新型冠状病毒感染诊治进展

新型冠状病毒感染是一种新发传染病,已持续在全球流行近2年,严重影响了人类的健康与经济的发展.至今,新型冠状病毒感染尚无特效抗病毒药物,防控策略主要采取早发现、早报告和早隔离,增加疫苗接种率建立有效免疫屏障,采取对症、支持、免疫治疗、适当给予抗病毒治疗、中医中药等治疗.有效的抗病毒药物研发和进一步疫苗的研发是控制疫情重要...     

腹腔镜手术器械的消毒灭菌处理

腹腔镜手术器械比普通手术器械的构造复杂、精细,有细小的管腔,不易清洗,极易残留污物,给清洗和消毒带来困难。所以,对此类器械要严格遵守清洗消毒流程,才能确保腹腔镜的手术安全,预防医院感染的发生。1腹腔镜器械的清洗腹腔镜器械的清洗严格按内镜清洗操作规范,每台手术结束后所用的器械先用流水冲净去除血液,然后用注射器或高压水枪冲洗腔道,拆卸器械各关节及部件,器械的轴节部、弯曲部、管腔内用软毛刷彻底刷洗,再擦干。将擦干后的器械置于多酶洗液中浸泡或超声清洗机洗10~30min,然后用流水冲洗并精细刷洗各个关节缝隙,最后擦干并上油。2…     

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。     

新型冠状病毒感染防控护理质量指标体系的构建

[目的]探讨初步构建一套科学、全面、客观的防控新型冠状病毒感染的护理质量指标体系。[方法]通过文献检索、国家政策指引等在三维质量结构理论基础上初步拟定护理质量指标,应用德尔菲专家函询法及层次分析法对指标进行初筛并确定指标权重,最终建立新型冠状病毒感染防控的护理质量指标体系。[结果]经过两轮函询,各级指标专家意见趋于一致,最终确定新型冠状病毒感染防控护理质量指标一级指标3项(结构指标、过程指标和结果指标),二级指标26项,三级指标102项。[结论]该指标体系的构建可规范管理新型冠状病毒感染防控各项工作,为各医疗机构评价新型冠状病毒感染防控护理工作提供客观、可量化依据。     

80例新型冠状病毒感染肺炎患者相关血液检测指标分析

目的研究新型冠状病毒感染肺炎患者实验室检测指标变化的情况及其临床意义,为临床诊断、治疗提供科学参考依据。方法回顾性分析本院在2020年收治的80例新冠肺炎确诊患者的相关血液检测指标,将健康体检者分为A组(n=40例),疑似新型冠状病毒感染的肺炎患者分为B组(n=40例),确诊为新型冠状病毒感染的肺炎患者分为C组(n=80例),比较三组人群的实验室血常规、T 淋巴细胞亚群免疫分型及生化等指标的变化水平。结果确诊组C组WBC、L(%)、RBC、HGB、CD3~+、CD4~+、CD8~+、BUN、UA均低于健康组A组,差异均有统计学意义(P0.05);确诊组C组G(%)、hs-CRP、ALT、AST、TB、DB、SAA、LDH、CK-MB均高于健康组A组,差异均有统计学意义(P0.05)。确诊组C组CD4~+、TnI均低于疑似组B组,差异均有统计学意义(P0.05);确诊组C组AST、SAA、LDH 、CK-MB均高于疑似组B组,差异均有统计学意义(P0.05);三组之间PLT、CD4~+/ CD8~+、CR、CYC、PCT、MYO、CK等项目差异均无统计学意义(P0.05)。多因素二元logistic逐步回归分析显示,SAA、CK-MB、LDH、AST、TB、DB越高,患新冠肺炎的危险性越大;WBC、L%、HGB、BUN、UA、CD4~+、CD8~+ 越低,患新冠肺炎的危险性也越大。结论新型冠状病毒肺炎患者的各项实验室指标有明显变化,对于病毒感染的早期诊断和治疗具有较强的参考价值,是对核酸金标准的有效补充,应予以重视。     

新型冠状病毒肺炎感染病房的护理管理实践

目的探讨新型冠状病毒肺炎感染病房的护理管理方法及效果。方法某部援汉医疗队利用武汉某定点医院有限的医疗卫生资源,充分准备、严格培训、有序组织、合理规划、科学管理、严防严控,因地制宜地制订分级诊疗方案及护理管理策略,为类似的事件同行提供借鉴和参考。结果该医院呼吸科病区共收治确诊新型冠状病毒肺炎患者125例,其中病危19例,病重33例,医护人员零感染。结论科学的防控及管理对有效控制病毒传播,提高救治成功率及保障医护人员零感染至关重要。     

新型冠状病毒肺炎患者新型冠状病毒抗体持续阳性时间的影响因素

目的 分析影响新型冠状病毒肺炎(COVID?19)患者的新型冠状病毒(SARS?CoV?2)抗体持续阳性时间的影响因素.方法 回顾性分析我院于2020年1月21日至10月25日收治并随访时间超过6个月的43例COVID?19患者,比较发病后随访6个月时抗体转阴组患者与持续阳性组患者的临床特点.结果 随访超过6个月的43...     

