zh-cn	2019年12月以来，湖北武汉市出现了新型冠状病毒肺炎疫情，
en-us	Since December 2019, a novel coronavirus pneumonia epidemic has appeared in Wuhan City, Hubei Province.

zh-cn	随着疫情的蔓延，我国其他地区及境外多个国家也相继发现了此类病例。
en-us	With the spread of the epidemic, other cities in China and many countries abroad have also found such cases.

zh-cn	该病作为急性呼吸道传染病已纳入《中华人民共和国传染病防治法》规定的乙类传染病，按甲类传染病管理。
en-us	As an acute respiratory infectious disease, the disease has been included in the Class B infectious diseases stipulated in the Law of the People's Republic of China on the Prevention and Control of Infectious Diseases, and is managed as a Class A infectious disease.

zh-cn	通过采取一系列预防控制和医疗救治措施，我国境内疫情上升的势头得到一定程度的遏制，
en-us	Through the adoption of a series of preventive control and medical treatment measures, the upward trend of the epidemic situation in China has been contained to a certain extent.

zh-cn	大多数省份疫情缓解，但境外的发病人数呈上升态势。
en-us	The epidemic situation in most provinces has eased, but the number of outbreaks abroad is on the rise.

zh-cn	随着对疾病临床表现、病理认识的深入和诊疗经验的积累，为进一步加强对该病的早诊早治，提高治愈率，降低病亡率，最大可能避免医院感染，同时提醒注意境外输入性病例导致的传播和扩散，我们对《新型冠状病毒肺炎诊疗方案（试行第六版）》进行修订，形成了《新型冠状病毒肺炎诊疗方案（试行第七版）》。
en-us	With the deepen understanding of the clinical manifestations, pathological features of this disease and the accumulation of experience in diagnosis and treatment, in order to further strengthen the early diagnosis and early treatment of the disease, improve the cure rate, reduce the mortality rate, and avoid in-hospital infection, and alert for the disease transmission caused by overseas input cases, we revised the previous clinical guidance to form this 7th version.

zh-cn	病原学特点
en-us	Etiology

zh-cn	新型冠状病毒属于β属的冠状病毒，有包膜，颗粒呈圆形或椭圆形，常为多形性，直径60-140nm。
en-us	The novel coronavirus (termed as COVID-19 by World Health Organization) belongs to the coronavirus β genus, which is encapsulated in round or oval shape, and 60-140mm in diameter.

zh-cn	其基因特征与SARS-CoV 和MERS-CoV有明显区别。
en-us	The genetic characteristics of COVID-19 are significantly different from SARS-Co V and MERS-CoV.

zh-cn	目前研究显示与蝙蝠SARS样冠状病毒（bat-SL-CoVZC45）同源性达85%以上。
en-us	It shares more than 85% homology with SARS-like coronavirus isolated from bat (bat-SL-CoVZC45).

zh-cn	体外分离培养时，新型冠状病毒96个小时左右即可在人呼吸道上皮细胞内发现，而在Vero E6和Huh-7细胞系中分离培养需约6天。
en-us	The COVID-19 can be detected in human respiratory epithelial cells for about 96 hours in vitro, but it takes about 6 days to isolate and culture in Vero E6 and Huh-7 cell lines.

zh-cn	对冠状病毒理化特性的认识多来自对SARS-CoV和MERS-CoV 的研究。
en-us	Our current understandings on the biochemical features of COVID-19are mostly derived from previous studies on SARS-CoV and MERS-CoV.

zh-cn	病毒对紫外线和热敏感，56°C 30分钟
en-us	COVID-19 is fragile to ultraviolet and heat (56 °C for 30 minutes).

zh-cn	乙醚、75%乙醇、含氯消毒剂、过氧乙酸和氯仿等脂溶剂均可有效灭活病毒，
en-us	It can also be inactivated by liposoluble solvents, such as ether, 75% ethanol (w/v), chlorine-containing disinfectant and chloroform.

zh-cn	氯己定不能有效灭活病毒。
en-us	However, chlorhexidine has been proved generally ineffective.

zh-cn	流行病学特点
en-us	Epidemiology

zh-cn	传染源
en-us	Source of infection

zh-cn	目前所见传染源主要是新型冠状病毒感染的患者,无症状感染者也可能成为传染源。
en-us	Infected patients (symptomatic or asymptomatic) are the main source of infection.

zh-cn	传播途径
en-us	Route of transmission

zh-cn	经呼吸道飞沫和密切接触传播是主要的传播途径。
en-us	COVID-19 is transmitted through respiratory droplets and close contact.

zh-cn	在相对封闭的环境中长时间暴露于高浓度气溶胶情况下存在经气溶胶传播的可能。
en-us	Aerosol transmission is plausible when patients are exposed to high concentration virus-containing aerosols for a long period of time and in a relatively closed environment.

zh-cn	由于在粪便及尿中可分离到新型冠状病毒，应注意粪便及尿对环境污染造成气溶胶或接触传播。
en-us	In addition, because COVID-19 has been isolated from stool and urine specimens, special attention should be paid to human waste disposal to avoid direct contact and/or environment contamination.

zh-cn	人群普遍易感。
en-us	Human beings are generally susceptible to COVID-19

zh-cn	病理改变
en-us	Pathology

zh-cn	根据目前有限的尸检和穿刺组织病理观察结果总结如下。
en-us	The following summary is based on limited numbers of autopsy and biopsy findings.

