	3.2老年患者的精神类药物选择 
en-us	3.2 The recommendation of psychotropic medications in elderly patients 

zh-cn	新冠肺炎在中老年人群中高发，常常共患高血压、糖尿病等躯体疾病，因此，在选择精神类药物时需充分考虑药物间的相互作用以及对呼吸的影响。
en-us	Middle-aged or elderly COVID-19 patients’ medical situations are often complicated by physical diseases such as hyper tension and diabetes. Therefore, when selecting psychotropic medications, the drug interactions and their effects on respiration must be fully considered. 

zh-cn	推荐使用西酞普兰、艾司西酞普兰等改善抑郁焦虑 情绪；苯二氮卓类药物如艾司唑仑、阿普唑仑等改善焦虑和睡眠质量；奥氮平、喹硫平等改善精神病性症状。 
en-us	We recommend using citalopram, escitalopram, etc. to improve depression and Anxiety symptoms; benzodiazepines such as estazolam, alprazolam, etc. to improve Anxiety and sleep quality; olanzapine, quetiapine, etc. to improve psychotic symptoms. 

zh-cn	十五. COVID-19患者康复治疗 
en-us	XV. Rehabilitation Therapy for COVID-19 Patients 

zh-cn	COVID-19重型、危重型患者，在急性期和恢复期，均表现有不同程度的功能损害。其中以呼吸功能障碍、躯体运动功能障碍、认知功能障碍尤为明显。 
en-us	Severe and critically ill patients suffer from different degrees of dysfunction, especially Respiratory insufficiency, dyskinesia and cognitive impairment, during both acute and recovery stages.  

zh-cn	重型、危重型患者康复治疗 
en-us	Rehabilitation therapy for severe and critically ill patients 

zh-cn	康复早期介入的目的是改善呼吸困难，帮助患者缓解症状、缓解焦虑抑郁情绪，减少并发症的发生。
en-us	The goal of early rehabilitation Intervention is to reduce breathing difficulties, relieve symptoms, ease anxiety and depression and lower the incidence of complications. 

zh-cn	康复早期介入的流程：康复评估—治疗—再评估。 
en-us	The process of early rehabilitation intervention is: rehabilitation assessment - therapy - reassessment.   

zh-cn	1.1康复评估 
en-us	1.1 Rehabilitation assessment 

zh-cn	在一般临床评估的基础上，尤其注意功能的评估，包括呼吸、心脏、运动、ADL评估。 
en-us	Based on general clinical assessment, especially functional evaluation, including respiration, cardiac status, motion and ADL should be emphasized. 

zh-cn	重点关注呼吸康复评估，主要包括评估胸廓活动度、测定膈肌活动幅度、观察呼吸模式和频率等。 
en-us	Focus on respiratory rehabilitation assessment, which includes the evaluation of thoracic activity, diaphragm activity amplitude, respiratory pattern and frequency, etc. 

zh-cn	1.2康复治疗 
en-us	1. 2 Rehabilitation therapy 

zh-cn	COVID-19重症危重症患者的康复治疗主要包括体位管理、呼吸训练，和物理因子治疗。 
en-us	The rehabilitation therapy of severe or critically ill COVID-19 patients mainly includes position management, Respiratory training, and physical therapy. 

zh-cn	1）体位管理。
en-us	(1) Position management. 

zh-cn	患者体位摆放可以减少痰液对于呼吸道的影响，尤其是对于改善患者的V/Q尤其重要。
en-us	Postural drainage may reduce the influence of sputum on the Respiratory tract, which is especially important to improve the patient’s V/Q. 

zh-cn	合理体位可以利用重力作用使肺叶或者肺段气道分泌物引流排出。
en-us	Patients must learn to tip themselves into a position which allows gravity to assist in draining excretion from lung lobes or lung segment s. 

zh-cn	对于镇静和意识障碍的患者，在生理状况允许的情况下，可采用起立床或抬高床头（30°-45°-60°）。
en-us	For patients using sedatives and suffering from consciousness disturbance, a standing-up bed or the bed head elevation (30°-45°-60°) may be applied if the patient’s condition permits. 

