新型冠状病毒肺炎患者手术流程和感染防控措施以及实施体会

2019年底我国暴发新型冠状病毒感染肺炎疫情,解放军总医院第五医学中心立即展开疫情防控的各项应急预案,我院外科手术室也紧急制定了新型冠状病毒肺炎患者手术流程及感染防控措施,主要做好医务人员管理、培训、术前评估、术前准备、接送手术患者流程、术中护理配合、术后器械与环境物表的消毒处理等,在实际工作中对上述措施不断进行了修正。     

Management and implementation strategies of pre-screening triage in children during coronavirus disease 2019 pandemic in Guangzhou,China

BACKGROUNDEmerging infectious diseases are a constant threat to the public’s health and health care systems around the world. Coronavirus disease 2019 (COVID-2019), which was defined by the World Health Organization as pandemic, has rapidly emerged as a global health threat. Outbreak evolution and prevention of international implications require substantial flexibility of frontline health care facilities in their response.AIMTo explore the effect of the implementation and management strategy of pre-screening triage in children during COVID-19.METHODSThe standardized triage screening procedures included a standardized triage screening questionnaire, setup of pre-screening triage station, multi-point temperature monitoring, extensive screenings, and two-way protection. In order to ensure the implementation of the pre-screening triage, the prevention and control management strategies included training, emergency exercise, and staff protection. Statistical analysis was performed on the data from all the children hospitalized from January 20, 2020 to March 20, 2020 at solstice during the pandemic period. Data were obtained from questionnaires and electronic medical record systems. RESULTSA total of 17561 children, including 2652 who met the criteria for screening, 192 suspected cases, and two confirmed cases without omission, were screened from January 20, 2020 to March 20, 2020 at solstice during the pandemic period. There was zero transmission of the infection to any medical staff. CONCLUSIONThe effective strategies for pre-screening triage have an essential role in the prevention and control of hospital infection.     

The cardiovascular aspect of COVID-19

The coronavirus disease-2019 (COVID-19), an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2), has hit the world very hard by affecting millions of people across countries hence posing a major health threat on a global scale. This novel virus is thought to enter and cause infection in its host through the attachment of its structural protein known as the S-glycoprotein to angiotensin-converting enzyme 2 (ACE2). Given the rapid spread of COVID-19 with its consequences globally, it is mandatory that health caregivers and researchers across all disciplines abreast themselves with the potential effects that this novel virus may have on their fields and the medical society at large. During the infection, the cardiovascular system is affected by unknown pathomechanistic processes, hence accounting for an increased prevalence of cardiovascular diseases (CVDs) among COVID-19 patients. As cardiovascular researchers, we are more concerned about the cardiovascular aspect of SARS-CoV-2/COVID-19. Hence, this concise review addresses these aspects where CVD as a risk factor of COVID-19, the prevalence of CVDs in COVID-19, and the potential cardiovascular disorders which may evolve owing to COVID-19 are discussed. A better understanding of these issues will be pivotal to improve cardiovascular health during this SARS-CoV-2/COVID-19 pandemic and beyond.     

Problematics of neurosurgical service during the COVID-19 pandemic in Slovenia

The novel coronavirus disease 2019 (COVID-19) is an ongoing disease caused by severe acute respiratory syndrome coronavirus-2 that still poses an important and urgent threat to global health. In Slovenia, the epidemic was declared on March 12^th, 2020, and since then COVID-19 has had a great impact on our health system. The field of neurosurgery in particular has been experiencing difficulties in both elective and emergency service. In this article, we described epidemiologic protocols and the effect that the COVID-19 pandemic had on the surgical practice and workflow of the Department of Neurosurgery at the University Medical Centre Ljubljana. We analyzed and compared the number of elective and emergency neurosurgical procedures in a 2-year period before and during the pandemic. We recorded a drop in cases mostly on account of elective procedures whilst emergency service remained relatively unaffected.     

新型冠状病毒肺炎疫情防控期间四脑室-延髓肿瘤切除术后ARDS救治一例及文献复习

在新型冠状病毒肺炎疫情防控期间,陆军军医大学第一附属医院神经外科急诊收治一例四脑室-延髓肿瘤伴梗阻性脑积水患者。成功切除肿瘤后患者继发急性呼吸窘迫综合征,影像学及血液检查指标高度疑似新型冠状病毒感染,且患者合并甲型和乙型流感病毒既往感染,对医护人员鉴别诊断、临床救治及疫情防控提出挑战。本文报告该病例的综合救治及应急处理,并结合文献分析神经源性肺水肿形成原因,指导我们在脑与外周器官交互作用基础上为神经重症患者提供更有利的医疗决策。     

北京协和医院成人新型冠状病毒感染患者术前评估与手术时机选择建议(2023)

