新型冠状病毒肺炎高风险地区开展神经外科限期手术的感染防控策略

目的 总结新型冠状病毒肺炎（COVID-19）高风险地区开展神经外科限期手术的感染防控策略。方法 回顾性总结COVID-19疫情期间手术治疗的5例神经外科危重病人的救治经验，主要包括门急诊筛查、围手术期防护及术后处理等。结果 5例在做好感染防控措施基础上手术，术后未发生感染的院内播散。结论 COVID-19高风险地区开展神经外科限期手术，首先，要全面评估病情，严格掌握手术适应证；对必须手术的病人，务必做好感染防控措施，以免导致病毒院内播散等不良事件     

神经外科临床工作中对新型冠状病毒肺炎的防控策略和措施

2019年12月以来,武汉市出现了新型冠状病毒肺炎(COVID-19)的爆发流行。华中科技大学同济医学院附属同济医院神经外科及时制定了疫情期间的防控策略,包括门诊调整、住院患者筛查、病区封闭管理和功能分区、医护人员三级防控措施,以及专科手术流程管理和术中防护措施,保障了神经外科全体医护人员无一人感染新型冠状病毒,住院患者无一例确诊COVID-19。     

新型冠状病毒性肺炎疫情下神经外科急诊诊疗行为的建议及策略

目的 探讨新型冠状病毒肺炎（COVID-19）疫情期间神经外科急诊诊疗行为的建议及策略。方法 回顾性分析2020年1月20日到2020年3月20日武汉大学人民医院神经外科一病区收治的67例急诊病人的临床资料。分析67例病人及与这些病人有接触的41位医护人员感染COVID-19的情况,总结防控经验。结果 67例病人中,4例确诊COVID-19,3例疑似COVID-19。所有医护人员中,2名医师确诊感染COVID-19,其中1人为无症状感染,1人为轻症感染;1名护士确诊COVID-19,为轻症感染;医师及护士均未见疑似感染者。医护人员确诊感染COVID-19均发生在标准化防控措施开始执行之前,且不能排除社区感染的可能性。结论 通过科学的防控措施可将COVID-19的院内感染发生率控制在低水平,在疫情期间为神经外科急诊病人持续提供优质,安全的医疗服务     

合并CVOID-19的高血压性脑出血急诊手术救治体会及防护管理方法

目的 探讨合并新型冠状病毒肺炎（COVID-19）的高血压性脑出血急诊手术救治体会及防护管理方法。方法 回顾性分析1例急诊手术治疗的合并COVID-19的高血压性脑出血病人的临床资料。结果 协同麻醉医师、手术室、感染科做好术前准备、协调好术前隔离性转运、术中管理及术后终末处置工作,同时制定相关防护流程,实行严格的三级防护,病人治愈,未出现医务人员感染。结论 对于合并COVID-19的高血压性脑出血,制定合理的防护管理方法,急诊手术治疗,是安全有效的。     

颅内动脉瘤合并新型冠状病毒肺炎的围手术期护理及医护人员防护

目的 探讨颅内动脉瘤合并新型冠状病毒肺炎（COVID-19）的围手术期护理及医护人员防护经验。方法 回顾性分析我科2020年2月11日救治的1例右侧大脑中动脉动脉瘤破裂伴蛛网膜下腔出血合并COVID-19的围手术期护理过程,总结神经外科病人合并COVID-19的护理及医护人员防护经验。结果 发病后,病人曾于武汉市两家医院就医后转入我院。入院时肺部CT、血常规未见异常,但仍然在围手术期提高防护级别,安全完成手术。术后及时复查,及时发现并确诊COVID-19。病区和医护人员没有发生感染。结论 合并COVID-19的颅内动脉瘤病人经过严格的隔离防护措施,可以完成手术,并能有效防止COVID-19的扩散。     