zh-cn	肺脏
en-us	Lungs

zh-cn	肺脏呈不同程度的实变。
en-us	Lung consolidation was observed in various degrees.

zh-cn	肺泡腔内见浆液、纤维蛋白性渗出物及透明膜形成。
en-us	Fibrinous exudation and hyaline membrane formation were filled in alveolar cavity.

zh-cn	渗出细胞主要为单核和巨噬细胞。
en-us	Exudative cells mainly consist of mononuclear cells and macrophages.

zh-cn	易见多核巨细胞。
en-us	Polynuclear giant cells were prominent.

zh-cn	II型肺泡上皮细胞显著增生，部分细胞脱落。
en-us	Type II alveolar epithelial cells were markedly proliferated, and some were detached into alveolar cavity.

zh-cn	II型肺泡上皮细胞和巨噬细胞内可见包涵体。
en-us	Inclusion bodies were found in type II alveolar epithelial cells and macrophages.

zh-cn	肺泡隔血管充血、水肿。
en-us	Hyperemia and edema were apparent in alveolar septal areas.

zh-cn	可见单核和淋巴细胞浸润及血管内透明血栓形成。
en-us	Mononuclear cell and lymphocyte infiltration, intravascular hyaline thrombosis, focal hemorrhage and necrosis of lung tissue could be seen, and hemorrhagic infarction occurred.

zh-cn	肺组织灶性出血、坏死，可出现出血性梗死。部分肺泡腔渗出物机化和肺间质纤维化。
en-us	Pathological features of organizing pneumonia and pulmonary interstitial fibrosis could be observed in pulmonary parenchyma.

zh-cn	肺内支气管黏膜部分上皮脱落，腔内可见黏液及黏液栓形 成。
en-us	Intrapulmonary bronchial epithelial cells were detached, and bronchial cavity was filled with mucus plugs.

zh-cn	少数肺泡过度充气、肺泡隔断裂或囊腔形成。
en-us	In some area, pulmonary alveoli were hyperinflated, alveolar septa fractured, and cystic cavities formed.

zh-cn	电镜下支气管黏膜上皮和II型肺泡上皮细胞胞质内可见冠状病毒颗粒。
en-us	Coronavirus particles were found in the cytoplasm of bronchial epithelium and type II alveolar epithelial cells under electron microscope.

zh-cn	免疫组化染色显示部分肺泡上皮和巨噬细胞呈新型冠状病毒抗原阳性。
en-us	Immunohistochemical staining showed that some alveolar epithelial cells and macrophages were positive for COVID-19 antigens.

zh-cn	RT-PCR检测新型冠状病毒核酸阳性。
en-us	COVID-19 nuclear acids were detected through RT-PCR.

zh-cn	脾脏、肺门淋巴结和骨髓
en-us	Spleen, hilar lymph nodes, and bone marrow

zh-cn	脾脏明显缩小，淋巴细胞数量明显减少，灶性出血和坏死，
en-us	Spleen was markedly shrunk, in which lymphocytes were significantly reduced in numbers, with apparent focal hemorrhage and necrosis.

zh-cn	脾脏内巨噬细胞增生并可见吞噬现象；
en-us	Macrophage proliferation and phagocytosis were also observed.

zh-cn	淋巴结淋巴细胞数量较少，可见坏死。
en-us	In lymph nodes, lymphocytes were also depleted and necrotized.

zh-cn	免疫组化染色显示脾脏和淋巴结内CD4+T和CD8+T 细胞均减少。
en-us	In addition, immunohistochemical staining showed that the number of CD4+T and  CD8+T cells in both spleen and lymph nodes were significantly decreased.

zh-cn	骨髓三系细胞数量减少。
en-us	All hematopoietic cell linages were reduced in bone marrow.

zh-cn	心脏和血管
en-us	Cardiovascular system

zh-cn	心肌细胞可见变性、坏死，间质内可见少数单核细胞、淋巴细胞和（或）中性粒细胞浸润。
en-us	It was found that some cardiomyocytes were degenerated and necrotized, and a small number of monocytes, lymphocytes and/or neutrophils are infiltrated in the myocardium.

zh-cn	部分血管内皮脱落、内膜炎 症及血栓形成。
en-us	In some areas, vascular endothelial cells were detached where inflammation and thrombosis occurred.

zh-cn	肝脏和胆囊
en-us	Liver and gallbladder

zh-cn	体积增大，暗红色。肝细胞变性、灶性坏死伴中性粒细胞 浸润；肝血窦充血，汇管区见淋巴细胞和单核细胞细胞浸润， 微血栓形成。
en-us	Liver was characterized by increased volume, dark red color, hepatocyte degeneration, focal necrosis with neutrophil infiltration, hepatic sinus congestion, infiltration of lymphocytes and monocytes in the portal area, and microthrombus formation.

zh-cn	胆囊高度充盈。
en-us	Gallbladder was also significantly increased in size.

zh-cn	肾脏
en-us	Kidney

zh-cn	肾小球球囊腔内见蛋白性渗出物，
en-us	Protein exudate was found in Bowman's capsules.

zh-cn	肾小管上皮变性、脱落， 可见透明管型。
en-us	Renal tubular epithelium was denatured and exfoliated, and hyaline cast was formed.

zh-cn	间质充血，可见微血栓和灶性纤维化。
en-us	Interstitial hyperemia, micro thrombus and focal fibrosis could be seen.

