新型冠状病毒肺炎疫情期间急诊手术应急护理管理

从术前准备、术中配合、术后终末处理等方面制定新型冠状病毒肺炎疫情期间急诊手术应急护理管理措施,以保证手术室具有高效的应对能力,降低新型冠状病毒感染率,减少重症病例发生,使手术医护人员在全面防护下安全地为病人实施手术。     

新型冠状病毒肺炎疫情防控期间手术患者的管理实践

总结新型冠状病毒肺炎疫情期间开展急诊及限期手术的安全防控措施。严格按照疫情期间防控工作流程,就诊前体温测量,流行病学筛查,入院前行相关检查进行新型冠状病毒肺炎筛查,住院期间避免病房人员聚集,手术中做好医护技的必要防护,加强患者家属的管理,术毕做好与各科室患者的交接工作。在新型冠状病毒肺炎期间,共完成254例手术,其中急诊手术184例,限期手术70例,取得了较好的手术效果。     

新型冠状病毒肺炎疫情期间单孔胸腔镜在胸部急诊手术中的优势及围手术期处理

目的探讨新型冠状病毒肺炎（新冠肺炎）疫情下单孔胸腔镜急诊手术的优势及围手术期注意事项。 方法回顾性分析涿州市医院在2020年1月至2月新冠肺炎疫情期间6例急诊单孔胸腔镜手术的术前筛查、手术室预防、麻醉、围手术期处理的特点及诊治要点,总结单孔胸腔镜手术的优势。 结果6例患者术前CT及血常规筛查均为阴性,经过术后证实最终均未检出新型冠状病毒感染。急诊手术按照潜在感染进行防护准备,尽量缩短麻醉和手术过程。6例手术胸腔内操作均采用单孔胸腔镜手术,术中另备一套吸引器加强胸腔内烟雾气体吸引。1例行支气管肺修补,4例行肺部分切除术,其中2例合并肋骨骨折的患者加行腔镜辅助下肋骨骨折固定术,1例在全麻双腔气管插管下行单孔胸腔镜下肺叶切除术。术后住院时间平均为5.8 d。无严重并发症发生,但一次性器材及消毒处理的费用较疫情前平均增加约30%。 结论单孔胸腔镜手术具有创伤小、烟雾密闭性好的特点,适宜疫情期间急诊手术采用;疫情期间围手术期预防处理应加强防护等级,即使初次CT及血常规筛查新型冠状病毒感染阴性的患者也应按照潜在感染患者对待。     

新型冠状病毒肺炎疫情期间糖尿病患者护理策略

新型冠状病毒肺炎传播性强,起病隐匿,合并有糖尿病患者年龄偏大,病情转归不良,因此做好疫情期间及疫情后糖尿病患者管理尤为重要 。本文针对武汉一线工作期间诊治的罹患新冠肺炎的患者病例特点,结合各医院针对疫情期间的诊疗工作调整措施,对疫情中糖尿病患者的护理特点做一总结,以提高糖尿病患者的护理管理水平。     

新型冠状病毒肺炎疫情期间日间手术安全防范及流程优化管理

总结新型冠状病毒肺炎疫情期间日间手术安全防范措施及流程优化管理。医院成立专项日间手术管理小组,优化流程及制度,重视日间手术医务人员的排摸,对医生及护士进行培训,优化护理人员配比与排班,完善新型冠状病毒筛查,新型冠状病毒肺炎可疑病例的隔离管理等。2020年3月9日至4月25日,1 224例患者进行了日间手术,期间未发生患者及医务人员医院内新型冠状病毒感染事件,患者满意度为98.0%。     

新型冠状病毒肺炎防控期间医用帐篷的应用

在新型冠状病毒肺炎防控期间,四川大学华西医院紧急搭建4顶医用帐篷对发热患者进行集中筛查,有效避免了交叉感染,同时也缓解了急诊科的压力,提高了发热患者的就诊效率。之后为积极响应国家对2019新型冠状病毒核酸的检测政策,又调整为5顶帐篷以进行2019新型冠状病毒核酸检测。该文介绍了新型冠状病毒肺炎防控期间四川大学华西医院医用帐篷的功能设置、人员安排和防护措施,旨在分享新型冠状病毒肺炎防控中紧急搭建医用帐篷的经验,以期为其他医疗机构的医用帐篷搭建提供参考。     