Using high sensitivity cardiac troponin values in patients with SARS-CoV-2 infection (COVID-19): The Padova experience

BackgroundThe spectrum of Coronavirus Disease 2019 (COVID-19) is broad and thus early appropriate risk stratification can be helpful. Our objectives were to define the frequency of myocardial injury using high-sensitivity cardiac troponin I (hs-cTnI) and to understand how to use its prognostic abilities.MethodsRetrospective study of patients with COVID-19 presenting to an Emergency Department (ED) in Italy in 2020. Hs-cTnI was sampled based on clinical judgment. Myocardial injury was defined as values above the sex-specific 99th percentile upper reference limits (URLs). Most data is from the initial hospital value.Results426 unique patients were included. Hs-cTnI was measured in 313 (73.5%) patients; 85 (27.2%) had myocardial injury at baseline. Patients with myocardial injury had higher mortality during hospitalization (hazard ratio = 9 [95% confidence interval (CI) 4.55–17.79], p < 0.0001). Multivariable analysis including clinical and laboratory variables demonstrated an AUC of 0.942 with modest additional value of hs-cTnI. Myocardial injury was associated with mortality in patients with low APACHE II scores (<13) [OR (95% CI): 4.15 (1.40, 14.22), p = 0.014] but not in those with scores > 13 [OR (95% CI): 0.48 (0.08, 2.65), p = 0.40]. Initial hs-cTnI < 5 ng/L identified 33% of patients that were at low risk with 97.8% sensitivity (95% CI 88.7, 99.6) and 99.2% negative predictive value. Type 1 myocardial infarction (MI) and type 2 MI were infrequent.Conclusionshs-cTnI at baseline is a significant predictor of mortality in COVID-19 patients. A value < 5 ng/L identified patients at low risk.     

53例腹部外科脓毒症患者并发多器官功能障碍综合征的救治分析

目的　探索降低腹部外科脓毒症患者并发MODS的死亡率的综合治疗措施。方法　 (1)整体治疗MODS时 ,在“炎性介质、细菌、内外毒素、微循环、免疫功能、营养代谢、基础疾病、脏器功能”等方面进行兼顾和并治 ,并相应实施 14条具体治疗措施 ;(2 )提出了短程联合应用山莨菪碱、地塞米松为主的综合救治方案 ;(3)提出并应用了“分阶段代谢营养支持”治疗 ,减少了严重并发症的发生率 ;(4)采用自制的“解毒固本汤”配合治疗 ,以改善免疫紊乱状态、调控炎性介质等。结果　按KnausW A教授MODS的诊断标准 ,本组共 5 3例 ,应用传统常规疗法的 31例患者 ,2 2例死亡 ,死亡率为 70 96 %。采用采用综合救治新策略的 2 2例患者 ,死亡 8例 ,病死率为 36 36 %。两组经t检验 ,P <0 0 1。结论　腹腔严重感染致MODS治疗困难 ,病死率高 ,采用综合救治新对策疗法能降低MODS的病死率。     

SARS-CoV-2, surgeons and surgical masks

The exact risk association of coronavirus disease 2019 (COVID-19) for surgeons is not quantified which may be affected by their risk of exposure and individual factors. The objective of this review is to quantify the risk of COVID-19 among surgeons, and explore whether facemask can minimise the risk of COVID-19 among surgeons. A systematised review was carried out by searching MEDLINE to locate items on severe acute respiratory syndrome coronavirus 2 or COVID-19 in relation to health care workers (HCWs) especially those work in surgical specialities including surgical nurses and intensivists. Additionally, systematic reviews that assessed the effectiveness of facemask against viral respiratory infections, including COVID-19, among HCWs were identified. Data from identified articles were abstracted, synthesised and summarised. Fourteen primary studies that provided data on severe acute respiratory syndrome coronavirus 2 infection or experience among surgeons and 11 systematic reviews that provided evidence of the effectiveness of facemask (and other personal protective equipment) were summarised. Although the risk of COVID-19 could not be quantified precisely among surgeons, about 14% of HCWs including surgeons had COVID-19, there could be variations depending on settings. Facemask was found to be somewhat protective against COVID-19, but the HCWs’ compliance was highly variable ranging from zero to 100%. Echoing surgical societies’ guidelines we continue to recommend facemask use among surgeons to prevent COVID-19.     

Intubation timing as determinant of outcome in patients with acute respiratory distress syndrome by SARS-CoV-2 infection

PurposeTo determine whether time-to-intubation was associated with higher ICU mortality in patients with COVID-19 on mechanical ventilation due to respiratory insufficiency.Materials and methodsWe conducted an observational, prospective, single-center study of patients with confirmed SARS-CoV-2 infection hospitalized with moderate to severe ARDS, connected to mechanical ventilation in the ICU between March 17 and July 31, 2020. We examined their general and clinical characteristics. Time-to-intubation was the time from hospital admission to endotracheal intubation.ResultsWe included 183 consecutive patients; 28% were female, and median age was 62 years old. Eighty-eight patients (48%) were intubated before 48 h (early) and ninety-five (52%) after 48 h (late). Patients intubated early had similar admission PaO₂/FiO₂ ratio (123 vs 99; p = 0.179) but were younger (59 vs 64; p = 0.013) and had higher body mass index (30 vs 28; p = 0.006) compared to patients intubated late. Mortality was higher in patients intubated late (18% versus 43%), with admission PaO₂/FiO₂ ratio < 100 mmHg (OR 5.2; p = 0.011), of older age (OR 1.1; p = 0.001), and with previous use of ACE inhibitors (OR 4.8; p = 0.026).ConclusionsIn COVID-19 patients, late intubation, Pafi <100, older age, and previous ACE inhibitors use were associated with increased ICU mortality.