zh-cn	其他器官
en-us	Other organs

zh-cn	脑组织充血、水肿，部分神经元变性。
en-us	The brain tissue was congested and edematous, and some neurons were degenerated.

zh-cn	肾上腺见灶性坏死。
en-us	Focal necrosis was observed in the adrenal gland.

zh-cn	食管、胃和肠管黏膜上皮不同程度变性、坏死、脱落。
en-us	The epithelium of esophagus, stomach and intestines were denatured, necrotic and exfoliated with different degrees.

zh-cn	临床特点
en-us	Clinical features

zh-cn	临床表现
en-us	Clinical manifestation

zh-cn	基于目前的流行病学调查，潜优期1-14天，多为3-7天。
en-us	Based on the current epidemiological survey, the incubation period of COVID-19 is 1-14 days. Most patients show clinical symptoms in 3-7 days.

zh-cn	以发热、干咳、乏力为主要表现。
en-us	Fever, dry cough, and fatigue are the main manifestations.

zh-cn	少数患者伴有鼻塞、流涕、咽痛、肌痛和腹泻等症状。
en-us	Other symptoms include nasal obstruction, runny nose, sore throat, myalgia and diarrhea.

zh-cn	重症患者多在发病一周后出现呼吸困难和/或低氧血症，
en-us	In severe cases, patients presented dyspnea and/or hypoxemia within one week after onset.

zh-cn	严重者可快速进展为急性呼吸窘迫综合征、脓毒症休克、难以纠正的代谢性酸中毒和出凝血功能障碍及多器官功能衰竭等。
en-us	Some of them rapidly deteriorated to acute respiratory distress syndrome (ARDS), septic shock, refractory metabolic acidosis, coagulation dysfunction, and multiple organ failure.

zh-cn	值得注意的是重型、危重型患者病程中可为中低热，甚至无明显发热。
en-us	Notably, some severe patients only presented mild- to moderate-grade fever in their entire course of disease, and some even did not show fever at all.

zh-cn	部分儿童及新生儿病例症状可不典型，表现为呕吐、腹泻等消化道症状或仅表现为精神弱、呼吸急促。
en-us	Some children and newborns presented atypical symptoms, such as vomiting, diarrhea and other gastrointestinal discomfort, or only exhibited drowsiness and shortness of breath.

zh-cn	轻型患者仅表现为低热、轻微乏力等，无肺炎表现。
en-us	In mild cases, patients only presented low-grade fever and slight fatigue, without evident pneumonia.

zh-cn	从目前收治的病例情况看，多数患者预后良好，少数患者 病情危重。
en-us	From our current observation, most patients have a good prognosis, and only a few patients are critically ill.

zh-cn	老年人和有慢性基础疾病者预后较差。
en-us	The prognosis for the elderly and those with chronic comorbidities is relatively worse.

zh-cn	患有新型冠状病毒肺炎的孕产妇临床过程与同龄患者相近。
en-us	The clinical course of COVID-19 pneumonia in pregnant women is similar to that of the same age group.

zh-cn	儿童病例症状相对较轻。
en-us	The severity of symptoms in children is relatively mild.

zh-cn	实验室检查
en-us	Laboratory examination

zh-cn	一般检查
en-us	Routine examination

zh-cn	发病早期外周血白细胞总数正常或减少，可见淋巴细胞计数减少，
en-us	In the early stage of the disease, the total count of peripheral leukocytes could be normal or decreased, and the lymphocyte decreased.

zh-cn	部分患者可出现肝酶、乳酸脱氢酶（LDH）、肌酶和肌红蛋白增高；
en-us	In some patients, liver transaminases, lactate dehydrogenase (LDH), creatine kinase and myoglobin were elevated.

zh-cn	部分危重者可见肌钙蛋白增高。
en-us	In some critically severe patients, troponins were also increased.

zh-cn	多数患者C反应蛋白（CRP）和血沉升高，降钙素原正常。
en-us	In most patients, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were increased, while procalcitonin generally remains in normal range.

zh-cn	严重者D-二聚体升高、 外周血淋巴细胞进行性减少。
en-us	Notably, D-dimer was significantly increased in severe patients, and peripheral lymphocytes were progressively decreased.

zh-cn	重型、危重型患者常有炎症因子 升高。
en-us	Inflammatory biomarkers are often elevated in severe and critically severe patients.

zh-cn	病原学及血清学检查
en-us	Etiological and serological examination

zh-cn	病原学检查：釆用RT-PCR或/和NGS方法在鼻咽拭子、痰和其他下呼吸道分泌物、血液、粪便等标本中可检测出新型 冠状病毒核酸。
en-us	Etiological examination: COVID-19 nucleic acids can be detected in nasopharyngeal swabs, sputum and other lower respiratory tract secretions, blood and feces by using RT-PCR and next generation sequencing technology (NGS).

zh-cn	检测下呼吸道标本（痰或气道抽取物）更加准确。
en-us	It is more accurate to detect the lower respiratory tract specimen (sputum or airway extract).

zh-cn	标本采集后尽快送检。
en-us	Once collected, specimen examination should be performed as soon as possible.

zh-cn	血清学检查：新型冠状病毒特异性IgM抗体多在发病 3-5天后开始出现阳性，
en-us	Serological examination: the COVID-19-specific IgM antibody starts to show positive after 3-5 days from onset.