zh-cn	站位状态是静息最佳通气体位，可有效增加患者通气效率，维持肺容积。
en-us	Standing is the best body position for breathing in a resting state, which can effectively increase the patient’s respiratory efficiency and maintain lung volume. 

zh-cn	在患者能耐受的情况下，尽量争取保持患者的站位并可逐渐增加站位时间。 
en-us	As long as the patient feels good, let the patient take a standing position and gradually increase the time standing. 

zh-cn	2）呼吸运动训练。
en-us	(2) Respiratory exercise. 

zh-cn	呼吸运动能使肺部充分的扩张，帮助肺泡和气道中的分泌物向大气道排出，避免痰液集聚在肺底部，增加肺活量，增强肺功能。
en-us	Exercise can fully expand the lungs, help the excretions from pulmonary alveoli and air way expel into the large air way so that sputum would not accumulate at the bottom of the lungs. It increases the vital capacity and enhances lung function. 

zh-cn	其中深慢呼吸、扩胸配合肩部外展呼吸是两种主要的呼吸运动训练技术。 
en-us	Deep-slow breathing and chest expansion breathing combined with shoulder expansion are the two major techniques of Respiratory exercises. 

zh-cn	①深漫呼吸：指吸气时尽量调动膈肌主动参与，呼吸尽量深慢，避免浅快呼吸造成的通气效率降低。
en-us	Deep-slow breathing: while inhaling, the patient should try his/her best to move the diaphragm actively. The breathing should be as deep and slow as possible to avoid the reduction of Respiratory efficiency caused by fast-shallow breathing. 

zh-cn	该呼吸方式比胸式呼吸做功低，潮气量、通气灌注比优，可用于呼吸急促时候调整呼吸。 
en-us	Compared with thoracic breathing, this kind of breathing needs less muscle strength but has better tidal volume and V/Q value, which can be used to adjust breathing when experiencing short of breath. 

zh-cn	②扩胸配合肩部外展呼吸：增加肺通气效应。
en-us	Chest expansion breathing combined with shoulder expansion: Increase pulmonary ventilation. 

zh-cn	做深慢呼吸，吸气时做扩胸、配合肩外展；呼气时含胸，肩内收。
en-us	When taking a deep-slow breath, one expands his/her chest and shoulders while inhaling; and moves back his/her chest and shoulders while exhaling. 

zh-cn	由于病毒性肺炎特殊病理性因素，呼吸时尽量避免长时间闭气，以免增加呼吸功、氧耗及心脏负担。
en-us	Due to the special pathological factors of viral pneumonia, suspending breathing for a long time should be avoided in order not to increase the burden of Respiratory function, and the heart, as well as oxygen consumption. 

zh-cn	同时，注意避免动作速度过快，尽量调整 
en-us	Meanwhile, avoid moving too fast. 

zh-cn	至12-15次/min呼吸频率为佳。 
en-us	Adjust the Respiratory rate at 12-15 times/min. 

zh-cn	3）主动循环技术。
en-us	(3) Active cycle of breathing techniques. 

zh-cn	可有效清除支气管分泌物、改善肺功能，同时不加重低氧血症和气流阻塞。
en-us	It can effectively remove bronchus excretion and improve lung function without exacerbation of hypoxemia and air flow obstruction. 

zh-cn	该技术由三个阶段（呼吸控制、胸廓扩张、呵气），根据患者情况选择构成方式，并进行反复循环。 
en-us	It consists of three stages (breathing control, thoracic expansion and exhalation). How to form a cycle of breathing should be developed according to the patient’s condition. 

zh-cn	4）呼气正压训练器。
en-us	(4) Positive expiratory pressure trainer. 

zh-cn	COVID-19患者肺间质结构破坏严重。
en-us	The pulmonary interstitium of COVID-19 patients has been severely damaged. 

zh-cn	在机械通气中一般采取低压力低潮避免造成肺间质损伤。
en-us	In mechanical ventilation, low pressure and low tidal volume are required to avoid damages to the pulmonary interstitium. 

zh-cn	因此脱机后可采取低压呼气正压训练器 可帮助分泌物由低容量肺段向高容量肺段移动，降低排痰难度、减少排痰做功。
en-us	Therefore, after the removal of mechanical ventilation, positive expiratory pressure trainer can be used to help the movement of excretions from the low volume lung segment s to the high-volume segments, lowering the difficulty of expectoration. 

