肺超声在不同临床分型新型冠状病毒肺炎中的应用

目的 探讨不同临床分型新型冠状病毒肺炎(COVID-19)的肺部超声声像图特点,为临床诊断与疗效评估提供参考.方法 回顾性分析2020年3月至7月首都医科大学附属北京地坛医院收治经临床确诊的COVID-19患者共39例,其中普通型13例、重型15例、危重型11例,均于入院时行床旁肺超声检查,观察入组患者肺部超声声像图特...     

急诊床边肺部超声改良方案对新型冠状病毒肺炎患者肺部病灶的评估价值

目的以胸部CT影像学为依据,探讨急诊床边肺部超声改良方案(BLUE-plus)评估新型冠状病毒肺炎(COVID-19)肺部病变的临床价值。方法对西安市COVID-19定点医院西安市胸科医院2020年1~2月收治的22例COVID-19确诊病例按BLUE-plus行肺部超声动态检查,并与胸部CT进行对比,分别采用Kappa检验和ROC曲线分析其一致性和诊断准确性。结果22例COVID-19确诊病例按照BLUE-plus进行肺超声检查可见病灶多分布于后蓝点、下蓝点垂直向后与同侧腋后线的交点(PLAPS点),BLUE-plus与胸部CT检查的一致性Kappa值为0.73(95%CI:0.442~1.018、P<0.001)。BLUE-plus发现肺部病变的灵敏度为94.7%,特异度为83.3%,准确度为93.2%。患者在COVID-19进展期超声图像特征为B线逐步变为小斑片状肺实变,逐渐加重为大片状实变,且实变病灶内支气管充气征逐渐减少。患者于COVID-19恢复期超声图像特征与进展期相反。结论BLUE-plus可用于评估COVID-19患者的肺部病变及动态变化,为临床判断患者病情进展与恢复提供动态信息。     

表现为磨玻璃影的新型冠状病毒肺炎和早期肺肿瘤的CT影像学对比研究

目的回顾性分析以磨玻璃影(GGO)为表现的新型冠状病毒(2019-nCoV,SARS-CoV-2)肺炎(COVID-19)与早期肺肿瘤的CT影像学特点,以指导抗疫防治工作。方法回顾性纳入华中科技大学同济医学院附属同济医院2020年1月17日至2月13日收治的CT表现为GGO的COVID-19临床诊断71例患者,作为COVID-19组;以2017年9月至2019年5月收治的CT表现为GGO并行手术切除、术后病理证实为早期肺肿瘤患者80例作对照,为早期肺肿瘤组。分析两组患者性别、年龄、就诊症状(发热、咳嗽、乏力、肌痛、呼吸困难)、流行病学史、SARS-CoV-2核酸检测结果、肺肿瘤术后病理结果的临床特征及包括病灶数量、病灶位置、最大直径的CT影像特征。结果相比早期肺肿瘤组,COVID-19组具有特异性临床症状和流行病学史(P<0.001),而在高分辨率CT(high resolution CT,HRCT)上多表现为2个以上病灶(61例,85.92%,P<0.001),主要分布在双肺的外周1/2带(69例,97.18%,P<0.001),病灶形态多为最大径>1 cm的较大片状(65例,91.55%,P<0.001)。COVID-19组在病程初期与早期肺肿瘤组形态相似,但随着病程进展则出现融合实变,可能出现GGO样的COVID-19和早期肺肿瘤共存的现象。结论以GGO为表现的COVID-19与早期肺肿瘤在CT影像上具有既相似又独立的特征。充分了解两者的影像特点并结合患者病史、实验室检验和确诊金标准、短期复查CT协助评估,有利于实现应收尽收、减少交叉感染,打赢疫情防控阻击战。     

肺部超声在新冠肺炎重症患者中的应用

目的总结疫情一线麻醉科医师将肺部超声用于新型冠状病毒肺炎(COVID-19)重症患者的评估效果。方法回顾性分析2020年2月10日至3月12日在武汉火神山医院重症一科ICU内接受治疗的50例COVID-19重症患者的临床资料及床旁肺部超声检查结果。结果 50例COVID-19重症患者年龄(70.3±9.0)岁,初始症状是咳嗽(100%)、发热(100%)和呼吸困难(24%)。入院后28 d的死亡率为30%。ICU内床旁肺部超声检查可发现不同程度的超声学病理征象,包括胸膜异常,间质综合征、肺实变、胸腔积液、碎片征和动态支气管征象等。在ICU治疗期间存活的患者肺超声评分(LUS)(12.8±4.4)分,非存活者具有持续的肺水肿和肺实变超声表现,LUS(21.0±3.5)分,明显高于存活患者(P0.05)。15例非存活患者全部发生急性呼吸窘迫综合征(ARDS)并接受有创机械通气(IMV),其中ImV治疗3 d时LUS(22.0±1.9)分,5 d时LUS(24.2±2.6)分。随着患者康复并转出ICU,病理性的超声征象呈现逐步减少趋势。结论床旁肺部超声具有简便易行及动态监测的优势,对COVID-19重症肺炎患者疗效的评估具有积极意义。     