随着我国疫情防控措施的调整,新型冠状病毒感染患者的术前评估、手术时机选择已成为医患双方共同关注的焦点问题。为此,北京协和医院组织相关多学科专家,遵循简明、个体化、分层分型、临床可操作的原则,结合最新临床指南、国内外临床研究证据与经验,编写了《北京协和医院成人新型冠状病毒感染患者术前评估与手术时机选择建议(2023)》。本建议提出,成人新型冠状病毒感染患者术前评估需关注新型冠状病毒感染史、症状严重程度、康复情况等;综合考虑患者基础疾病、症状严重程度、手术麻醉等因素,进行全面、个体化的评估,从而为医务人员开展术前评估及手术时机选择提供决策支持,有助于加强围术期管理并提升术后康复质量。     

老年危重型新冠肺炎患者救治病例报告

2020年2月8日,阳光融和医院收治1例重型新冠肺炎感染患者,病情进展迅速,短期内转为新冠肺炎危重型患者,后经精心治疗与护理,该患者2次咽拭子核酸检测阴性,解除隔离,转入隔离观察区继续治疗基础疾病,且参与本次救治的重症组所有医护人员无感染发生。本文回顾了该新冠肺炎危重型患者救治过程中的工作情景及细节,以病例讨论的形式,还原诊疗过程、护理记录,针对该患者护理中的重点、疑点、难点进行讨论分析,旨在总结新冠肺炎的护理要点,提高对危重型新冠肺炎患者在不同时期的护理管理,推广医护人员避免感染的防护措施,为临床救治新冠肺炎危重型患者提供医疗及护理经验,为医护人员职业防护提供依据。     

Surgery for pancreatic tumors in the midst of COVID-19 pandemic

The spread of the new coronavirus (COVID-19) infection in 2020 has had a significant impact on the treatment of cancer worldwide. During the COVID-19 pandemic, the biggest challenge for pancreatic surgeons is the difficulty in providing oncological care. In this review article, from the standpoint of surgeons, we explain the concept of triaging of patients with pancreatic tumors under the COVID-19 pandemic, and the actual impact of COVID-19 on the treatment of patients with pancreatic tumors. The most vital points in selecting the best therapeutic approach for patients with pancreatic tumors during this pandemic are (1) Oncologists need to tailor the treatment plan based on the COVID-19 phase, tumor malignant potential, and patients’ comorbidities; and (2) Optimal treatment for pancreatic cancer should be planned according to the condition of each patient and tumor resectability based on national comprehensive cancer network resectability criteria. To choose the best therapeutic approach for patients with pancreatic tumors during this pandemic, we need to tailor the treatment plan based on elective surgery acuity scale (ESAS). Newly established ESAS for pancreatic tumor and flowchart indicating the treatment strategy of pancreatic cancer, are feasible to overcome this situation.     

French Spine Surgery Society guidelines for management of spinal surgeries during COVID-19 pandemic

Since the outbreak of coronavirus disease 2019 (COVID-19) in December 2019 in China, various measures have been adopted in order to attenuate the impact of the virus on the population. With regard to spine surgery, French physicians are devoted to take place in the national plan against COVID-19, the French Spine Surgery Society therefore decided to elaborate specific guidelines for management of spinal disorders during COVID-19 pandemic in order to prioritize management of patients. A three levels stratification was elaborated with Level I: Urgent surgical indications, Level II: Surgical indications associated to a potential loss of chance for the patient and Level III: Non-urgent surgical indications. We also report French experience in a COVID-19 cluster region illustrated by two clinical cases. We hope that the guidelines formulated by the French Spine Surgery Society and the experience of spine surgeons from a cluster region will be helpful in order optimizing the management of patients with urgent spinal conditions during the pandemic.     

基于新型冠状病毒肺炎疫情防控的大型公立医院医疗流程构建

新型冠状病毒肺炎疫情的全球暴发给医院应急防控带来严峻挑战.大型公立医院作为应对新型冠状病毒肺炎的主战场,应从门诊、急诊、住院、手术、出院全流程进行把控.预检分诊作为医院的首层关卡,是疫情防控的关键节点,需重点关注并加强相关应对机制的建设,以快速遏制外源性/内源性危险因素;同时落实全员培训与考核,加强互联网诊疗等信息化建...     

Are Migraine Patients at Increased Risk for Symptomatic Coronavirus Disease 2019 Due to Shared Comorbidities?