zh-cn	通过振荡气流产生呼气正压，振动气道，达到一定气道支撑效应，再通过高呼气流速，松动痰液、移除分泌物。 
en-us	Expiratory positive pressure can be generated through air flow vibration, which vibrates the air way to achieve air way supporting. The excretions can then be removed as the high-speed expiratory flow moves the excretions. 

zh-cn	5）物理因子治疗。
en-us	(5) Physical therapy. 

zh-cn	包括超短波、振荡器、体外膈肌起搏器，肌肉功能电刺激等等。 
en-us	This includes ultrashort wave, oscillators, external diaphragm pacemaker, electrical muscle stimulation, etc.  

zh-cn	十六. COVID-19患者肺移植  
en-us	XVI. Lung Transplantation in Patients with COVID-19 

zh-cn	肺移植是终末期慢性肺病的有效治疗手段，据文献报道，鲜有用于治疗急性传染性肺部疾病。
en-us	Lung transplantation is an effective treatment approach for final-stage chronic lung diseases. However, it is rarely repo ted that lung transplantation has been per formed to treating acute infectious lung diseases. 

zh-cn	我院根据目前临床实践结果，总结出以下体会，供同行参考。
en-us	Based on current clinical practice and result s, FAHZU summarized this chapter as a reference for medical workers. 

zh-cn	总体遵循探索性，抢救性，高选择，高防护的 原则，在充分、合理、优化的内科治疗后，肺部病变仍无明显好转，严重威胁生命安全时，需考虑肺移植评估。 
en-us	In general, following the principles of exploration, doing the best to save life, highly selective and high protection, if lung lesions are not significantly improved after adequate and reasonable medical treatment, and the patient is in critical condition, lung transplantation could be considered with other evaluations.  

zh-cn	移植前评估 
en-us	Pre-transplantation assessment 

zh-cn	1）年龄：建议＜70岁，70岁以上患者需谨慎评估其他脏器功能及术后恢复能力； 
en-us	(1) Age: It is recommended that the recipients are not older than 70. Patients over 70 years old are subject to careful evaluation of other organ functions and postoperative recovery capability. 

zh-cn	2）病程：虽然病程长短与疾病严重程度无直接相关性
en-us	(2) The course of the disease: There is no direct correlation between the length of the disease course and the severity of the disease. 

zh-cn	但对于病程短于4-6周者，需充分评估是否给予充分的药物、呼吸机辅助和ECMO的支持； 
en-us	However, for patients with short disease courses (fewer than 4-6 weeks), a full medical assessment is recommended to evaluate whether adequate medication, ventilator assistance, and ECMO support have been provided. 

zh-cn	3）肺功能状态：肺部CT、呼吸机、ECMO参数可作为参考，需充分评估是否存在逆转机会； 
en-us	(3) Lung function status: Based on the parameters collected from lung CT, ventilator, and ECMO, it is necessary to evaluate whether there is any chance of recovery. 

zh-cn	4）其他大脏器功能评估：多数危重症患者长期处于镇静状态，意识状态的判断十分重要的，有条件者建议行头颅CT、脑电图检查。
en-us	(4) Functional assessment of other major organs: a. Evaluation of the consciousness status of patients in critical condition using brain CT scan and electroencephalography is crucial, as most of them would have been sedated for an extended period; 

zh-cn	心脏评估包括心电图、心超，重点评估右心大小，肺动脉压力，以及左心功能情况。
en-us	b. Cardiac assessments, including electrocardiogram and echocardiography that focus on right heart size, pulmonary artery pressure and left heart function, are highly recommended; 

zh-cn	血清肌酐、胆红素都应纳入评估范围，合并肝功能衰竭、肾功能衰竭者应等待肝肾功能好转； 
en-us	c.The level s of serum creatinine and bilirubin should al so be monitored; for patients with liver failure and renal failure, they should not be subjected to lung transplantation until the functions of the liver and kidney are recovered. 

