COVID-19 大流行
大流行期间，所有咳嗽、发热或出现提示症状的患者，均应对于 COVID-19 加以考虑，除非被另行证明。参阅主题2019 冠状病毒病（COVID-19）。
英国国家卫生与临床优化研究所（National Institute for Health and Care Excellence, NICE）已发布 COVID-19 大流行期间疑似或确诊 CAP 评估和管理新指南。 1,2它暂时停用 COVID-19 之前成人肺炎诊断和管理指南。 3
关键更改为新指南：1,2
- 须注意，COVID-19 之前的指南中建议用于严重程度评估的 CRB-65 工具未在 COVID-19 人群中得到验证，因为该工具需进行血压测量，而这在 COVID-19 大流行期间则“较难进行或并不希望进行”。 1大流行期间建议使用临床判断评估严重程度，并为住院决策提供依据。 1
重症征象和症状为：1- 静息时呼吸短促或呼吸困难
- 咳血
- 唇面部呈紫蓝色
- 皮肤苍白或呈斑状，触之湿冷
- 虚脱或晕眩（晕厥）
- 新发意识模糊
- 难以唤醒
- 尿少或无尿。
- 建议对所有疑似中重度 CAP 的患者以及所有住院期间出现肺炎的患者考虑进行 SARS-CoV2 聚合酶链反应检测 。2
- 建议口服多西环素作为一线治疗（优先于口服阿莫西林）用于接受社区诊疗的疑似细菌性 CAP 非妊娠患者，而口服阿莫西林则作为替代选择。1其包括口服多西环素作为在医院接受治疗的中重度细菌性 CAP 患者推荐一线选择，这些患者可耐受口服药物且病情并未严重至需要静脉给予抗生素。2
- 多西环素比阿莫西林具有更广的覆盖范围，尤其是对于肺炎支原体和金黄色葡萄球菌，而在 COVID-19 大流行期间，它们则更可能成为引发肺炎的继发性细菌感染。1
参考资料
小结
定义
病史和体格检查
诊断性检查
治疗流程
撰稿人
专家顾问
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.
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
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
Section Editor, BMJ Best Practice
利益声明
HDC declares that she has no competing interests.
Lead Section Editor, BMJ Best Practice
利益声明
RW declares that she has no competing interests.
Comorbidities Editor, BMJ Best Practice
利益声明
JC declares that she has no competing interests.
Drug Editor, BMJ Best Practice
利益声明
AM declares that he has no competing interests.
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