zh-cn	IgG抗体滴度恢复期较急性期有4倍及以上增高。
en-us	In comparison, the titer of COVID-19-specific IgG antibody is 4 times higher in recovery period than that in acute phase.

zh-cn	胸部影像学
en-us	Chest imaging

zh-cn	早期呈现多发小斑片影及间质改变，以肺外带明显。
en-us	At the early stage of the disease, multiple small patchy shadows and interstitial changes appear, which are more obvious in the periphery of the lung.

zh-cn	进而发展为双肺多发磨玻璃影、浸润影，
en-us	Then it developed into multiple ground-glass shadows and infiltrates shadows.

zh-cn	严重者可出现肺实变，胸腔积液少见。
en-us	In severe cases, pulmonary consolidation may occur. Pleural effusion is rare.

zh-cn	诊断标准
en-us	Diagnostic criteria

zh-cn	疑似病例
en-us	Suspected cases

zh-cn	结合下述流行病学史和临床表现综合分析：
en-us	Comprehensive analysis of the following epidemiological history and clinical manifestations:

zh-cn	流行病学史
en-us	Epidemiological history

zh-cn	发病前14天内有武汉市及周边地区，或其他有病例报告社区的旅行史或居住史；
en-us	Travel or residence history of Wuhan and surrounding areas, or other communities with documented COVID-19 positive cases within 14 days before the onset of illness.

zh-cn	发病前14天内与新型冠状病毒感染者(核酸检测阳性者)有接触史；
en-us	History of contact with COVID-19-infected persons (positive for nucleic acid detection) within 14 days before the onset of illness.

zh-cn	发病前14天内曾接触过来自武汉市及周边地区，或 来自有病例报告社区的发热或有呼吸道症状的患者；
en-us	History of contact with the patients presenting fever or respiratory symptoms, who travel to or reside in Wuhan and surrounding areas, or in other communities with documented COVID-19 positive cases within 14 days before the onset of illness.

zh-cn	聚集性发病(2周内在小范围如家庭、办公室、学校 班级等场所，出现2例及以上发热和/或呼吸道症状的病例)。
en-us	(Clustering onset (2 or more cases of fever and/or respiratory symptoms within 2 weeks in small areas such as home, office, school class, etc.)

zh-cn	临床表现
en-us	Clinical manifestation

zh-cn	发热和/或呼吸道症状； ’
en-us	Presenting with fever and/or respiratory symptoms.

zh-cn	具有上述新型冠状病毒肺炎影像学特征；
en-us	With imaging features of above mentioned COVID-19 pneumonia.

zh-cn	发病早期白细胞总数正常或降低，淋巴细胞计数正常 或减少。
en-us	In the early stage of the disease, the total number of leukocytes was normal or decreased, and the lymphocyte count was normal or decreased.

zh-cn	有流行病学史中的任何一条，且符合临床表现中任意2条。
en-us	A case that meets any one of the epidemiological history criteria and any two of the clinical manifestations can be identified as a suspected case.

zh-cn	无明确流行病学史的，符合临床表现中的3条。
en-us	If there is no clear epidemiological history, 3 of the clinical manifestations is required.

zh-cn	确诊病例
en-us	Confirmed cases

zh-cn	疑似病例同时具备以下病原学或血清学证据之一者：
en-us	Suspected cases with one of the following etiology or serological evidence can be identified as confirmed cases:

zh-cn	实时荧光RT-PCR检测新型冠状病毒核酸阳性；
en-us	Real-time RT-PCR detection is positive for COVID-19 nucleic acid.

zh-cn	病毒基因测序，与已知的新型冠状病毒高度同源；
en-us	The viral gene identified by gene sequencing is highly homologous with known COVID-19;

zh-cn	血清新型冠状病毒特异性IgM抗体和IgG抗体阳性；
en-us	The COVID-19-specific lgM and IgG antibodies are tested positive.

zh-cn	血清新型冠状病毒特异性IgG抗体由阴性转为阳性或恢复期较急 性期4倍及以上升高。
en-us	The titer of COVID-19-specific IgG antibody is 4 times higher in recovery period than that in acute phase.

zh-cn	重型、危重型临床预警指标
en-us	Warning signals for severe and critically severe types

zh-cn	外周血淋巴细胞进行性下降；
en-us	Progressive decline in the number of peripheral lymphocytes;

zh-cn	外周血炎症因子如IL-6、C反应蛋白进行性上升；
en-us	Progressive increase in the levels of peripheral inflammatory biomarkers, such as IL-6 and CRP;

zh-cn	乳酸进行性升高；
en-us	Progressive increase in lactic acid concentration;

zh-cn	肺内病变在短期内迅速进展。
en-us	Pulmonary lesions progress rapidly in a short time.

zh-cn	呼吸频率增快；
en-us	Increased respiration rate;

zh-cn	精神反应差、嗜睡；
en-us	Poor mental responsiveness and drowsiness;

zh-cn	乳酸进行性升高；
en-us	Progressive increase in lactic acid concentration;

zh-cn	影像学显示双侧或多肺叶浸润、胸腔积液或短期内病变快速进展；
en-us	Imaging showed bilateral or multilobes infiltration and pleural effusion; or pulmonary lesions progress rapidly in a short time;

zh-cn	3月龄以下的婴儿或有基础疾病（先天性心脏病、支气管肺发育不良、呼吸道畸形、异常血红蛋白、重度营养不良等），有免疫缺陷或低下（长期使用免疫抑制剂）。
en-us	Infants under 3 months of age, or children having coexisting conditions (congenital heart disease, bronchopulmonary dysplasia, respiratory deformity, abnormal hemoglobin, severe malnutrition, etc.), or children with immunodeficiency or under immunosuppressive state (long-term use of immunosuppressants).

