最后审阅: 28 九月 2021
最后更新: 12 五月 2021

COVID-19 大流行

在大流行期间,对于存在咳嗽、发热或任何其他提示性症状的患者,除非证实为其他疾病,否则应考虑 COVID-19。

英国国家卫生与临床优化研究所(National Institute for Health and Care Excellence, NICE)发布了一项有关 COVID-19 大流行期间疑似或确诊 CAP 患者的管理的快速指南。1 NICE 暂时撤回了其先前针对成人肺炎诊断和管理的 COVID-19 指南。2

参考文献

  1. National Institute for Health and Care Excellence. COVID-19 rapid guideline: managing COVID-19. April 2021 [internet publication].
    Full text
  2. National Institute for Health and Care Excellence. Pneumonia in adults: diagnosis and management. Sep 2019 [internet publication]. 于 COVID-19 大流行期间撤回
    Full text

小结

定义

病史和体格检查

关键诊断因素

  • 咳嗽伴痰增多
  • 呼吸困难
  • 胸膜炎性胸痛
  • 寒颤或者盗汗
  • 发热
  • 听诊异常
  • 意识模糊
  • 危险因素

其他诊断因素

  • 肌痛
  • 不适感
  • 厌食
  • 昏睡
  • 已有疾病恶化
  • 咽痛
  • 头痛
  • 恶心
  • 腹痛
  • 腹泻

危险因素

  • 年龄>65 岁
  • 居住在医疗照护机构
  • 慢性阻塞性肺疾病 (COPD)
  • 暴露于香烟烟雾
  • 酗酒
  • 口腔卫生不佳
  • 使用胃酸抑制类药物
  • 与儿童接触
  • 糖尿病
  • 慢性肾病
  • 慢性肝病
  • 阿片类药物的应用

诊断性检查

首要检查

  • 胸部 X 线检查
  • 脉搏血氧测量测定法
  • 动脉血气 (ABG)
  • 尿素和电解质
  • 全血细胞计数
  • C 反应蛋白 (CRP)
  • 肝功能检测

需考虑的检查

  • 血培养
  • 痰培养(± 革兰染色)
  • 针对军团菌和肺炎球菌的尿抗原检测
  • 聚合酶链反应(polymerase chain reaction, PCR)和/或血清学检测
  • 胸部 CT 扫描
  • 胸腔超声
  • 胸腔穿刺术和胸水培养
  • 计算机断层扫描肺动脉造影(CTPA)
  • 支气管镜检查

治疗流程

撰稿人

专家顾问

Jonathan Bennett, MD

Honorary Professor of Respiratory Sciences

University of Leicester

Respiratory Consultant

Glenfield Hospital

Leicester

UK

简介

JB is Chair of the British Thoracic Society.

利益声明

JB declares that he has no competing interests.

Acknowledgements,

BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work has been retained in parts of the content:

Catia Cilloniz MSc, PhD

Post-doctoral Research

Pneumology Department

Hospital Clinic of Barcelona

CIBERES

IDIBAPS

Barcelona

Spain

Antoni Torres MD, PhD

Professor of Medicine

Director

Pulmonary Intensive Care Unit

Respiratory Institute

Hospital Clinic of Barcelona

Barcelona

Spain

利益声明

CC and AT are each authors of a number of references cited in this topic.

同行评议者

Wei Shen Lim,

Consultant Respiratory Physician and Honorary Professor of Medicine

Nottingham University Hospitals NHS Trust

Nottingham

UK

利益声明

WSL was chairman of the British Thoracic Society community-acquired pneumonia guidelines committee and a member of the guideline development group for the National Institute for Health and Care Excellence pneumonia guidelines. His institution has received unrestricted investigator-initiated research funding from Pfizer for a multicentre study of pneumococcal pneumonia in which he was the chief investigator, and research funding from the National Institute for Health Research for studies in pneumonia in which he was the principal investigator. He is also an author of at least one reference cited in the topic.

编辑

Helena Delgado-Cohen,

Section Editor, BMJ Best Practice

利益声明

HDC declares that she has no competing interests.

Rachel Wheeler,

Lead Section Editor, BMJ Best Practice

利益声明

RW declares that she has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

利益声明

JC declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

利益声明

AM declares that he has no competing interests.

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