zh-cn	5）新冠病毒核酸检测：最少连续2次核酸检测阴性，每次间隔24小时
en-us	(5) The nucleic acid test of COVID-19: The patient should be tested negative for at least two consecutive nucleic acid tests with a time interval longer than 24 hours.

zh-cn	考虑目前复阳情况增多，建议增加到连续3次阴性以上。
en-us	 Given the increased incidents of COVID-19 test result returning from negative to positive after treatment, it is recommended to revise the standard to three consecutive negative results. 

zh-cn	理想情况为所有体液标本，包括血、痰、鼻咽、肺泡灌洗液、尿液、粪便均阴性
en-us	Ideally, negative results should be observed in all body fluid samples, including blood, sputum, nasopharynx, broncho-alveolar lavage, urine, and feces. 

zh-cn	但考虑实际操作问题，至少痰、肺泡灌洗液标本检测为阴性； 
en-us	Considering the difficult y in operation, however, at least the testing of sputum and broncho-alveolar lavage samples should be negative. 

zh-cn	6）感染状态评估：随着住院时间延长，部分新冠肺炎患者合并多重细菌感染，充分评估目前感染控制情况
en-us	(6) Assessment of infection status: With the extended in-patient treatment, some COVID-19 patients may have multiple bacterial infections, and thus a full medical assessment is recommended to evaluate the situation of infection control, especially for multidrug-resistant bacterial infection. 

zh-cn	尤其是多重耐药菌感染，需建立术后抗菌药物治疗方案，预估术后感染进展风险； 
en-us	Moreover, post-procedure antibacterial treatment plans should be formed to estimate the risk of post-procedure infections. 

zh-cn	7）新冠肺移植术前评估流程：由重症监护室医生团队提出→多学科积极讨论（MDT）→完善全面检查→分析处理相对禁忌症→术前康复创 造肺移植条件。 
en-us	(7) The preoperative medical assessment process for lung transplantation in COVID-19 patients: a treatment pl an proposed by the ICU team → multidisciplinary discussion →comprehensive medical evaluation → analysis and treatment of relative contraindications → pre-habilitation before lung transplantation.  

zh-cn	禁忌症 
en-us	Contraindications 

zh-cn	请参考2014 ISHLT共识：肺移植受者选择（更新版）。 
en-us	Please refer to The 2014 ISHLT Consensus: A consensus document for the selection of lung transplantation candidates issued by the International Society for Heart and Lung Transplantation (updated in 2014). 

zh-cn	十七. COVID-19患者出院标准及随访计划  
en-us	XVII. Discharge Standards and Follow-up Plan for COVID-19 Patients 

zh-cn	出院标准 
en-us	Discharge standards 

zh-cn	1）体温正常（耳温＜37.5°C）至少3d； 
en-us	(1) Body temperature remains normal for at least 3 days (ear temperature is lower than 37.5 °C); 

zh-cn	2）呼吸道症状明显好转； 
en-us	(2) Respiratory symptoms are significantly improved; 

zh-cn	3）病毒核酸检测连续2次以上阴性（每次间隔＞24h），有条件医疗机构可同时行粪便病毒核酸检测； 
en-us	(3) The nucleic acid is tested negative for Respiratory tract pathogen twice consecutively (sampling interval more than 24 hours); the nucleic acid test of stool samples can be per formed at the same time if possible; 

zh-cn	4）肺部影像学检查结果病灶较前明显好转； 
en-us	(4) Lung imaging shows obvious improvement in lesions; 

zh-cn	5）无其他需要住院治疗的合并症或并发症； 
en-us	(5) There is no comorbidities or complications which require hospitalization; 

zh-cn	6）不吸氧情况下SpO2＞93%； 
en-us	(6) SpO2 > 93% without assisted oxygen inhalation; 

zh-cn	7）经医院多学科团队专家组讨论并认可达到出院标准。 
en-us	(7) Discharge approved by multi-disciplinary medical team. 

zh-cn	出院后用药 
en-us	Medication after discharge 

zh-cn	一般患者无需继续服用抗病毒药物。
en-us	Generally, antiviral drugs are not necessary after discharge. 