新型冠状病毒肺炎疫情期间非医务工作人员防控现状调查及策略探讨

[目的]了解新型冠状病毒肺炎疫情期间非医务工作人员防控现状,探讨相应策略。[方法]采用网络问卷调查法,在疫情初期对医院非医务工作人员(120名护工、100名工人)进行新型冠状病毒肺炎相关知识、感染防控知识掌握情况及感染防控知识需求情况进行调查。[结果]护工、工人对新型冠状病毒肺炎疫情初期相关知识的认知合格率为51.6%和49.0%,感染防控知识掌握的合格率为65.0%和52.0%;非医务工作人员对职业防护知识的需求量较大,护工、工人分别为93.3%和97.0%。[结论]非医务工作人员对新型冠状病毒肺炎疫情初期感染防控知识认知情况一般,应加强对其进行新型冠状病毒肺炎疫情期间感染防控知识的培训,减少新型冠状病毒肺炎的发生。     

新型冠状病毒肺炎疫情期间急性心肌梗死患者急诊介入手术的应急策略

新型冠状病毒肺炎(COVID-19)具有强传染性、人群普遍易感性、高病死率等特点;而急性心肌梗死具有发病迅速、最佳救治窗口期短、病情危重等特点,其救治关键在于选择最佳策略以最大限度地提高再灌注效率.目前疫情防控形势严峻,对急性心肌梗死行急诊腔内介入治疗等临床工作也提出了新的要求.为规范救治流程,本研究对心血管医务人员的...     

新型冠状病毒肺炎疫情期间孕产妇管理探讨

新型冠状病毒肺炎是2019年12月在武汉发现的一种新发传染病。孕产妇是一个非常特殊的群体,是新型冠状病毒肺炎的易感人群。在新型冠状病毒肺炎疫情期间,做好孕产妇的感染防控、确保疫情期间母胎安全非常重要。本文从孕期检查、居家生活管理、前往医院的路上和医院内注意事项、家中消毒及空气净化、住院后的自我防护、产后注意事项等方面做了探讨。     

麻醉科疫情防控质量与体系建设的体会

新型冠状病毒肺炎(COVID-19)是一种突发的新型传染性呼吸道疾病,由于起病隐匿,传染性强,对我国公共卫生系统提出了严峻挑战。麻醉科如何做好COVID-19疫情下感染控制工作,保障患者安全并预防医务人员感染,是参与抗击疫情的前提和保障。结合本科室在2003年应对SARS及针对COVID-19患者手术应急预案制定中的经验,本文对相关工作进行总结。建立完备的科室麻醉感染控制体系,做好此类突发公共卫生事件应急预案的制定,不仅可为战胜此次疫情奠定基础,而且为未来可能发生的其他突发公共卫生事件做好准备。     

Management of cancer patients during COVID-19 pandemic at developing countries

Cancer patient care requires a multi-disciplinary approach and multiple medical and ethical considerations. Clinical care during a pandemic health crisis requires prioritising the use of resources for patients with a greater chance of survival, especially in developing countries. The coronavirus disease 2019 crisis has generated new challenges given that cancer patients are normally not prioritised for admission in critical care units. Nevertheless, the development of new cancer drugs and novel adjuvant/neoadjuvant protocols has dramatically improved the prognosis of cancer patients, resulting in a more complex decision-making when prioritising intensive care in pandemic times. In this context, it is essential to establish an effective and transparent communication between the oncology team, critical care, and emergency units to make the best decisions, considering the principles of justice and charity. Concurrently, cancer treatment protocols must be adapted to prioritise according to oncologic response and prognosis. Communication technologies are powerful tools to optimise cancer care during pandemics, and we must adapt quickly to this new scenario of clinical care and teaching. In this new challenging pandemic scenario, multi-disciplinary work and effective communication between clinics, technology, science, and ethics is the key to optimising clinical care of cancer patients.     

