新型严重急性呼吸系统综合症冠状病毒2(SARS-CoV-2)是导致疾病迅速传播的原因,2019年冠状病毒病(COVID-19),影响了全世界一千七百多万人。需要临床医生照顾患者的诊断和治疗指南。在早期阶段,我们已经发布了“2019年新型冠状病毒(2019-nCoV)感染肺炎的诊断和治疗快速建议指南(标准版)”;现在有许多直接证据出现,可能会改变以前的一些建议,制定循证指南的时机已经成熟。我们成立了一个由临床专家和方法学家组成的工作组。指导组成员提出了29个与COVID-19管理相关的问题,涵盖以下领域:化学预防,诊断,治疗,和出院管理。我们搜索了文献,寻找关于COVID-19管理的直接证据,并使用建议分级评估了其确定性产生的建议,评估,开发和评估(等级)方法。建议不是强就是弱,或以未分级的基于共识的声明的形式。最后,我们发表了34份声明。其中,6是强有力的建议,14是薄弱的建议,3是反对的弱建议,11是未分级的基于共识的声明。他们涵盖了化学预防(包括药物和中药(TCM)药物)的主题,诊断(包括临床表现,逆转录-聚合酶链反应(RT-PCR),呼吸道标本,IgM和IgG抗体测试,胸部计算机断层扫描,胸部X光,和无症状感染的CT特征),治疗(包括洛匹那韦-利托那韦,umifenovir,favipiravir,干扰素,remdesivir,抗病毒药物的组合,羟氯喹/氯喹,白细胞介素-6抑制剂,白细胞介素-1抑制剂,糖皮质激素,清肺排毒汤,连花清瘟颗粒/胶囊,恢复期血浆,肺移植,有创或非有创通气,和体外膜氧合(ECMO),和出院管理(包括出院后RT-PCR复测SARS-CoV-2阳性的患者的出院标准和管理计划)。我们还为执行目的创建了这些建议的两个数字。我们希望这些建议可以帮助支持医护人员照顾COVID-19患者。
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, coronavirus disease 2019 (COVID-19), affecting more than seventeen million people around the world. Diagnosis and treatment
guidelines for clinicians caring for patients are needed. In the early stage, we have issued \"A rapid advice
guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)\"; now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based
guideline. We formed a working group of clinical experts and methodologists. The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas: chemoprophylaxis, diagnosis, treatments, and discharge management. We searched the literature for direct evidence on the management of COVID-19, and assessed its certainty generated recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Recommendations were either strong or weak, or in the form of ungraded
consensus-based statement. Finally, we issued 34 statements. Among them, 6 were strong recommendations for, 14 were weak recommendations for, 3 were weak recommendations against and 11 were ungraded
consensus-based statement. They covered topics of chemoprophylaxis (including agents and Traditional Chinese Medicine (TCM) agents), diagnosis (including clinical manifestations, reverse transcription-polymerase chain reaction (RT-PCR), respiratory tract specimens, IgM and IgG antibody tests, chest computed tomography, chest x-ray, and CT features of asymptomatic infections), treatments (including lopinavir-ritonavir, umifenovir, favipiravir, interferon, remdesivir, combination of antiviral drugs, hydroxychloroquine/chloroquine, interleukin-6 inhibitors, interleukin-1 inhibitors, glucocorticoid, qingfei paidu decoction, lianhua qingwen granules/capsules, convalescent plasma, lung transplantation, invasive or noninvasive ventilation, and extracorporeal membrane oxygenation (ECMO)), and discharge management (including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge). We also created two figures of these recommendations for the implementation purpose. We hope these recommendations can help support healthcare workers caring for COVID-19 patients.