zh-cn	鉴别诊断
en-us	Differential diagnosis

zh-cn	新型冠状病毒感染轻型表现需与其他病毒引起的上 呼吸道感染相鉴别。
en-us	The mild manifestations of COVID-19 infections need to be distinguished from upper respiratory tract infections caused by other viruses.

zh-cn	新型冠状病毒肺炎主要与流感病毒、腺病毒、呼吸 道合胞病毒等其他已知病毒性肺炎及肺炎支原体感染鉴别，
en-us	The COVID-19 pneumonia needs to be distinguished from other known viral pneumonia or mycoplasma pneumoniae infections, such as influenza virus, adenovirus and respiratory syncytial virus.

zh-cn	尤其是对疑似病例要尽可能采取包括快速抗原检测和多重PCR核酸检测等方法，对常见呼吸道病原体进行检测。
en-us	For suspected cases, technique such as rapid antigen detection and multiplex PCR nucleic acid detection should be taken to detect common respiratory pathogens.

zh-cn	还要与非感染性疾病，如血管炎、皮肌炎和机化性 肺炎等鉴别。
en-us	It should also be distinguished from non-infectious diseases such as vasculitis, dermatomyositis, and organizing pneumonia.

zh-cn	病例的发现与报告
en-us	Identifying cases and filing reports

zh-cn	各级各类医疗机构的医务人员发现符合病例定义的疑似病例后，应当立即进行单人间隔离治疗，
en-us	When a COVID-19 suspected case is found by any medical practitioners, it is critical to immediately isolate the suspected person in a solitary cell for further monitoring and treatment.

zh-cn	院内专家会诊或主诊医 师会诊，仍考虑疑似病例，在2小时内进行网络直报，
en-us	If COVID-19 infection is still suspected after comprehensive evaluation by medical experts and/or physicians, a case report should be submitted through internet to Centers for Disease Control (CDC) within 2 hours after the initial suspicion.

zh-cn	并釆集标本进行新型冠状病毒核酸检测，
en-us	In addition, specimens should be collected for COVID-19 nucleic acid test.

zh-cn	同时在确保转运安全前提下 立即将疑似病例转运至定点医院。
en-us	Meanwhile, the suspected person should be immediately transferred to a predesignated hospital with secured transportation modalities.

zh-cn	与新型冠状病毒感染者有密切接触的患者，即便常见呼吸道病原检测阳性，也建议及时进 行新型冠状病毒病原学检测。
en-us	If the suspected person has a close contact history with patient(s) already diagnosed with COVID-19 pneumonia, COVID-19 nucleic acid test should be performed, even if his or her common respiratory pathogen detection test has shown positive result(s).

zh-cn	疑似病例连续两次新型冠状病毒核酸检测阴性（釆样时间至少间隔24小时）且发病7天后新型冠状病毒特异性抗体IgM 和IgG仍为阴性可排除疑似病例诊断。
en-us	If COVID-19 nucleic acid tests are negative for two consecutive times (with at least 24 hours interval between each test), and if COVID-19-specific lgM and IgG antibodies remain negative after 7 days from onset, the suspected diagnosis of COVID-19 can be ruled out.

zh-cn	根据病情确定治疗场所。
en-us	Determine the treatment place according to patients' condition.

zh-cn	疑似及确诊病例应在具备有效隔离条件和防护条件的定点医院隔离治疗，
en-us	Suspected and confirmed cases should be isolated and treated m designated hospitals with effective isolation and protection conditions.

zh-cn	疑似病例应单人单间隔离治疗，确诊病例可多人收治在同一病室。
en-us	Suspected cases should be isolated in a single ward, while confirmed cases can be admitted to multiple bedded ward.

zh-cn	危重型病例应当尽早收入ICU治疗。
en-us	Critically severe cases should be admitted to ICU as soon as possible.

zh-cn	一般治疗
en-us	General treatment.

zh-cn	卧床休息，加强支持治疗，保证充分热量；
en-us	Rest in bed with supportive treatment to ensure sufficient energy supply.

zh-cn	注意水、电解质平衡，维持内环境稳定；
en-us	The water and electrolyte balance should be noticed to maintain internal environment stability.

zh-cn	密切监测生命体征、指氧饱和度等。
en-us	Vital signs and oxygen saturation should be closely monitored.

zh-cn	根据病情监测血常规、尿常规、CRP、生化指标（肝酶、 心肌酶、肾功能等）、凝血功能、动脉血气分析、胸部影像学等。
en-us	Monitor the blood routine, urine routine, CRP, biochemical indicators (liver enzyme, myocardial enzyme, renal function, etc.), coagulation function, arterial blood gas analysis, chest imaging according to the condition.

zh-cn	有条件者可行细胞因子检测。
en-us	If possible, cytokine test should be performed.

zh-cn	及时给予有效氧疗措施，包括鼻导管、面罩给氧和经鼻高流量氧疗。
en-us	Effective oxygen therapy measures should be given m time, including nasal cannula, mask oxygen and high-flow nasal cannula oxygen therapy.

