新型冠状病毒肺炎疫情期间普通外科门诊筛查的临床价值

目的探讨新型冠状病毒肺炎(以下简称新冠肺炎)疫情期间普通外科门诊筛查的临床价值。方法采用回顾性描述性研究方法。收集2020年2月1—26日华中科技大学同济医学院附属协和医院收治的57例外科门诊或急诊就诊患者的临床资料;男30例,女27例;年龄为(53±16)岁,年龄范围为17~87岁。57例患者均行普通外科门诊筛查评分,总分≥3分为高危,<3分为低危。观察指标:(1)患者临床资料。(2)患者新冠肺炎筛查评分情况。正态分布的计量资料以±s表示,组间比较采用t检验。偏态分布的计量资料以M(IQR)表示,组间比较采用秩和检验。计数资料以绝对数表示,组间比较采用χ2检验。结果(1)患者临床资料:57例患者中,26例新冠肺炎确诊或疑似患者男、女分别为12、14例,年龄为(57±16)岁;31例非新冠肺炎患者男、女分别为18、13例,年龄为(50±16)岁,两者上述指标比较,差异均无统计学意义(χ2=0.805,t=-1.646,P>0.05)。(2)患者新冠肺炎筛查评分情况:57例患者中,26例新冠肺炎确诊或疑似患者新冠肺炎筛查评分为3.0分(4.0分),31例非新冠肺炎患者新冠肺炎筛查评分为1.0分(1.0分),两者比较,差异有统计学意义(Z=-3.695,P<0.05)。26例新冠肺炎确诊或疑似患者新冠肺炎筛查为高危、低危例数分别为17、9例,31例非新冠肺炎患者新冠肺炎筛查为高危、低危例数分别为3、28例,两者比较,差异有统计学意义(χ2=19.266,P<0.05)。结论新冠肺炎疫情期间普通外科门诊筛查可有效筛查新冠肺炎高危患者。     

新型冠状病毒肺炎疫区胸腰椎骨折诊疗的防控措施及方案

新型冠状病毒肺炎(COVID-19)传染性强,湖北为疫情爆发最严重的地区,尤其武汉处于疫情的中心,疫情防控不到位,极易引起COVID-19扩散,甚至导致医护感染。胸腰椎骨折(thoracolumbar fracture, TLF)是一种常见急性严重的脊柱损伤,如果不能够及时规范救治,往往会遗留肌力、感觉及大小便等功能障碍,甚至截瘫。在这种疫情与病情混杂的局面,如何解决疫情防控和TLF及时规范救治是一个巨大挑战。本院处于COVID-19的中心疫区,为武汉市COVID-19定点医院,同时也为武汉市非COVID-19特殊患者医疗救治单位,收治了一批合并COVID-19的TLF患者及非COVID-19的TLF患者。本文作者从脊柱外科医师的角度出发,总结疫情爆发以来对TLF相关诊疗经验体会,归纳TLF的诊疗流程,为骨科一线医务人员在接诊、治疗和防护等方面提供参考,以期在疫情期间减少医患COVID-19感染风险,提高TLF治愈率,降低并发症与后遗症。     

泌尿外科诊疗工作中防控新型冠状病毒肺炎的建议

2019年12月武汉陆续出现新型冠状病毒肺炎(COVID-19)疫情并蔓延至全球多个国家和地区。为更好地增强泌尿外科医护人员防控工作的针对性和有效性,我们结合本专业临床诊疗工作特点及疫区防控措施和经验,起草了泌尿外科诊疗工作中防控新型冠状病毒肺炎的建议,以供泌尿外科医护人员参考。     