新型冠状病毒肺炎高风险地区出血性卒中的治疗对策

目的探讨新型冠状病毒肺炎(COVID-19)高风险地区神经外科开展出血性卒中救治的方法及防控对策。方法回顾性分析2020年1月22日至2020年3月31日中国人民解放军中部战区总医院神经外科收治的51例出血性卒中的隔离防护、诊治措施和结果。结果所有出血性卒中病人入院时均视为COVID-19高危疑似感染者,采取三级防护,隔离区单间病房或ICU负压病房收治,待两次核酸检测后在负压手术间进行手术。51例中,2例确诊COVID-19,外科处理后转入感染科隔离病房治疗。自发性蛛网膜下腔出血20例中,颅内动脉瘤介入手术12例、开颅夹闭术4例;烟雾病3例对症治疗,1例颅后窝动静脉瘘行OYNX和GRUB胶介入栓塞治疗。31例高血压性脑出血中,22例行开颅血肿清除术或立体定向血肿穿刺引流术;9例血肿较小行保守治疗。未发生COVID-19交叉感染。出院时改良Rankin量表评分0分13例,1分6例,2分5例,3分18例,4分5例,5分3例;6分(死亡)1例。高等级安全防护和病毒排查导致手术时间平均拖延2~5 d,颅内动脉瘤及血管畸形再次破裂率及介入手术中脑血管痉挛发生率增高。结论COVID-19高风险地区,神经外科收治出血性脑卒中时,严格按三级防护措施处理病人是防止COVID-19交叉感染的关键。但等待核酸检测可能会影响出血性脑卒中救治时机和疗效,进一步优化COVID-19核酸检测时间是当务之急。     

综合医院神经外科应对新型冠状病毒肺炎的护理应急管理

目的 总结我院神经外科应对新型冠状病毒肺炎（COVID-19）的护理应急管理经验。方法 2019年12月25日至2月3日,我院神经外科先后出现3例COVID-19确诊病例,科室高度重视并迅速成立疫情防控应急管理小组,实施护理应急管理策略,包括启动护理组织应急管理工作,落实院感防护安全管理和护患双方的心理支持与疏导。结果 我院神经外科顺利完成各项常规诊疗、护理等工作,并完成对疑似病人的筛查、确诊、救治及护理工作,疫情防控工作取得初步成效。结论 综合医院神经外科通过护理应急管理进行科学防疫和精准施策,可有效提高各级护理人员的应急管理能力和水平。     

新型冠状病毒肺炎疫情时期急性缺血性卒中的急诊取栓治疗

目的 探讨总结新型冠状病毒（coronavirus disease-19，COVI D-19）肺炎疫情时期急性缺血性卒中 （acute ischemic stroke，AIS）的急诊取栓治疗经验。 方法 回顾性分析2020年1月20日-3月20日疫情期间，首都医科大学附属北京天坛医院神经介入中 心进行急诊取栓治疗的AIS病例资料，包括患者的一般资料、NIHSS评分、ASPECTS评分（DWI）、病变部 位、手术策略、恢复情况，以及COVID-19筛查、预防标准与流程。并与2019年1月20日-3月20日同期取栓 病例进行对照分析。 结果 共纳入33例颅内大血管闭塞致AIS进行急诊取栓的患者，其中2020年18例，2019年15例。2020 年疫情期间与2019年同期相比，入院到手术开始时间稍长[4.0（2.9～4.1）h vs 3.0（2.0～4.0）h， P =0.103]，更少采用全身麻醉（55.6% vs 100.0%，P =0.003），更倾向采取直接导管抽吸取栓（27.8% vs 13.3%，P =0.32）。出院时死亡率低于2019年同期取栓患者（0 vs 20.0%，P =0.050）。2020年疫情期 间纳入的患者及参与救治的医护人员无COVID-19可疑病例，无COVI D-19疑似或确诊病例。 结论 COVID-19疫情期间，入院到手术开始时间受到疫情筛查的影响而有所延长，取栓策略倾向于 采取局部麻醉、抽吸取栓策略，作为疫情期间的特殊考虑是合理的。     