COVID-19 Susceptibility in chronic obstructive pulmonary disease

In barely nine months, the pandemic known as COVID-19 has spread over 200 countries, affecting more than 22 million people and causing over than 786 000 deaths. Elderly people and patients with previous comorbidities such as hypertension and diabetes are at an increased risk to suffer a poor prognosis after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Although the same could be expected from patients with chronic obstructive pulmonary disease (COPD), current epidemiological data are conflicting. This could lead to a reduction of precautionary measures in these patients, in the context of a particularly complex global health crisis. Most COPD patients have a long history of smoking or exposure to other harmful particles or gases, capable of impairing pulmonary defences even years after the absence of exposure. Moreover, COPD is characterized by an ongoing immune dysfunction, which affects both pulmonary and systemic cellular and molecular inflammatory mediators. Consequently, increased susceptibility to viral respiratory infections have been reported in COPD, often worsened by bacterial co-infections and leading to serious clinical outcomes. The present paper is an up-to-date review that discusses the available research regarding the implications of coronavirus infection in COPD. Although validation in large studies is still needed, COPD likely increases SARS-CoV-2 susceptibility and increases COVID-19 severity. Hence, specific mechanisms to monitor and assess COPD patients should be addressed in the current pandemic.     

Convalescent plasma therapy in patients with COVID-19

IntroductionPassive antibody therapy has been used to immunize vulnerable people against infectious agents. In this study, we aim to investigate the efficacy of convalescent plasma (CP) in the treatment of severe and critically ill patients diagnosed with COVID-19.MethodThe data of severe or critically ill COVID-19 patients who received anti-SARS-CoV-2 antibody-containing CP along with the antiviral treatment (n = 888) and an age-gender, comorbidity, and other COVID-19 treatments matched severe or critically ill COVID-19 patients at 1:1 ratio (n = 888) were analyzed retrospectively.ResultsDuration in the intensive care unit (ICU), the rate of mechanical ventilation (MV) support and vasopressor support were lower in CP group compared with the control group (p = 0.001, p = 0.02, p = 0.001, respectively). The case fatality rate (CFR) was 24.7 % in the CP group, and it was 27.7 % in the control group. Administration of CP 20 days after the COVID-19 diagnosis or COVID-19 related symptoms were associated with a higher rate of MV support compared with the first 3 interval groups (≤5 days, 6?10 days, 11?15 days) (p=0.001).ConclusionCP therapy seems to be effective for a better course of COVID-19 in severe and critically ill patients.     

Decreased number of inpatients with community-acquired pneumonia during the COVID-19 pandemic: A large multicenter study in Japan

The COVID-19 pandemic has shaped the dynamics of many diseases. This study aims to assess how the pandemic affected community-acquired pneumonia admission of all age groups among Japanese hospitals with various size and availability of COVID-19 wards. Our findings revealed a 44%–53% reduction in community-acquired pneumonia admission among 82 hospitals in Japan, from April through September of 2020, compared to the same period of 2019. Decreases were consistently found among hospitals with and without COVID-19 wards. The most significant decrease was found in the age group <20 years old. COVID-19 preventive measures and personal hygiene are considered to be effective measures to prevent the spreading of this disease. As vaccination progresses and the public gradually become less attentive to infection countermeasures, incidence of community-acquired pneumonia may increase in the coming season. Continued monitoring is required.     