疫情期间非COVID-19患者静脉血栓栓塞症临床特征的单中心研究

目的:探讨新型冠状病毒肺炎（COVID-19）疫情是否影响非COVID-19患者的静脉血栓栓塞症（VTE）临床特征。方法:回顾性分析疫情期间（2020-01-23至2020-04-16）南京市第一医院介入血管科收治的因VTE就诊的非COVID-19患者临床资料,与2019同期VTE患者资料进行对比分析;同时以3月15日...     

新型冠状病毒肺炎受者接受肺移植治疗的研究现状及思考

2020年初, 席卷全球的新型冠状病毒肺炎(corona virus disease 2019, COVID-19)疫情冲击着全球医疗系统, 各国器官捐献数量、列入等待名单的受者数量和肺移植手术量, 都受到了不同程度的影响。肺移植临床研究领域最受到关注的, 是对患有COVID-19伴严重急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)及不可逆肺纤维化患者的救治。目前, 以中国、韩国为代表的亚洲国家, 以美国、加拿大为代表的北美地区和以巴西为代表的拉丁美洲国家和欧洲多国, 均开展了COVID-19相关ARDS及不可逆肺纤维化受者肺移植的相关临床研究和病例报道, 关注点主要在如何评估肺移植的时机以及受者的选择方面, 这也成为了2022年4月在美国波士顿举办的第42届国际心肺移植年会(International Society for Heart and Lung Transplantation, ISHLT)上的讨论热点。本文现对COVID-19疫情以来, 新型冠状病毒肺炎受者接受肺移植治疗的研究现状进行总结, 提出未来的研究方向, ...     

武汉胸外科医护人员及手术患者新型冠状病毒感染防治临床实践

目的总结武汉市大型三甲医院胸外科防治新型冠状病毒(2019-nCoV,SARS-CoV-2)肺炎(COVID-19)的临床经验,提供可行的临床实践策略。方法回顾性分析2019年12月15日至2020年2月15日武汉市7家大型三甲医院胸外科确诊COVID-1941例患者的临床资料,其中手术患者20例,男10例、女10例,年龄(54.35±10.80)岁;医护人员21例,男7例、女14例,年龄(30.38±6.23)岁。结果COVID-19患者临床表现主要为发热(70.73%)和咳嗽(53.66%)。COVID-19患者外周血白细胞总数正常或减少,淋巴细胞计数减少,部分患者可出现C反应蛋白增高。COVID-19患者胸部CT早期呈现局限性磨玻璃影改变,以肺外带明显,进而发展为双肺多发浸润影,严重者出现肺实变。确诊时医护人员多为磨玻璃影及单侧病变,甚至肺部无明显异常。COVID-19确诊患者均及时转入隔离病房按国家卫生健康委员会《新型冠状病毒肺炎诊疗方案》规范治疗。随访截至2020年2月20日,手术患者出院7例(35.00%),死亡7例(35.00%),医护人员出院13例(61.90%),无死亡。结论武汉市医院胸外科COVID-19患者中,手术患者重症比例及死亡率明显高于普通人群。医护人员易院内感染。早期氧疗及呼吸支持有可能改善预后。COVID-19疫情期间应推迟择期或限期手术。严格把握急诊手术指征。急诊手术应按三级防护处理。胸外科有专科特殊性,若有确诊患者,全科人员应积极排查。早发现、早隔离、早诊断、早治疗是改善COVID-19预后的最佳防治措施。     

新型冠状病毒肺炎疫情期间全国器官捐献与移植工作的指导原则(二○二○年二月二十三日通过)