新型冠状病毒肺炎病人手术中医务人员的安全防护

目的 总结手术室在新型冠状病毒肺炎（COVID-19）病人手术中的防护经验。方法 COVID-19病人手术时,不仅手术间要进行特殊处理,术中医务人员务必做好安全防护措施。结果 2020年1月30日至2020年3月1日实施手术19例,其中确诊COVID-19病人14例,疑似5例。实施手术的医务人员未发生COVID-19情况。结论 在COVID-19病人手术过程中,对医务人员实施安全防护措施,可以有效地避免医护人员发生COVID-19     

一级响应常态化防控下神经外科病房护理管理

目的 总结在新型冠状病毒肺炎（COVID-19）疫情常态化防控下神经外科病房的护理管理经验。方法 根据COVID-19的特点和防制原则,结合临床护理管理实践经验,在常态化防控下从开放病区前的准备、病人及家属管理、人力资源管理、病室设施及物资管理、床位管理和护理质量管理六个方面进行总结。结果 我科在常态化防控下,调整护理管理策略后,相比疫情防控阶段,入院人数同比增长65.9%,出院人数同比增长69.3%,期间未发生COVID-19相关院内感染,手卫生执行率增长5%。结论 在严格的常态化防控下,采取合理的护理管理模式不仅加快病人周转,同时有效减少住院病人感染发生率,从而减少疫情反复及爆发的可能,加快解决非COVID-19病人的就医问题。     

新型冠状病毒肺炎合并急性脑梗死一例

新型冠状病毒肺炎(COVID-19)为2019新型冠状病毒所致,其起病隐匿,潜伏期较长,具有高度传染性的特点。新型冠状病毒除了可累及呼吸系统,还可累及其他系统,如心脏、肾脏、消化道,并且可合并多个系统疾病,如急性脑血管病等,如果在接诊患者时不引起高度重视、做好防护,极易造成医护人员的感染。文中总结1例起病隐匿的COVID-19患者合并脑梗死症状,在行静脉溶栓治疗后造成1名医务人员感染的临床体会,探讨其临床特点、治疗经过并对其防控环节进行分析,以帮助疫情防控中首诊医生注意识别、减少漏诊、科学排查以减少职业感染。     

2019冠状病毒病(COVID-19)临床防治神经科专家共识

目前2019冠状病毒病(coronavirus disease 2019,COVID-19)疫情严重,该病毒除主要累及肺外,还可累及神经系统等,尤其早期以神经系统症状为首发症状时,往往容易误诊,延误治疗,这类患者还是隐形的传播者。为了让神经科医师了解这一疾病的发生发展和转归,熟悉相关的防治流程,我们将目前有关COVID-19的临床诊治以及相关研究的进展做一总结,以指导神经科医师对COVID-19的临床防治。     

Effects of an Infection Control Protocol for Coronavirus Disease in Emergency Mechanical Thrombectomy