The coronavirus disease 2019 (COVID-19) pandemic has rapidly transformed the whole world and forced us to look through comorbid diseases and risk factors from a different perspective. COVID-19 shows some inherent risk factors like cardiovascular comorbidities independent from age, gender, and geographic location. One of the most peculiar features of the COVID-19 pandemic is that severe acute respiratory syndrome coronavirus 2 respiratory infections disproportionately impact patients with hypertension, diabetes, and other cardiovascular comorbidities rather than those with allergic respiratory diseases and immune-compromised conditions. Migraine is a complex neuro-vasculo-inflammatory disorder that is also packed frequently with certain medical conditions including vascular disorders, hypertension, allergic diseases such as asthma and systemic inflammatory disorders. Accordingly, 2 different questions arise during the pandemic: (1) Do share comorbidities of cardiovascular diseases and hypertension increase the risk of symptomatic COVID-19 for migraine patients? (2) Do comorbid allergic and atopic diseases, including asthma act as opposite influencers alongside with female gender? This paper focuses on the co-existence of comorbidities of COVID-19, in comparison with migraine, based on a wide clinical dataset and available reports. Discussed mechanisms include potential strategic roles of angiotensin-converting enzyme 2, angiotensin-II, and nucleotide oligomerization domain-like receptor family, pyrin domain containing 3 inflammasome, playing remarkable parts in the pathogenesis of COVID-19 and migraine. There are also some clues about the importance of endothelial and pericyte dysfunction and neuroinflammation in COVID-19 infection, related to complications and survival of the patients. The large epidemiological studies as well as basic research, focusing on migraine patients with COVID-19 will clarify these vital questions during the upcoming periods.     

Combined cesarean delivery and repair of acute aortic dissection at 34 weeks of pregnancy during COVID-19 outbreak: A case report

BACKGROUNDSince the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, the exclusion of a patient from COVID-19 should be performed before surgery. However, patients with type A acute aortic dissection (AAD) during pregnancy can seriously endanger the health of either the mother or fetus that requires emergency surgical treatment without the test for COVID-19. CASE SUMMARYA 38-year-old woman without Marfan syndrome was admitted to the hospital because of chest pain in the 34^th week of gestation. She has diagnosed as having a Stanford type-A AAD involving an aortic arch and descending aorta via aortic computed tomographic angiography. The patient was transferred to the isolated negative pressure operating room in one hour and underwent cesarean delivery and ascending aorta replacement. All medical staff adopted third-level medical protection measures throughout the patient transfer and surgical procedure. After surgery, the patient was transferred to the isolated negative pressure intensive care unit ward. The nucleic acid test and anti-COVID-19 immunoglobulin (Ig) G and IgM were performed and were negative. The patient and infant were discharged without complication nine days later and recovered uneventfully. CONCLUSIONThe results indicated that the procedure that we used is feasible in patients with a combined cesarean delivery and surgery for Stanford type-A AAD during the COVID-19 outbreak, which was mainly attributed to rapid multidisciplinary consultation, collaboration, and quick decision-making.     

基于新型冠状病毒肺炎疫情防控的大型公立医院医疗流程构建

新型冠状病毒肺炎疫情的全球暴发给医院应急防控带来严峻挑战。大型公立医院作为应对新型冠状病毒肺炎的主战场,应从门诊、急诊、住院、手术、出院全流程进行把控。预检分诊作为医院的首层关卡,是疫情防控的关键节点,需重点关注并加强相关应对机制的建设,以快速遏制外源性/内源性危险因素;同时落实全员培训与考核,加强互联网诊疗等信息化建设,为医院诊疗工作的有序开展保驾护航。     

Surgical treatment of hepatocellular carcinoma in the era of COVID-19 pandemic: A comprehensive review of current recommendations

The new coronavirus disease 2019 (COVID-19) pandemic has resulted in a global health emergency that has also caused profound changes in the treatment of cancer. The management of hepatocellular carcinoma (HCC) across the world has been modified according to the scarcity of care resources that have been diverted mostly to face the surge of hospitalized COVID-19 patients. Oncological and hepatobiliary societies have drafted recommendations regarding the adaptation of guidelines for the management of HCC to the current healthcare situation. This review focuses on specific recommendations for the surgical treatment of HCC (i.e., hepatic resection and liver transplantation), which still represents the best chance of cure for patients with very early and early HCC. While surgery should be pursued for very selected patients in institutions where standards of care are maintained, alternative or bridging methods, mostly thermoablation and transarterial therapies, can be used until surgery can be performed. The prognosis of patients with HCC largely depends on both the characteristics of the tumour and the stage of underlying liver disease. Risk stratification plays a pivotal role in determining the most appropriate treatment for each case and needs to balance the chance of cure and the risk of COVID-19 infection during hospitalization. Current recommendations have been critically reviewed to provide a reference for best practices in the clinical setting, with adaptation based on pandemic trends and categorization according to COVID-19 prevalence.     