2019年12月,我国湖北省发生新型冠状病毒肺炎(COVID-19)疫情,随即向多省市迅速蔓延。我国的器官移植事业正处于高质量发展阶段,如何在严峻的疫情期间科学有序地开展器官捐献与移植工作,总结分析器官移植受者COVID-19的临床特点并优化对COVID-19的预防、早期诊断和治疗策略,确保医疗安全,既关系到器官移植事业的发展和终末期器官功能衰竭患者的救治,又关系到全国乃至全球COVID-19疫情防控的大局。为此,根据国家卫生健康委员会指示要求,中华医学会器官移植学分会组织国内相关专家撰写了本指导原则,供我国器官捐献与移植工作者及管理者参照执行。本指导原则参考国内已发表的"专家建议"、"防治策略"和"指导意见",经中华医学会器官移植学分会常委会线上审议通过,并将随着对COVID-19的进一步认识和疫情防控形势的变化进行修订。     

新型冠状病毒肺炎患者早期外周血淋巴细胞亚群及细胞因子特征

目的 分析新型冠状病毒肺炎(COVID-19)早期(起病14天内)外周血免疫学特征及其与疾病严重程度的关系.方法 收集2020年1月至3月广州医科大学附属市八医院收治的98例确诊COVID-19患者住院资料,分析COVID-19早期外周血淋巴细胞亚群[CD4+ T、CD8+ T细胞、B细胞、自然杀伤(NK)细胞、NKT...     

可切除肺癌伴发肺结节良恶性的多因素分析

目的 分析可切除肺癌伴发的肺结节的临床特征,探讨恶性结节的预测指标,为优化手术切除范围提供科学依据.方法 纳入2013年9月～2019年12月我院手术治疗的肺癌同时存在伴发肺结节患者,收集患者的人口学特征,临床及影像学资料及病理结果,对良恶性伴发肺结节的特征进行单因素及多因素分析.结果 共入组93例,以女性(77.4％...     

Perioperative mortality and morbidity of hip fractures among COVID-19 infected and non-infected patients: A systematic review and meta-analysis

PurposeHip fractures among elderly patients are surgical emergencies. During COVID-19 pandemic time, many such patients could not be operated at early time because of the limitation of the medical resources, the risk of infection and redirection of medical attention to a severe infective health problem.MethodsA search of electronic databases (PubMed, Medline, CINAHL, EMBASE and the Cochrane Central Register of Controlled Trials) with the keywords “COVID”, “COVID-19″, “SARS-COV-2”, “Corona”, “pandemic”, “hip fracture”, “trochanteric fracture” and “neck femur fracture” revealed 64 studies evaluating treatment of hip fracture in elderly patients during COVID-19 pandemic time. The 30-day mortality rate, inpatient mortality rate, critical care/special care need, readmission rate and complications rate in both groups were evaluated. Data were analyzed using Review Manager (RevMan) V.5.3.ResultsAfter screening, 7 studies were identified that described the mortality and morbidity in hip fractures in both COVID-19 infected (COVID-19 +) and non-infected (COVID-19 −) patients. There were significantly increased risks of 30-day mortality (32.23% COVID-19 + death vs. 8.85% COVID-19 − death) and inpatient mortality (29.33% vs. 2.62%) among COVID-19 + patients with odds ratio (OR) of 4.84 (95% CI: 3.13 – 7.47, p < 0.001) and 15.12 (95% CI: 6.12 – 37.37, p < 0.001), respectively. The COVID-19 + patients needed more critical care admission (OR = 5.08, 95% CI: 1.49 – 17.30, p < 0.009) and they remain admitted for a longer time in hospital (mean difference = 3.6, 95% CI: 1.74 – 5.45, p < 0.001); but there was no difference in readmission rate between these 2 groups. The risks of overall complications (OR = 17.22), development of pneumonia (OR = 22.25), and acute respiratory distress syndrome/acute respiratory failure (OR = 32.96) were significantly high among COVID-19 + patients compared to COVID-19 − patients.ConclusionsThere are increased risks of the 30-day mortality, inpatient mortality and critical care admission among hip fracture patients who are COVID-19 +. The chances of developing pneumonia and acute respiratory failure are more in COVID-19 + patients than in COVID-19 ‒ patients.     

Chest CT in COVID-19 pneumonia: A review of current knowledge

The current COVID-19 pandemic has highlighted the essential role of chest computed tomography (CT) examination in patient triage in the emergency departments, allowing them to be referred to “COVID” or “non-COVID” wards. Initial chest CT examination must be performed without intravenous administration of iodinated contrast material, but contrast material administration is required when pulmonary embolism is suspected, which seems to be frequent in severe forms of the disease. Typical CT features consist of bilateral ground-glass opacities with peripheral, posterior and basal predominance. Lung disease extent on CT correlates with clinical severity. Artificial intelligence could assist radiologists for diagnosis and prognosis evaluation.     