ObjectiveSince the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, neurointerventionists have been increasingly concerned regarding the prevention of infection and time delay in performing emergency thrombectomy procedures in patients with acute stroke. This study aimed to analyze the effects of changes in mechanical thrombectomy protocol before and after the COVID-19 pandemic on procedure time and patient outcomes and to identify factors that significantly impact procedure time. MethodsThe last-normal-to-door, first-abnormal-to-door, door-to-imaging, door-to-puncture, and puncture-to-recanalization times of 88 patients (45 treated with conventional pre-COVID-19 protocol and 43 with COVID-19 protection protocol) were retrospectively analyzed. The recanalization time, success rate of mechanical thrombectomy, and modified Rankin score of patients at discharge were assessed. A multivariate analysis was conducted to identify variables that significantly influenced the time delay in the door-to-puncture time and total procedure time. ResultsThe door-to-imaging time significantly increased under the COVID-19 protection protocol (p=0.0257) compared to that with the conventional pre-COVID-19 protocol. This increase was even more pronounced in patients who were suspected to be COVID-19-positive than in those who were negative. The door-to-puncture time showed no statistical difference between the conventional and COVID-19 protocol groups (p=0.5042). However, in the multivariate analysis, the last-normal-to-door time and door-to-imaging time were shown to affect the door-to-puncture time (p=0.0068 and 0.0097). The total procedure time was affected by the occlusion site, last-normal-to-door time, door-to-imaging time, and type of anesthesia (p=0.0001, 0.0231, 0.0103, and 0.0207, respectively). ConclusionThe COVID-19 protection protocol significantly impacted the door-to-imaging time. Shortening the door-to-imaging time and performing the procedure under local anesthesia, if possible, may be required to reduce the door-to-puncture and door-to-recanalization times. The effect of various aspects of the protection protocol on emergency thrombectomy should be further studied.     

新型冠状病毒导致脑血管疾病相关机制探讨

2019冠状病毒病（coronavirus disease 2019,COVID-19）已经成为人类社会迄今为止面临的 最大挑战之一,具有传播广、重症及死亡率高的特点。现有研究发现COVID-19患者脑血管病发病率为 0.5%,发病机制以栓塞和大动脉粥样硬化为主,大血管病变似乎在COVID-19相关卒中患者中更常见。 病毒与血管紧张素转化酶2受体的相互作用、炎症反应和凝血紊乱等在COVID-19相关卒中发病中可能 发挥作用。因此本文对COVI D-19患者的脑血管病流行病学、临床特点和发病机制进行归纳总结,以期 更好地指导临床诊疗。     

重大突发传染病(新型冠状病毒肺炎)防控期间精神障碍诊治流程和路径专家建议

重大突发传染病,如新型冠状病毒肺炎疫情,严重威胁公众健康。中国绝大多数精神病医院或综合医院精神科病房实施封闭式管理,在防治传染性疾病方面都较为薄弱,难以有效应对疫情。在当前新型冠状病毒肺炎疫情严峻情形下,中华医学会精神医学分会牵头中国精神医学领域主要学会和(或)协会,组织专家制定《重大突发传染病(新型冠状病毒肺炎)防控期间精神障碍诊治流程和路径专家建议》,供相关医疗机构参照执行。本专家建议分精神病医院和综合医院精神科两部分,从门诊、住院和居家管理3个方面提出了详细的诊治流程和路径,具有很好的操作性和指导价值,对于预防精神卫生医疗机构院内感染发生和保障精神障碍患者医疗安全具有重要意义。     

Acute Confusion as an Initial Presentation of SARS-CoV-2 Infection

Background and PurposeThe respiratory manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been extensively documented. There is emerging evidence that coronavirus disease 2019 (COVID-19) has number of other presenting features which might not be related to the severity of the respiratory disease. We have previously described a case of hypoactive delirium as the first manifestation of COVID-19 without profound lung disease. Here we present five cases of elderly patients, without a prior history of dementia and had no overt COVID-19-related pneumonia, who presented with the acute onset of delirium as the primary manifestation of COVID-19.MethodsThis retrospective, single-center study performed a health informatics search to produce a list of patients who were admitted with acute confusion and tested positive for the SARS-CoV-2 virus between March 1 and June 30, 2020. The electronic medical admission notes were screened for all patients with confusion who tested positive for SARS-CoV-2. Patients with a history of dementia and a high risk of delirium were excluded, such as severe COVID-19-related pneumonia or any other infection, malignancy, drugs, or severe illness of any kind.ResultsDuring the first wave of the COVID-19 pandemic our hospital experienced just over 3,000 SARS-CoV-2 positive patients, and 45 of them had documented confusion upon admission. Secondary causes for their acute confusion were excluded. Five patients were identified as having delirium as the initial presentation of COVID-19-related illness without significant COVID-19-related pneumonitis. None of them had overt chest symptoms or a previous history of confusion, and the 3 patients who underwent head CT scans had normal findings.ConclusionsThis case series illustrates the importance of recognizing acute confusion as the first manifestation of COVID-19 in susceptible individuals.     

