COVID-19 的临床管理：生活指南

Overview

The WHO COVID-19 Clinical management: living guidance contains the Organization’s most up-to-date recommendations for the clinical management of people with COVID-19. Providing guidance that is comprehensive and holistic for the optimal care of COVID-19 patients throughout their entire illness is important. The latest version of this living guideline is available in pdf format (via the ‘Download’ button) and via an online platform, and is updated regularly as new evidence emerges. No further updates to the previous existing recommendations were made in this latest version.

This updated (fifth) version contains 16 new recommendations for the rehabilitation of adults with post COVID-19 condition (see Chapter 24), which includes:

strong recommendation that exertional desaturation and cardiac impairment following COVID-19 should be ruled out and managed before consideration of physical exercise training; and conditional recommendations for

-   support for the delivery of rehabilitation services;

-   early referral for appropriate rehabilitation services;

-   rehabilitation service delivery using a hybrid approach of in-person and remote models which are integrated across all levels of health care;

-   a rehabilitation workforce that includes physiotherapists, occupational therapists, nurses, psychologists, speech and language therapists, physicians, social workers, and (based on local needs) community health care workers;

-   use of education and skills training on energy conservation techniques, such as pacing approaches, for the clinical rehabilitation management of post-exertional symptom exacerbation (PESE);

-   use of a combination of pain education, skills training on self-management strategies, prescription of short-term anti-inflammatory drugs and, in the absence of PESE, physical exercise training for the clinical rehabilitation management of arthralgia;

-   use of a combination of education and skills training on self-management strategies, such as nasal breathing and pacing approaches and, in the absence of PESE, physical exercise training for the clinical rehabilitation management of breathing impairment;

-   use of a combination of education, skills training on self-management strategies and cognitive exercises for the clinical rehabilitation management of cognitive impairment;

-   use of a combination of education, skills training on energy conservation techniques such as pacing approaches and, in the absence of PESE, a cautious return to symptom titrated physical exercise training for the clinical rehabilitation management of fatigue;

-   use of psychological support and, in the absence of PESE, physical exercise training, mindfulness-based approaches and peer support groups for the clinical rehabilitation management of anxiety and depression;

-   use of education and skills training for olfactory training for the clinical rehabilitation management of olfactory impairment;

-   use of a combination of education and skills training on self-management strategies and, in the absence of PESE, physical exercise training for the clinical rehabilitation management of orthostatic intolerance. Environmental modifications may be useful to support activities of daily living for people experiencing difficulties with upright positions or standing.

-   use of a combination of education and skills training on positioning, maneuvers and dietary modifications, and swallowing exercises for the clinical rehabilitation management of swallowing impairment;

-   use of education and skills training about voice rest and vocal behaviours for the clinical rehabilitation management of voice impairment;

-   rehabilitation interventions for a return to everyday activities that could include education and skills training on energy conservation techniques, the provision and training in the use of assistive products to those who need further assistance with activity management and mobility, and a return-to-work action plan that supports a prolonged and flexible phased return. Environmental modifications at work may be needed based on an individualized workplace risk assessment of personal capabilities matched to work requirements.

Guidelines regarding the use of drugs to treat COVID-19 are included in a separate WHO document, Therapeutics and COVID-19: living guideline, that can via an online platform and in  pdfformat (or click ‘PDF’ in top right corner of online platform).

Guidelines regarding the use of drugs to prevent COVID-19 are included in a separate document, WHO Living guideline: Drugs to prevent COVID-19, that can be accessed via an online platform and in pdf format (or click ‘PDF’ in top right corner of online platform).