zh-cn	若有轻度咳嗽、胃纳不佳、舌苔偏厚等问题时，可采用对症处理；对于部分肺部病灶较多，核酸转阴时间＜3天的病人，可考虑继续带抗病毒药。 
en-us	Treatments for symptoms can be applied if patients have mild cough, poor appetite, thick tongue coating, etc. Antiviral drugs can be used after discharge for patients with multiple lung lesions in the first 3 days after their nucleic acid are tested negative. 

zh-cn	居家隔离 
en-us	Home isolation 

zh-cn	出院后患者仍须居家隔离2周。
en-us	Patients must continue two weeks of isolation after discharge. 

zh-cn	建议居家隔离条件：
en-us	Recommended home isolation conditions are: 

zh-cn	①有独立的生活区，需勤通风、勤消毒；
en-us	① Independent living area with frequent ventilation and disinfection; 

zh-cn	②避免与家中的婴幼儿、老人及免疫功能低下者接触；
en-us	② Avoid contacting with infant s, the elderly and people with weak immune functions at home; 

zh-cn	③患者及患者的家属须佩戴口罩，勤洗手；
en-us	③ Patients and their family members must wear masks and wash hands frequently; 

zh-cn	④每日测量体温2次（早晚），密切关注机体的变化。 
en-us	④ Body temperature are taken twice a day (in the morning and evening) and pay close attention to any changes in the patient’s condition. 

zh-cn	随访 
en-us	Follow-up 

zh-cn	针对每一位出院患者，医院安排随访医生专人专管
en-us	A specialized doctor should be arranged for each discharged patient’s follow-ups. 

zh-cn	在出院后48h内进行第一次电话随访
en-us	The first follow-up call should be made within 48 hours after discharge. 

zh-cn	在出院后1周、2周及1个月的时间节点进行门诊随访，根据患者情况进行。
en-us	The outpatient follow-up will be carried out 1 week, 2 weeks, and 1 month after discharge.

zh-cn	血液标本肝肾功能、血常规；痰液及粪便标本病毒核酸检测；肺功能评估；肺部CT复检。
en-us	Examinations include liver and kidney functions, blood test, nucleic acid test of sputum and stool samples, and pulmonary function test or lung CT scan should be reviewed according to the patient’s condition. 

zh-cn	在出院后3个月及6个月的时间节点进行电话随访。 
en-us	Follow-up phone call s should be made 3 and 6 months after discharge.  

zh-cn	复阳患者的处理 
en-us	Management of patients tested positive again after discharge 

zh-cn	我院严格执行出院标准。
en-us	Strict discharge standards have been implemented in our hospital. 

zh-cn	已出院的患者在随访中未发现痰液、粪便核酸再次阳性情况。
en-us	There is no discharged case in our hospital whose sputum and stool samples are tested positive again in our follow-ups. 

zh-cn	但已有较多的报道参照我国指南推荐的标准（间隔24h连续2次咽拭子核酸阴性+体温正常3天+症状明显好转+肺部影像吸收好转），患者在复诊中发现核酸阳性。
en-us	However, there are some reported cases that patients are tested positive again, after being discharged based on the standards of national guidelines (negative results from at least 2 consecutive throat swabs collected at an interval of 24 hours; body temperature remaining normal for 3 days, symptoms significantly improved; obvious absorption of inflammation on lung images). 

zh-cn	这主要与标本留取、检测假阴性有关，
en-us	It is mainly due to sample collection errors and false negative testing results. 

zh-cn	针对此类患者，我们建议： 
en-us	For these patients, the following strategies are recommended: 

zh-cn	1）按COVID-19患者标准进行隔离； 
en-us	(1) Isolation according to the standards for COVID-19 patients. 

zh-cn	2）继续给予前期有效的抗病毒方案治疗； 
en-us	(2) Continuing to provide antiviral treatment which has been proved to be effective during prior hospitalization. 

zh-cn	3）在肺部影像进一步好转，痰液、粪便SARS-COV-2核酸持续阴性3次（每次间隔24h）后出院； 
en-us	(3) Discharge only when improvement is observed on lung imaging and the sputum and stool are tested negative for 3 consecutive times (with an interval of 24 hours). 

zh-cn	4）出院后按上文提到的居家隔离及随访要求进行观察。 
en-us	(4) Home isolation and follow-up visits after discharge in accordance with the requirement s mentioned above.