New onset acute symptomatic seizure and risk factors in coronavirus disease 2019: A retrospective multicenter study

Our aim was to clarify the incidence and risk of acute symptomatic seizures in people with coronavirus disease 2019 (COVID-19). This multicenter retrospective study enrolled people with COVID-19 from January 18 to February 18, 2020 at 42 government-designated hospitals in Hubei province, the epicenter of the epidemic in China; Sichuan province; and Chongqing municipality. Data were collected from medical records by 11 neurologists using a standard case report form. A total of 304 people were enrolled, of whom 108 had a severe condition. None in this cohort had a known history of epilepsy. Neither acute symptomatic seizures nor status epilepticus was observed. Two people had seizurelike symptoms during hospitalization due to acute stress reaction and hypocalcemia, and 84 (27%) had brain insults or metabolic imbalances during the disease course known to increase the risk of seizures. There was no evidence suggesting an additional risk of acute symptomatic seizures in people with COVID-19. Neither the virus nor potential risk factors for seizures seem to be significant risks for the occurrence of acute symptomatic seizures in COVID-19.     

Care Process of Recanalization Therapy for Acute Stroke during the COVID-19 Outbreak in South Korea

Background and PurposeWe aimed to determine whether the care process and outcomes in patients with acute stroke who received recanalization therapy changed during the outbreak of coronavirus disease 2019 (COVID-19) in South Korea.MethodsWe used data from a prospective multicenter reperfusion therapy registry to compare the care process—including the time from symptom onset to treatment, number of treated patients, and discharge disposition—and treatment outcomes between before and during the COVID-19 outbreak in South Korea.ResultsUpon the COVID-19 outbreak in South Korea, the number of patients receiving endovascular treatment to decrease temporarily but considerably. The use of emergency medical services by stroke patients increased from 91.5% before to 100.0% during the COVID-19 outbreak (p=0.025), as did the median time from symptom onset to hospital visit [median (interquartile range), 91.0 minutes (39.8–277.0) vs. 176.0 minutes (56.0–391.5), p=0.029]. Furthermore, more functionally dependent patients with disabilities were discharged home (59.5% vs. 26.1%, p=0.020) rather than staying in a regional or rehabilitation hospital. In contrast, there were no COVID-19-related changes in the times from the hospital visit to brain imaging and treatment or in the functional outcome, successful recanalization rate, or rate of symptomatic intracerebral hemorrhage.ConclusionsThese findings suggest that a prehospital delay occurred during the COVID-19 outbreak, and that patients with acute stroke might have been reluctant to visit and stay in hospitals. Our findings indicate that attention should be paid to prehospital care and the behavior of patients with acute stroke during the COVID-19 outbreak.     

The care of patients with Duchenne,Becker, and other muscular dystrophies in the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic has resulted in the reorganization of health-care settings affecting clinical care delivery to patients with Duchenne and Becker muscular dystrophy (DBMD) as well as other inherited muscular dystrophies. The magnitude of the impact of this public health emergency on the care of patients with DBMD is unclear as they are suspected of having an increased risk for severe manifestations of COVID-19. In this article, the authors discuss their consensus recommendations pertaining to care of these patients during the pandemic. We address issues surrounding corticosteroid and exon-skipping treatments, cardiac medications, hydroxychloroquine use, emergency/respiratory care, rehabilitation management, and the conduct of clinical trials. We highlight the importance of collaborative treatment decisions between the patient, family, and health-care provider, considering any geographic or institution-specific policies and precautions for COVID-19. We advocate for continuing multidisciplinary care for these patients using telehealth.