zh-cn	有条件可釆用氢氧混合吸入气（H2/02: 66.6%/33.3%）治疗。
en-us	Hydrogen-oxygen inhalation (H2/02: 66.6%/33.3%) treatment can be considered for use.

zh-cn	抗病毒治疗：可试用a-干扰素（成人每次500万U或相当剂量，加入灭菌注射用水2ml,每日2次雾化吸入）、洛匹那韦/利托那韦（成人200mg/50mg/粒，每次2粒，每日2次，疗程不超过10天）、
en-us	Antiviral therapy: a-interferon ( 5 million U or equivalent for adult, add 2ml of sterile water, 2 times daily inhalation), lopinavir/ritonavir (200 mg/50mg/capsule, 2 capsules each time for adults, twice a day, the course of treatment should not exceed 10 days).

zh-cn	利巴韦林（建议与干扰素或洛匹那韦/利托那 韦联合应用，成人500mg/次，每日2至3次静脉输注，疗程不超过10天）、磷酸氯壑（18岁-65岁成人。体重大于50公斤者，每次500mg、每日2次，疗程7天；
en-us	Ribavirin (combination with interferon or lopinavir/ritonavir is recommended, 500 mg each time for adults, 2 to 3 times intravenous infusions per day, the course of treatment should not exceed 10 days), chloroquine phosphate ( for adults whose weigh over 50 kg, 500 mg each time, twice daily for 7 days;

zh-cn	体重小于50公斤者，第一、 二天每次每日2次，第三至第七天每次500mg，每日1 次）、阿比多尔（成人200mg,每日3次，疗程不超过10天）。
en-us	for those whose weigh less than 50 kg, 500 mg each time, twice daily for day 1 and day 2, once daily for day 3- day 7), Abidol (200 mg each time, three times a day for adults, the course of treatment should not exceed 10 days) can be tried.

zh-cn	要注意上述药物的不良反应、禁忌症（如患有心脏疾病者禁用 氯噌）以及与其他药物的相互作用等问题。
en-us	Attention should be paid to the adverse reactions of the above drugs, contraindications (such as chloroquine should not be used in patients with heart disease), and interaction with other drugs.

zh-cn	不建议同时应用3种及以上抗病毒药物，
en-us	It is not recommended to use 3 or more antiviral drugs at the same time.

zh-cn	出现不可耐受的毒副作用时应停止使用相关药物。
en-us	The use of related drugs should be stopped when intolerable side effects occur.

zh-cn	对孕产妇患者的治疗应考虑妊娠周数，尽可能选择对胎儿影响 较小的药物，以及是否终止妊娠后再进行治疗等问题，并知情告知。
en-us	The treatment of pregnant women should consider the number of weeks of gestation and choose drugs that have less impact on the fetus.

zh-cn	抗菌药物治疗：避免盲目或不恰当使用抗菌药物，尤其是联合使用广谱抗菌药物。
en-us	Antibacterial drug treatment: inappropriate use of antibacterial drugs should be avoided, especially the broad-spectrum antibacterial drugs.

zh-cn	重型、危重型病例的治疗。
en-us	Treatment of severe and critically severe cases.

zh-cn	治疗原则
en-us	Principles of treatment

zh-cn	在对症治疗的基础上，积极防治并发症，治疗基础疾病，预防继发感染，及时进行器官功能支持。
en-us	In addition to symptom treatments, it is important to actively prevent complications, treat underlying diseases, prevent secondary infections, and provide organ function support.

zh-cn	呼吸支持
en-us	Respiratory support:

zh-cn	氧疗：重型患者应当接受鼻导管或面罩吸氧，并及时 评估呼吸窘迫和/或低氧血症是否缓解。
en-us	Oxygen therapy: Severe patients should receive nasal cannula or mask to inhale oxygen, and evaluate m time whether respiratory distress and/or hypoxemia is relieved.

zh-cn	高流量鼻导管氧疗或无创机械通气：当患者接受标准 氧疗后呼吸窘迫和/或低氧血症无法缓解时，可考虑使用高流量 鼻导管氧疗或无创通气。
en-us	High-flow nasal cannula oxygen therapy or non-mvas1ve mechanical ventilation: When patients with respiratory distress and / or hypoxemia cannot be relieved after receiving standard oxygen therapy, high-flow nasal cannula oxygen therapy or non-invasive ventilation can be considered.

zh-cn	若短时间（1-2小时）内病情无改善甚 至恶化，应当及时进行气管插管和有创机械通气。
en-us	If the condition does not improve or worsens within a short time (1-2 hours), tracheal intubation and invasive mechanical ventilation should be performed in time.

zh-cn	有创机械通气：釆用肺保护性通气策略，即小潮气量 （6-8mL/kg理想体重）和低水平气道平台压力（≤30cmH20）进行机械通气，以减少呼吸机相关肺损伤。
en-us	Invasive mechanical ventilation: Using lung protective ventilation strategy, that is, small tidal volume (6-8 mL/kg ideal body weight) and low level of airway plateau pressure (≤30cmH20) for mechanical ventilation to reduce ventilator-related lung injury.

zh-cn	在保证气道平台压≤35cmH2O时，可适当釆用高PEEP,
en-us	When the airway plateau pressure is ≤35cmH2O, high PEEP can be appropriately used.