新型冠状病毒肺炎相关性急性胰腺炎：证据，挑战与思考

由新型冠状病毒（SARS-CoV-2）感染引起的新型冠状病毒肺炎（COVID-19）自2019年12月发病以来,现已全球大流行。COVID-19除影响呼吸系统外,还可造成全身多系统、多脏器的损害。目前关于COVID-19累及胰腺的证据十分有限,COVID-19患者中急性胰腺炎（AP）的发病率存在不确定性,其临床特征和发病机制也存在诸多疑问。在全球COVID-19流行仍未得到完全控制的背景下,由于目前对COVID-19与AP之间相互作用知之甚少,我们必须警惕他们之间可能存在的联系。临床上诸多治疗程序需要合理化,应采取有效的防护措施,在科学诊治患者的同时有效避免医护人员SARS-CoV-2感染。     

北京协和医院成人新型冠状病毒感染实用诊疗建议(2023)

随着我国疫情防控措施的科学调整,新型冠状病毒感染患者尤其是重症、危重症患者的救治成为医务人员现阶段的工作重点。疫情发生以来,北京协和医院在新型冠状病毒感染救治方面积累了较多经验,在结合众多国际循征医学证据的基础上,新型冠状病毒感染诊疗多学科专家组编写了《北京协和医院成人新型冠状病毒感染实用诊疗建议(2023)》。秉承循证、简洁、临床可操作的原则,本诊疗建议对目前最新研究证据进行整合,对于缺乏循证医学证据的关键临床问题,结合北京协和医院一线临床工作经验和专家意见给出一定推荐,旨在提升医务人员对新冠病毒感染及其危重症的认识,提高患者救治水平。     

新型冠状病毒肺炎疫情防控期间放疗科的应对策略与思考

新型冠状病毒肺炎疫情属于突发公共卫生事件,严重威胁人类健康,肿瘤患者是新型冠状病毒感染的高危人群.放疗作为肿瘤治疗的重要手段之一,在疫情期间成为重要的替代或延缓手术的治疗手段.北京协和医院放疗科在疫情防控期间通过制定严密而科学的防控管理体系,保证了放疗工作的顺利开展.本文对防控管理相关策略进行总结与思考,为突发公共卫生...     

Management of cancer patients during the COVID-19 pandemic:A narrative review

Objective: We wrote this review with the objective of helping the physicians to manage patients with cancer during the COVID-19 pandemic. Background: In the absence of specific curative treatments, COVID-19 exerted worldwide a dramatic impact on public health and socio-economic aspects. Patients with cancer represent a vulnerable population when suffering from COVID-19 infection since they usually present a series of risk factors such as immunosuppressed state, older age, comorbidities(e.g., cardiovascular diseases, chronic lung disease, diabetes) and need for frequent hospitalizations and visits. A series of observational studies demonstrated that cancer patients infected with COVID-19, particularly with lung cancer, have a high rate of morbidity and mortality. Methods: We conducted a review of several observational studies and guidelines regarding the management of cancer patients in the context of COVID-19 infection. Conclusions: The oncologists, according to the main available recommendations, should carefully weigh risks/benefits when planning therapies and follow-up visits. They should defeat the "distraction effect" of the pandemic, which is represented by the risk of shifting attention away from standard therapeutic approach to COVID-19 only. In addition, health authorities should prioritize COVID-19 vaccinations for cancer patients with the aim of limiting the consequences of the pandemic in this particularly frail population.     

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。     

Emergency Department Use by Young Adults With Chronic Illness Before and During the COVID-19 Pandemic

IntroductionThere was a significant decrease in emergency department encounters during the COVID-19 pandemic. Our large urban emergency department observed decreased encounters and admissions by youths with chronic health conditions. This study aimed to compare the frequency of emergency department encounters for certain young adults before the pandemic and during the COVID-19 pandemic.MethodsA retrospective cohort study using medical records of patients ages 20 to 26 years from October 2018 to September 2019 and February 2020 to February 2021. Files set for inclusion were those with a primary diagnosis of human immunodeficiency virus, diabetes mellitus, epilepsy, cerebral palsy, sickle cell disease, asthma, and certain psychiatric disorders for potentially preventable health events.ResultsWe included 1203 total encounters (853 before the pandemic and 350 during the pandemic), with the total number of subjects included in the study 568 (293 before the pandemic to 239 during the pandemic). During the pandemic, young adults with mental health conditions (53.1%) accounted for most encounters. Encounters requiring hospital admissions increased from 27.4% to 52.5% during the pandemic, primarily among patients with diabetes (41.8% vs 61.1%) and mental health conditions (50% vs 73.3%).DiscussionThe number of young adults with certain chronic health conditions decreased during COVID-19, with encounters for subjects with mental health conditions increasing significantly. The proportion of admissions increased during the pandemic with increases for subjects with mental health disorders and diabetes. The number of frequent users decreased during COVID-19. Future research is needed to understand better the causes for these disparities in young adults with chronic conditions who use the emergency department as a source of care.