新型冠状病毒肺炎疫情期间外科手术安全防控体会

目的探讨新型冠状病毒肺炎疫情期间外科手术安全防控措施及流程。方法解读新型冠状病毒肺炎诊疗方案、新型冠状病毒肺炎防控方案以及医疗机构内新型冠状病毒肺炎感染预防与控制技术指南后,笔者所在医院制定及完善了手术安全防控措施及流程。结果统计笔者所在医院从2020年1月22日至2020年2月10日行手术患者567例,其中手术中心手术501例,介入中心手术66例。所有手术中,急诊手术303例,限期及择期手术264例。在急诊手术中,占前3位的分别是剖腹产130例,占42.9%;腹部消化系统手术63例,占20.8%;头颅手术31例,占10.2%。限期及择期手术中占前4位的是眼科良性疾病手术65例,占24.6%;肿瘤患者57例,占21.6%;骨科手术53例,占20.1%;冠脉造影25例,占9.4%。所有手术患者均顺利完成手术,术后均恢复良好,无外科严重并发症发生,无感染相关并发症发生。结论在新型冠状病毒肺炎疫情期间,通过调整优化措施及流程,可以开展外科手术和实施疫情防控。     

新型冠状病毒肺炎暴发流行中心疫区急腹症诊治经验

目的分析新型冠状病毒肺炎(COVID-19)疫情下在中心疫区开展急腹症诊治的临床效果,总结临床经验。方法回顾性分析2020年1月24日至2020年2月29日华中科技大学同济医学院附属同济医院急诊收治和院内会诊的急腹症病人的临床处置和预后,随访结束时间为2020年3月8日。结果2020年1月24日至2020年2月29日已处置腹痛为主要表现的急腹症病人19例,其中,合并COVID-19病人(确诊及疑似病例)5例。19例病人中,有急诊手术指征并行急诊手术处置的9例,恢复顺利者7例,死亡2例,其中确诊COVID-19病人行急诊手术处置1例,死亡1例;行保守治疗并密切观察病情变化者10例(包括4例COVID-19病人),均恢复良好;随访至今未见密切接触上述COVID-19病人的医护人员出现感染表现。结论COVID-19疫情期间在中心疫区诊治急腹症病人时无论其是否是COVID-19病人都做到仔细检查,严格把握手术指征,术中熟练操作,术后密切监护及观察,同时做好医护人员个人防护。     

新型冠状病毒肺炎疫情期间普通外科的病区管理及对策

目的探讨新型冠状病毒肺炎疫情期间普通外科病区安全防护管理流程及对策。 方法制定规划病区安全防护管理方案，拟定管理流程，即把好"四个安全防护管理环节"，做到确保病区安全，避免院内交叉感染的发生。 结果按制定的安全防护管理流程，保证了病区安全、医护人员安全，病人和陪护家属安全，无疫情不良事件发生。 结论制定的病区安全防护管理流程，四个安全防护管理环节，能有效避免院内交叉感染的发生。     

疑似或确诊新型冠状病毒肺炎患者相关手术室感染防控建议

根据新型冠状病毒肺炎的流行病学特点,结合国家近期印发的有关该疾病的相关防控方案、指引和感染防控的相关法律、法规,结合手术室工作特点,组织我省手术室护理专家制订首版-该疾病患者手术在手术室过程的感染防控指引,内容包括手术间准备、用物准备、手术人员准备、患者转运、手术中和手术后的管理等各个环节,以预防和控制新型冠状病毒肺炎手术患者在手术过程中造成交叉感染,并供全国各地医院手术室参考。     

新型冠状病毒肺炎疫情期间危重症病房中普通外科相关问题处理策略

新型冠状病毒肺炎(以下简称新冠肺炎)疫情期间,为提高武汉疫区危重症患者治愈率,降低病死率,我国政府从全国抽调优势力量支援武汉,集中收治危重症患者。笔者单位由重症医学科、呼吸科、感染科、心内科、普通外科等专业组建133人医护队伍,成建制接管武汉大学人民医院东院危重症病房,与当地医务人员组成多学科协作团队共同救治患者。截至2020年3月13日,笔者所在医疗队共收治109例患者,其中48例康复出院。新冠肺炎危重症患者多为高龄、伴合并症,病情复杂、诊断与治疗难度大,笔者团队结合临床实践,总结在危重症病人救治过程中,普通外科相关问题的处理经验和策略,以期为普通外科同道提供参考。     