zh-cn	保持气道温化湿化，避免长时间镇静，早期唤醒患者并进行肺康复治疗。
en-us	Keep the airway warm and humid, avoid prolonged sedation, and awaken patients early and perform pulmonary rehabilitation treatment.

zh-cn	较多患者存在人机不同步，应当及时使用镇静以及肌松剂。
en-us	For those patients with problem of man-machine synchronization, sedation and muscle relaxants should be used in time.

zh-cn	根据气道分泌物情况, 选择密闭式吸痰，必要时行支气管镜检查釆取相应治疗。
en-us	According to the airway secretions, closed sputum suction should be considered, and bronchoscopy should be performed if necessary.

zh-cn	挽救治疗：对于严重ARDS患者，建议进行肺复张。
en-us	Salvage treatment: For patients with severe ARDS, it is recommended to perform lung expansion.

zh-cn	每天应当进行12小时以上的俯卧位通气。
en-us	Prone ventilation should be performed for more than 12 hours per day.

zh-cn	俯卧位机械通气效果不佳者，如条件允许，应当尽快考虑体外膜肺氧合（ECMO）。
en-us	When prone position mechanical ventilation is not effective, if conditions permit, extracorporeal membrane pulmonary oxygenation (ECMO) should be considered as soon as possible.

zh-cn	相关指征
en-us	Related indications

zh-cn	在Fi02>90%时，氧合指数小于80mmHg,持续3-4小时以上；
en-us	When FiO2> 90%, the oxygenation index is less than 80mmHg, which lasts more than 3-4 hours;

zh-cn	气道平台压≥35cmH20o单纯呼吸衰竭患者，首选VV-ECMO模式；
en-us	Patients with simple respiratory failure with airway plateau pressure≥35 cm H2O, the VV-ECMO mode is preferred;

zh-cn	若需要循环支持，则选用VA-ECM0模式。
en-us	if circulatory support is needed, then VA-ECMO mode will be selected.

zh-cn	在基础疾病得以控制，心肺功能 有恢复迹象时，可开始撤机试验。
en-us	When the underlying disease is under control and cardiopulmonary function shows signs of recovery, weaning trials should be considered to begin.

zh-cn	循环支持
en-us	Circulation support

zh-cn	在充分液体复苏的基础上，改善微循环，使用血管活性药物，
en-us	Based on adequate fluid resuscitation, improvement of microcirculation and use of vasoactive drugs may be considered.

zh-cn	密切监测患者血压、心率和尿量的变化，以 及动脉血气分析中乳酸和碱剩余，
en-us	Changes in patients' blood pressure, heart rate, and urine output, as well as lactic acid and alkali residuals in arterial blood gas analysis should be closely monitored.

zh-cn	必要时进行无创或有创血流动力学监测，如超声多普勒法、超声心动图、有创血压或持续心排血量（PiCCO）监测。
en-us	Noninvasive or invasive hemodynamic monitoring, such as Doppler echocardiography, echocardiography, invasive blood pressure or continuous cardiac output (PiCCO) monitoring, is necessary.

zh-cn	在救治过程中，注意液体平衡策略， 避免过量和不足。
en-us	In the process of treatment, attention should be paid to the liquid balance to avoid excess and deficiency.

zh-cn	如果发现患者心率突发增加大于基础值的20%或血压下降大约基础值20%以上时，若伴有皮肤灌注不良和尿量减少等表现时，应密切观察患者是否存在脓毒症休克、消化道出血或心功 能衰竭等情况。
en-us	When the patient's heart rate suddenly increases over 20% of the baseline value or the blood pressure has dropped by more than 20% of the baseline value, accompanying symptoms such as poor skin perfusion and decreased urine output, it should be alert whether patients have septic shock, gastrointestinal bleeding, or severe heart failure.

zh-cn	肾功能衰竭和肾替代治疗：
en-us	Renal failure and renal replacement therapy:

zh-cn	危重症患者的肾功能损伤应积极寻找导致肾功能损伤的原因，如低灌注和药物等因素。
en-us	When renal insufficiency occurs in critically severe patients, the causes of renal function insufficiency, such as hypoperfusion and drugs, should be analyzed.

zh-cn	对于肾功能衰竭患者的治疗应注重体液平衡、酸碱平衡和电解质平衡，
en-us	The treatment of patients with renal failure should pay attention to fluid balance, acid-base balance and electrolyte balance.

zh-cn	在营养支持治疗方面应注意氮平衡、热量和微量元素等补充。
en-us	For nutrition support treatment, attention should be paid to nitrogen balance, and supplement of calorie and minerals.

zh-cn	重症患者可选择连续性肾替代治疗（continuous renal replacement therapy, CRRT）。
en-us	Renal replacement therapy (CRRT) can be considered in severe patients.

zh-cn	其指征包括
en-us	The indications include

zh-cn	高钾血症
en-us	hyperkalemia

zh-cn	酸中毒
en-us	acidosis

zh-cn	肺水肿或水负荷过重
en-us	pulmonary edema or excessive water load

zh-cn	多器官功能不全时的液体管理。
en-us	fluid management when multiple organ dysfunction occurs.

zh-cn	康复者血浆治疗：
en-us	Recovered patients' plasma therapy:

zh-cn	适用于病情进展较快、重型和危重型 患者。
en-us	It is suitable for severe and critically severe patients with rapid disease progression.

