最后审核时间: 六月 2020
最近更新时间: 七月  2020
06 Jul 2020

COVID-19 大流行信息更新

根据约翰·霍普金斯大学系统科学与工程中心收集的数据,全球报道了超过 1140 万例 COVID-19 病例,至今超过 610 万康复,约 534,000 例死亡。美国报道的感染和死亡数量为全世界最高,约占全球所有病例和死亡的四分之一。巴西报道病例数量位居第二,有超过 160 万例感染。印度、俄罗斯、秘鲁、智利、英国、墨西哥和西班牙拥有除巴西以外最多的病例数量。中国北京已出现新一轮暴发。

Johns Hopkins University: coronavirus COVID-19 global cases external link opens in a new window

最新消息

  • 病史和体格检查

    • 根据 CDC 最新指南,对危险因素进行更新。

  • 新兴治疗

    • 洛匹那韦/利托那韦 – 英国 RECOVERY 试验初步结果。

    • 维生素 D – NICE 建议每日补充维生素 D,以维持骨骼和肌肉健康。

  • 预防

    • WHO 对感染防控指南进行更新。

  • 并发症

    • 小儿炎性多系统综合征 – 根据美国新数据和信息图表进行更新。

欢迎收听 COVID-19 每周播客。Best Practice 临床实践编辑在播客中将讨论 COVID-19 指南最新进展。

BMJ talk medicine podcast: Covid-19 update external link opens in a new window

Best Practice 临床实践目前已发布一个针对 COVID-19 合并症管理的专题。最新更新包含 COVID-19 大流行背景下,下消化道症状、头颈肿瘤、急性髓系白血病、霍奇金和非霍奇金淋巴瘤,以及肾移植注意事项,和类风湿性关节炎、乳腺癌、造血干细胞移植、儿童和年轻成人免疫功能低下,以及围产期诊疗的最新信息。

BMJ Best Practice: Management of co-existing conditions in the context of COVID-19 external link opens in a new window 

该专题基于当前可获得的最佳证据,但是由于形势正在迅速发生变化,因此证据有限,部分建议可能基于病例报道、观察性研究和回顾性分析以及随机对照试验和指南。

参见流行病学

更新的原始来源external link opens in a new window

小结

定义

病史和查体

关键诊断因素

  • 发热
  • 咳嗽
  • 呼吸困难
  • 嗅觉/味觉改变

其他诊断因素

  • 乏力
  • 肌痛或关节痛
  • 厌食
  • 痰液产生/排出
  • 胸闷
  • 咽痛
  • 胃肠道症状
  • 头晕
  • 头痛
  • 神经系统症状
  • 皮肤症状
  • 流涕/鼻塞
  • 胸痛
  • 结膜炎
  • 咯血
  • 支气管呼吸音
  • 呼吸急促
  • 心动过速
  • 紫绀
  • 听诊发现湿啰音/啰音

危险因素

  • 居住于/前往有社区传播报道的地区
  • 与确诊病例密切接触
  • 老年
  • 居住于长期照护机构
  • 男性
  • 种族
  • 合并症的发生
  • 心血管疾病
  • 高血压
  • 糖尿病
  • 慢性呼吸系统疾病
  • 慢性肾病
  • 恶性肿瘤
  • 肥胖
  • 镰状细胞病
  • 实质脏器移植
  • 吸烟
  • 脑血管病
  • 慢性肝病
  • 代谢功能障碍相关性脂肪性肝病
  • 手术
  • 妊娠
  • 免疫抑制
  • 空气污染
  • 气候和纬度
  • 居住于城市或贫困地区
  • 使用 ACE 抑制剂/血管紧张素 II 受体拮抗剂
  • 自身免疫性疾病
  • 神经系统疾病
  • 地中海贫血
  • 伴有某些基础疾病的儿童
  • A 型血群体
  • 菌群失调

诊断性检查

首要检查

  • 脉搏血氧测定
  • 动脉血气分析(ABG)
  • 全血细胞计数(FBC)
  • 生化全项
  • 血糖水平
  • 凝血筛查
  • 血清 C 反应蛋白
  • 血清红细胞沉降率
  • 血清乳酸脱氢酶
  • 血清白细胞介素-6 水平
  • 心脏生物标志物
  • 血清降钙素原
  • 血清铁蛋白水平
  • 血清淀粉样蛋白 A 水平
  • 血清肌酸激酶
  • 血液和痰液培养
  • 实时逆转录聚合酶链反应 (RT-PCR)
  • 胸部 X 线检查
更多 首要检查

需要考虑的检查

  • 胸部计算机体层成像(Computed Tomography, CT)
  • 血清学
更多 需要考虑的检查

新兴检查

  • 抗原检测
  • 逆转录环介导等温扩增(RT-LAMP)
  • 肺部超声
更多 新兴检查

治疗流程

贡献者

Consultant and Honorary Senior Lecturer in Infectious Diseases

Royal Liverpool University Hospital and Liverpool School of Tropical Medicine

Liverpool

UK

利益冲突披露

NJB is partially supported by the National Institute of Health Research Health Protection Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), in collaboration with Liverpool School of Tropical Medicine. He is affiliated with Liverpool School of Tropical Medicine. The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or PHE.

Senior Clinical Lecturer and Defence Consultant in Infectious Diseases

Royal Liverpool University Hospital and Liverpool School of Tropical Medicine

Liverpool

UK

利益冲突披露

TEF is a consultant/expert panel member to the World Health Organization, and is funded by the UK Surgeon General, the NHS, and Liverpool School of Tropical Medicine. TEF is partially supported by the National Institute of Health Research Health Protection Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), in collaboration with Liverpool School of Tropical Medicine. He is affiliated with Liverpool School of Tropical Medicine. He has received research grants from the Wellcome Trust, Medical Research Council, and the UK Public Health Rapid Support Team (UK-PHRST). The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or PHE.

H. Barrie Fairley Professor of Critical Care

University Health Network and Interdepartmental Division of Critical Care Medicine

Director

Clinical Epidemiology and Health Care Research

Institute of Health Policy, Management and Evaluation

Dalla Lana School of Public Health

University of Toronto

Chief

Tory Trauma Program

Sunnybrook Hospital

Toronto

Canada

利益冲突披露

RF declares that he has no competing interests.

同行评议专家查看所有

Professor

Division of Infectious Diseases and International Health

University of Virginia

Charlottesville

VA

利益冲突披露

WAP declares that he has no competing interests.

Attending Physician

The Fifth Medical Center of PLA General Hospital

Clinical Division and Research Center of Infectious Disease

Beijing

China 

利益冲突披露

XZ declares that he has no competing interests.

Associate Professor in Medicine

Department of Clinical Microbiology and Infectious Diseases

Hadassah Hebrew University Medical Center

Jerusalem

Israel

利益冲突披露

RNP has received research grants from US-Israel Binational Science Foundation, Hebrew University, Rosetrees Trust, and SpeeDx. He is chair of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycoplasma and Chlamydia Infections (ESGMAC). RNP is a consultant for and has stocks in eDAS Healthcare. He is also chairperson of the Israeli Society for Infectious Diseases guidelines committee.

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