疑似新型冠状病毒肺炎患者的手术室防控对策

目的探讨手术室在伴发疑似/确诊新冠肺炎而需要手术治疗患者的应急预案和工作流程。方法总结我院肝胆外科1例疑似合并新冠肺炎的急性梗阻性化脓性胆管炎患者的救治经过。结果术后患者体温正常,术后第8 d带T管出院,患者体温均正常,无呼吸系统不适主诉。结论对疑似新型冠状病毒肺炎患者,手术期间应明确专人专岗责任,严格执行三级防护,以切断空气、飞沫、接触三个传播途径。应着重患者转运、医护人员防护、负压手术间管控和术后处理等环节,确保患者和医护人员的安全。     

新型冠状病毒肺炎防控中的热点和难点问题

新型冠状病毒肺炎(COVID-19)疫情已持续1年余,目前全球的感染人数仍在上升,疫情走向不明确。COVID-19疫情后续会如何发展？目前新冠肺炎治疗药物的研究现状,应用于临床的疫苗是否会改变目前疫情流行的格局？在疫情常态化的背景下,其他呼吸道病毒的流行病学是否会发生变化？本文将围绕这些热点和难点问题进行讨论和分析。     

新型冠状病毒肺炎疫情期间放射科分层防护培训机制的建立与应用

目的探讨新型冠状病毒肺炎疫情期间放射科人员分层防护快速培训机制,以提高防护技能。方法根据放射科六类人员(医生、护士、技师、工勤、保洁、安保人员)不同的工作范畴和职责对新型冠状病毒肺炎的理论知识、防护技能、制度、流程等内容进行培训,采用腾讯课堂网上教学、微信自主理论学习、现场防护技能练习、情景模拟病例演练相结合等方式,进行分层快速培训。结果六类人员经培训考核均合格后上岗。结论分层防护培训可以缩短培训时间,防止交叉感染。     

新型冠状病毒感染肺炎背景下泌尿外科诊疗防控工作建议

2019年12月以来,湖北省武汉市发现了多例新型冠状病毒感染的肺炎(NCP)患者,随着疫情的蔓延,我国其他地区及境外也相继发现了相关病例,该病通过基因测序确定为一种新的冠状病毒,世界卫生组织(WHO)将其命名为2019冠状病毒病(Corona Virus Disease 2019,COVID-19)。该病毒传染性极强,主要通过飞沫和密切接触的途径传播,泌尿外科老年患者居多,往往伴有不同程度的基础疾病或免疫功能低下,这些特点导致感染NCP机会明显增加,且易发展为重症患者。本文从泌尿外科日常防控工作出发,结合NCP疫情相关国家政策方案及最新研究进展,制定了泌尿外科诊疗防控工作建议。     

Cardiac surgery considerations and lessons learned during the COVID-19 pandemic

The COVID-19 pandemic has transformed cardiac surgical practices. Limitations in intensive care resources and personal protective equipment have required many practices throughout the globe to pause elective operations and now slowly resume operations. However, much of cardiac surgery is not elective and patients continue to require surgery on an urgent or emergent basis during the pandemic. This continued need for providing surgical services has introduced several unique considerations ranging from how to prioritize surgery, how to ensure safety for cardiac surgical teams, and how best to resume elective operations to ensure the safety of patients. Additionally, the COVID-19 pandemic has required a careful analysis of how best to carry out heart transplantation, extra-corporeal membrane oxygenation, and congenital heart surgery. In this review, we present the many areas of multidisciplinary consideration, and the lessons learned that have allowed us to carry out cardiac surgery with excellence during the COVID-19 pandemic. As various states experience plateaus, declines, and rises in COVID-19 cases, these considerations are particularly important for cardiac surgical programs throughout the globe.     