Epidemiological and clinical characteristics of 65 hospitalized patients with COVID-19 in Liaoning,China

BACKGROUNDCoronavirus disease 2019 (COVID-19) has spread rapidly to multiple countries through its infectious agent severe acute respiratory syndrome coronavirus 2. The severity, atypical clinical presentation, and lack of specific anti-viral treatments have posed a challenge for the diagnosis and treatment of COVID-19. Understanding the epidemiological and clinical characteristics of COVID-19 cases in different geographical areas is essential to improve the prognosis of COVID-19 patients and slow the spread of the disease.AIMTo investigate the epidemiological and clinical characteristics and main therapeutic strategy for confirmed COVID-19 patients hospitalized in Liaoning Province, China.METHODSAdult patients (n = 65) with confirmed COVID-19 were enrolled in this retrospective study from January 20 to February 29, 2020 in Liaoning Province, China. Pharyngeal swabs and sputum specimens were collected from the patients for the detection of severe acute respiratory syndrome coronavirus 2 nucleic acid. Patient demographic information and clinical data were collected from the medical records. Based on the severity of COVID-19, the patients were divided into nonsevere and severe groups. All patients were followed until March 20, 2020.RESULTSThe mean age of 65 COVID-19 patients was 45.5 ± 14.4 years, 56.9% were men, and 24.6% were severe cases. During the 14 d before symptom onset, 25 (38.5%) patients lived or stayed in Wuhan, whereas 8 (12.3%) had no clear history of exposure. Twenty-nine (44.6%) patients had at least one comorbidity; hypertension and diabetes were the most common comorbidities. Compared with nonsevere patients, severe patients had significantly lower lymphocyte counts [median value 1.3 × 10⁹/L (interquartile range 0.9-1.95) vs 0.82 × 10⁹/L (0.44-1.08), P < 0.001], elevated levels of lactate dehydrogenase [450 U/L (386-476) vs 707 U/L (592-980), P < 0.001] and C-reactive protein [6.1 mg/L (1.5-7.2) vs 52 mg/L (12.7-100.8), P < 0.001], and a prolonged median duration of viral shedding [19.5 d (16-21) vs 23.5 d (19.6-30.3), P = 0.001]. The overall median viral shedding time was 19.5 d, and the longest was 53 d. Severe patients were more frequently treated with lopinavir/ritonavir, antibiotics, glucocorticoid therapy, immunoglobulin, thymosin, and oxygen support. All patients were discharged following treatment in quarantine.CONCLUSIONOur findings may facilitate the identification of severe cases and inform clinical treatment and quarantine decisions regarding COVID-19.     

Medical research during the COVID-19 pandemic

The current pandemic of coronavirus disease 2019 (COVID-19) which was first detected in Wuhan, China in December 2019 is caused by the novel coronavirus named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The virus has quickly spread to a large number of countries leading to a great number of deaths. Unfortunately, till today there is no specific treatment or vaccination for SARS-CoV-2. Most of the suggested treatment medications are based on in vitro laboratory investigations, experimental animal models, or previous clinical experience in treating similar viruses such as SARS-CoV-1 or other retroviral infections. The running of any clinical trial during a pandemic is affected at multiple levels. Reasons for this include patient hesitancy or inability to continue investigative treatments due to self-isolation/quarantine, or limited access to public places (including hospitals). Additional barriers relate to health care professionals being committed to other critical tasks or quarantining themselves due to contact with COVID-19 positive patients. The best research approaches are those that adapt to such external unplanned obstacles. Ongoing clinical trials before COVID-19 pandemic have the potential for identifying important therapies in the long-term if they can be completed as planned. However, these clinical trials may require modifications due a pandemic such as this one to ensure the rights, safety, and wellbeing of participants as well as medical staff involved in the conduction of clinical trials. Clinical trials initiated during the pandemic must be time-efficient and flexible due to high contagiousness of severe acute respiratory syndrome coronavirus 2, the significant number of reported deaths, and time constraints needed to perform high quality clinical trials, enrolling adequate sample sizes. Collaboration between different countries as well as implementation of innovative clinical trial designs are essential to successfully complete such initiatives during the current pandemic. Studies looking at the long term sequalae of COVID-19 are also of importance as recent publications describe multi-organ involvement. Long term follow-up of COVID-19 survivors is thus also important to identify possible physical and mental health sequellae.