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[新型冠状病毒肺炎:诊断与治疗]

[COVID-19: diagnosis and treatment].

作者信息

Štefan Marek, Chrdle Aleš, Husa Petr, Beneš Jiří, Dlouhý Pavel

机构信息

Clinical microbiology and antibiotic center, Bulovka hospital, Prague, e-mail:

出版信息

Klin Mikrobiol Infekc Lek. 2021 Jun;27(2):61-87.

Abstract

The guidelines provide evidence-based recommendations for the management of COVID-19. The clinical manifestations of the disease are described and indication criteria for hospital admission of patients with COVID-19 are listed. Polymerase chain reaction and antigen testing are used in direct diagnostics. Indirect detection of infection by antibodies is currently of limited value. There are a number of hematological and biochemical laboratory test used to diagnose COVID-19. Pathological values of some laboratory parameters are associated with severity of COVID-19. Of the imaging studies, chest X-ray, chest computer tomography and lung ultrasound are used. COVID-19 therapy includes symptomatic and specific therapy (antivirals, immunotherapeutics and anticoagulants) and intensive care in the severe and critical forms of the disease. Remdesivir and favipiravir are available as antiviral agents. Immunotherapeutics include monoclonal antibodies (casirivimab/imdevimab, bamlanivimab/etesevimab), dexamethas one, baricitinib and tocilizumab. Low-molecular-weight heparin is a dominant form of anticoagulant therapy. The guidelines provide specific therapeutic recommendations for each stage of the disease. Antibiotics are recommended only if bacterial superinfection is suspected or demonstrated, which is not common in the early stages of the disease.

摘要

本指南为新型冠状病毒肺炎(COVID-19)的管理提供了循证建议。描述了该疾病的临床表现,并列出了COVID-19患者住院的指征标准。聚合酶链反应和抗原检测用于直接诊断。目前,通过抗体间接检测感染的价值有限。有多种血液学和生化实验室检测用于诊断COVID-19。一些实验室参数的病理值与COVID-19的严重程度相关。在影像学检查中,使用胸部X线、胸部计算机断层扫描和肺部超声。COVID-19治疗包括对症治疗和特异性治疗(抗病毒药物、免疫治疗药物和抗凝剂),以及对该疾病严重和危重症形式的重症监护。瑞德西韦和法匹拉韦可作为抗病毒药物使用。免疫治疗药物包括单克隆抗体(卡西瑞维单抗/英地维单抗、巴姆兰单抗/依替塞韦单抗)、地塞米松、巴瑞替尼和托珠单抗。低分子量肝素是抗凝治疗的主要形式。本指南为疾病的每个阶段提供了具体的治疗建议。仅在怀疑或证实有细菌重叠感染时才推荐使用抗生素,这在疾病早期并不常见。

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