Cardiac surgery in patients with confirmed COVID-19 infection: Early experience

The novel coronavirus, now termed SARS-CoV-2, has caused a significant global impact in the space of 4 months. Almost all elective cardiac surgical operations have been postponed in order to reduce transmission and to allocate resources adequately. Urgent and emergency cardiac surgery is still taking place during the pandemic. The decision to operate in urgent patients with active/recent COVID-19 infection is difficult to make, particularly as it is still an unknown disease entity in the setting of emergent cardiac surgery. We present a case series of three patients who underwent urgent cardiac surgery and who have had recent or active COVID-19 infection.     

The impact of COVID-19 on foot and ankle surgery in a major trauma centre

Introduction and aimsCOVID-19 has had a significant impact on orthopaedic surgery globally. This paper aims to evaluate the impact of COVID-19 on foot and ankle trauma in a major trauma centre.MethodsA retrospective observational study of prospectively collected data was performed. All foot and ankle trauma patients over a 33 week period (1st December 2019–16th July 2020) were analysed. All patients with trauma classified by the AO/OTA as occurring at locations 43 and 81–88 were included.ResultsOver the 33 weeks analysed, there was a total of 1661 trauma cases performed; of these, only 230 (13.85%) were foot and ankle trauma cases. As percentage of cases during each period of lockdown, foot and ankle made up 15.20% (147 out of 967) pre-lockdown, 8.81% (17 out of 193) during lockdown and 13.17% (66 out of 501) post lockdown. This difference was statistically significant (p < .001). The most significant change in trauma management was the treatment of malleolar fractures.Further analysis showed that during the lockdown period 29 foot and ankle fractures were treated the same and 13 were treated differently, (i.e. 31% of fractures were treated conservatively, when the consultants preferred practice would have been surgical intervention). Of the 13 patients, 3 have had surgical management since lockdown has been eased.ConclusionIt is evident that the trauma case activity within foot and ankle was significantly reduced during the COVID-19 period. The consequences of change in management were mitigated due to a reduction in case load.     

Bariatric surgery and COVID-19 outcomes: a systematic review and meta-analysis

BackgroundObesity and its associated complications have a negative impact on human health. Metabolic and bariatric surgery (MBS) ameliorates a series of clinical manifestations associated with obesity. However, the overall efficacy of MBS on COVID-19 outcomes remains unclear.ObjectivesThe objective of this article is to analyze the relationship between MBS and COVID-19 outcomes.SettingA meta-analysis.MethodsThe PubMed, Embase, Web of Science, and Cochrane Library databases were searched to retrieve the related articles from inception to December 2022. All original articles reporting MBS-confirmed SARS-CoV-2 infection were included. Outcomes including hospital admission, mortality, intensive care unit (ICU) admission, mechanical ventilation utilization, hemodialysis during admission, and hospital stay were selected. Meta-analysis with fixed or random-effect models was used and reported in terms of odds ratios (ORs) or weighted mean differences (WMDs) along with their 95% confidence intervals (CIs). Heterogeneity was assessed with the I² test. Study quality was assessed using the Newcastle-Ottawa Scale.ResultsA total of 10 clinical trials involving the investigation of 150,848 patients undergoing MBS interventions were included. Patients who underwent MBS had a lower risk of hospital admission (OR: .47, 95% CI: .34–.66, I² = 0%), mortality (OR: .43, 95% CI: .28–.65, I² = 63.6%), ICU admission (OR: .41, 95% CI: .21–.77, I² = 0%), and mechanical ventilation (OR: .51, 95% CI: .35–.75, I² = 56.2%) than those who did not undergo surgery, but MBS did not affect hemodialysis risk or COVID-19 infection rate. In addition, the length of hospital stay for patients with COVID-19 after MBS was significantly reduced (WMD: −1.81, 95% CI: −3.11–.52, I² = 82.7%).ConclusionsOur findings indicate that MBS is shown to improve COVID-19 outcomes, including hospital admission, mortality, ICU admission, mechanical ventilation, and hospital stay. Patients with obesity who have undergone MBS infected with COVID-19 will have better clinical outcomes than those without MBS.