Point-of-care lung ultrasound in patients with COVID-19 – a narrative review

Ultrasound imaging of the lung and associated tissues may play an important role in the management of patients with COVID-19–associated lung injury. Compared with other monitoring modalities, such as auscultation or radiographic imaging, we argue lung ultrasound has high diagnostic accuracy, is ergonomically favourable and has fewer infection control implications. By informing the initiation, escalation, titration and weaning of respiratory support, lung ultrasound can be integrated into COVID-19 care pathways for patients with respiratory failure. Given the unprecedented pressure on healthcare services currently, supporting and educating clinicians is a key enabler of the wider implementation of lung ultrasound. This narrative review provides a summary of evidence and clinical guidance for the use and interpretation of lung ultrasound for patients with moderate, severe and critical COVID-19–associated lung injury. Mechanisms by which the potential lung ultrasound workforce can be deployed are explored, including a pragmatic approach to training, governance, imaging, interpretation of images and implementation of lung ultrasound into routine clinical practice.     

A comprehensive narrative review of the cutaneous manifestations associated with COVID-19

The systemic and respiratory clinical manifestations of coronavirus disease 2019 (COVID-19) include fever, coughing, sneezing, sore throat, rhinitis, dyspnea, chest pain, malaise, fatigue, anorexia and headache. Moreover, cutaneous manifestations have been reported in 0.2% to 20.4% of cases. Early diagnosis of COVID-19 leads to a better prognosis; knowledge of its cutaneous manifestations is one way that may help fulfil this goal. In this review, PubMed and Medline were searched with the terms “dermatology”, “skin” and “cutaneous”, each in combination with “SARS-CoV-2” or “COVID-19”. All articles, including original articles, case reports, case series and review articles published from the emergence of the disease to the time of submission, were included. In this comprehensive narrative review, we tried to provide an analysis of the cutaneous manifestations associated with COVID-19, including maculopapular rash, urticaria, Chilblain-like, vesicular lesions, livedo reticularis and petechiae in asymptomatic/symptomatic COVID-19 patients that might be the first complication of infection after respiratory symptoms. Immune dysregulation, cytokine storms, side effects of antiviral drugs, environmental conditions and high-dose intravenous immunoglobulin (IVIG) therapy might be involved in the pathogenesis of the cutaneous manifestations in COVID-19 patients. Therefore, knowledge of cutaneous COVID-19 manifestations might be vital in achieving a quick diagnosis in some COVID-19 patients, which would help control the pandemic. Further research is very much warranted to clarify this issue.     

CT features of lung metastases from pancreatic adenocarcinoma: Correlation with histopathologic findings

PurposeThe purpose of this study was to evaluate the prevalence of an atypical, alveolar presentation of pulmonary metastases from pancreatic adenocarcinoma (PDAC) on computed tomography (CT) and to correlate CT features with those obtained at histopathologic analysis.Material and methodsA total of 76 patients with lung metastases from PDAC over a 10-year period (2009–2019) in a French university hospital were retrospectively included. There were 34 men and 42 women with a mean age of 67.6 ± 11.3 (SD) years (range: 38–89 years). CT features of PDAC were classified according to their presentations as usual metastatic pattern or atypical alveolar pattern; the atypical alveolar pattern corresponding to either ground glass nodules or opacities, solid nodules with a halo sign, “air-space” nodules with air bronchogram, or parenchymal consolidation. Imaging-histopathologic correlation was performed when tissue samples were available.ResultsPulmonary metastases were synchronous in 36 patients (36/76; 47%) and metachronous in 40 patients (40/76; 53%). A predominant alveolar presentation on CT was observed in 17 patients (17/76, 22%). Nodules with halo sign were the predominant alveolar pattern in 7 patients (7/17; 41%), air-space nodules were predominant in 4 patients (4/17; 24%) whereas pure ground glass nodules and consolidations were observed as predominant features in 3 patients (3/17; 18%) each. For 5 patients who had histopathological confirmation, alveolar metastases of PDAC were characterized by columnar tumor cells lining the alveolar wall, which was not seen in other radiological presentations, whereas there were no differences regarding mucin secretion between pulmonary metastases with alveolar presentation and those with typical pattern.ConclusionsLung metastases from PDAC may present with a so-called “alveolar” pattern on CT. This misleading CT features is found in 22% of patients with lung metastases from PDAC and is due to lepidic growth of the metastatic cells.