zh-cn	血液净化治疗：
en-us	Blood purification treatment:

zh-cn	血液净化系统包括血浆置换、吸附、灌 流、血液/血浆滤过等，能清除炎症因子，阻断“细胞因子风暴”, 从而减轻炎症反应对机体的损伤，
en-us	The blood purification system includes plasma exchange, adsorption, perfusion, blood/plasma filtration, etc., which can remove inflammatory factors and stop the "cytokine storm", thereby reducing the damage to the body caused by the inflammatory response.

zh-cn	可用于重型、危重型患者细 胞因子风暴早中期的救治。
en-us	It can be used for treatment of early and mid-term cytokine storms in severe and critically severe patients.

zh-cn	免疫治疗：
en-us	Immunotherapy:

zh-cn	对于双肺广泛病变者及重型患者，且实验室检测IL-6水平升高者，可试用托珠单抗治疗。
en-us	For patients with extensive lung lesion and severe patients with elevated IL-6 levels, tocilizumab treatment can be tried.

zh-cn	首次剂量 4-8mg/kg,推荐剂量为400mg、 9%生理盐水稀释至100ml,输注时间大于1小时；
en-us	The first dose is 4-8mg/kg, the recommended dose is 400mg with dilution of 0.9% physiological saline to 100ml, and the infusion time should be more than 1 hour.

zh-cn	首次用药疗效不佳者，可在12小时后追加 应用一次（剂量同前），累计给药次数最多为2次，单次最大剂 量不超过800mg。
en-us	If the first medication is not effective, it can be applied once more after 12 hours (the dose is the same as before), cumulative number of administrations should not be more than 2 times, and the maximum single dose should not exceed 800 mg.

zh-cn	注意过敏反应，
en-us	Pay attention to allergic reactions.

zh-cn	有结核等活动性感染者禁用。
en-us	It is not recommended for people with active infections such as tuberculosis.

zh-cn	其他治疗措施
en-us	Other treatment measures

zh-cn	对于氧合指标进行性恶化、影像学进展迅速、机体炎症反 应过度激活状态的患者，酌情短期内（3-5日）使用糖皮质激素，
en-us	For patients with progressive deterioration of oxygenation indicators, rapid imaging progress, and excessive activation of inflammatory response, the use of glucocorticoids in the short term (3 to 5 days) should be considered.

zh-cn	建议剂量不超过相当于甲泼尼龙1-2mg/kg/日，
en-us	The dosage of methylprednisolone should not be over l-2mg/kg/day.

zh-cn	应当注意较大剂量糖皮质激素由于免疫抑制作用，会延缓对冠状病毒的清除；
en-us	It should be noted that large doses of glucocorticoids will delay the removal of coronavirus due to immunosuppressive effects.

zh-cn	可使用肠道微生态调节剂，维持肠道微生态平衡，预防继发细菌感染。
en-us	Intestinal microecological regulators can be used to maintain intestinal microecological balance and prevent secondary bacterial infections.

zh-cn	儿童重型、危重型病例可酌情考虑给予静脉滴注丙种球蛋白。
en-us	For severe and critically severe children patients, intravenous gamma globulin should be considered.

zh-cn	患有重型或危重型新型冠状病毒肺炎的孕妇应积极终止妊娠，剖腹产为首选。
en-us	Pregnant women with severe or critically severe COVID-19 pneumonia should consider pregnancy termination, and cesarean delivery is preferred.

zh-cn	患者常存在焦虑恐惧情绪，应当加强心理疏导。
en-us	Psychological counseling should be strengthened in patients with anxiety and fear.

zh-cn	出院标准
en-us	Discharge criteria

zh-cn	体温恢复正常3天以上；
en-us	The body temperature returns to normal for more than 3 days;

zh-cn	呼吸道症状明显好转；
en-us	Significant improvement in respiratory symptoms;

zh-cn	肺部影像学显示急性渗出性病变明显改善；
en-us	Pulmonary imaging shows a marked improvement in acute exudative lesions;

zh-cn	连续两次痰、鼻咽拭子等呼吸道标本核酸检测阴性（釆样时间至少间隔24小时）。
en-us	Negative nucleic acid test for sputum, nasopharyngeal swabs and other respiratory specimens for two consecutive times (at least 24 hours interval between each test).

zh-cn	满足以上条件者可出院。
en-us	Those who meet all the above conditions can be discharged.

zh-cn	出院后注意事项。
en-us	Precautions after discharge.

zh-cn	定点医院要做好与患者居住地基层医疗机构间的联系，共享病历资料，及时将出院患者信息推送至患者辖区或居住地 居委会和基层医疗卫生机构。
en-us	The hospital should make good contact with the basic medical and health institutions where the patients live, share the medical records, and timely send the discharged patients' information to the residential committee and the basic medical and health institutions.

zh-cn	患者出院后，建议应继续进行14天的隔离管理和健康状况监测，佩戴口罩，有条件的居住在通风良好的单人房间，减 少与家人的近距离密切接触，分餐饮食，做好手卫生，避免外 出活动。
en-us	After the patient is discharged from the hospital, it is recommended to continue the isolation management and health monitoring for 14 days, wear a mask, and live in a well-ventilated single room, reduce close contact with family members, wash hands frequently, and avoid going out.

zh-cn	建议在出院后第2周和第4周到医院随访、复诊。
en-us	It is recommended to follow up and return to the hospital in the 2nd and 4th week after discharge.