To view previous (now outdated) versions of this guideline, please see the links below:

First version, published 27 May 2020 (accessible as pdf only), was originally published under the title "Clinical management of COVID-19: interim guidance, 27 May 2020".Second version, published 25 January 2021 (access via an online platform or as pdf).Third version, published 23 November 202 (access via an online platform or as a pdf)Fourth version, published 23 June 2022 (access via an online platform or as a pdf)

概述

世卫组织 COVID-19 临床管理：生活指南 包含本组织对 COVID-19 患者临床管理的最新建议。为 COVID-19 患者在整个疾病期间的最佳护理提供全面和全面的指导非常重要。本指南的最新版本以pdf格式（通过“下载”按钮）和在线平台提供，并随着新证据的出现定期更新。在这个最新版本中，没有对以前的现有建议进行进一步更新。

此更新（第五版）版本包含16 条针对 COVID-19 后成人康复的新 建议（见第 24 章），其中包括：

强烈建议在考虑体育锻炼训练之前应排除和管理 COVID-19 后的劳力性去饱和和心脏损伤；和

有条件的建议

-   支持提供康复服务；

-   及早转介适当的康复服务；

-   使用面对面和远程模式的混合方法提供康复服务，这些模式集成在各级医疗保健中；

-包括物理治疗师、职业治疗师、护士、心理学家、言语和语言治疗师、医生、社会工作者和（根据当地需要）社区卫生保健工作者的康复劳动力；

- 使用节能技术的教育和技能培训，例如起搏方法，用于运动后症状加重(PESE)的临床康复管理；

- 结合使用疼痛教育、自我管理策略技能培训、短期抗炎药处方，以及在没有 PESE 的情况下， 为关节痛的临床康复管理进行体育锻炼训练；

- 结合使用关于自我管理策略的教育和技能培训，例如鼻呼吸和起搏方法，在没有 PESE 的情况下，为呼吸障碍的临床康复管理进行体育锻炼；

- 将教育、自我管理策略技能培训和认知练习相结合，用于认知障碍的临床康复管理；

- 结合使用教育、节能技术（如起搏方法）的技能培训，以及在没有 PESE 的情况下谨慎地恢复症状滴定体育锻炼训练，以 进行疲劳的临床康复管理；

- 使用心理支持，在没有 PESE 的情况下，体育锻炼训练、基于正念的方法和同伴支持小组用于焦虑和抑郁的临床康复管理；

- 将教育和技能培训用于嗅觉障碍临床康复管理的嗅觉训练；

- 结合自我管理策略的教育和技能培训，在没有 PESE 的情况下，对直立性不耐受的临床康复管理进行体育锻炼。环境改造可能有助于支持难以直立或站立的人的日常生活活动。

-在吞咽障碍的临床康复管理中结合使用关于定位、动作和饮食调整以及吞咽练习的教育和技能培训；

-在语音障碍的临床康复管理中使用有关语音休息和发声行为的教育和技能培训；

- 恢复日常活动的康复干预措施，可能包括关于节能技术的教育和技能培训，为需要进一步帮助活动管理和行动的人提供和培训使用辅助产品，以及重返工作岗位支持长期和灵活的分阶段返回的行动计划。根据与工作要求相匹配的个人能力的个性化工作场所风险评估，可能需要对工作环境进行调整。

有关使用药物治疗 COVID-19 的指南包含在单独的 WHO 文件《 治疗学和 COVID-19：生活指南》中，可以通过 在线平台 和  pdf格式（或单击在线右上角的“PDF”）平台）。

有关使用药物预防 COVID-19 的指南包含在单独的文件《 世界卫生组织生活指南：预防 COVID-19 的药物》中，可通过 在线平台 以 pdf 格式访问（或单击右上角的“PDF”在线平台一角）。

要查看 本指南以前（现已过时）的版本 ，请参阅以下链接：

第一版于 2020 年 5 月 27 日发布（仅以 pdf 格式访问），最初以“ COVID-19 的临床管理：临时指南，2020 年 5 月 27 日”为标题发布。第二版，2021 年 1 月 25 日发布（通过 在线平台 或 pdf 格式访问）。第三版，202 年 11 月 23 日发布（通过 在线平台 或 pdf 格式访问）第四版，2022 年 6 月 23 日发布（通过在线平台或pdf 格式访问）。

WHO-2019-nCoV-Clinical-2022.2-eng.pdf (2.91 MB, 下载次数: 588)

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来源世界卫生组织：https://www.who.int/publications ... CoV-Clinical-2022.2

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