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。

Treatment strategies for hemorrhagic stroke in high-risk areas of Corona Virus Disease 2019

Objective To explore the treatment methods of the hemorrhagic stroke in high-risk areas of Corona Virus Disease 2019 (COVID-19) and preventive measures for COVID-19 cross-infection. Methods The clinical data of 53 patients with hemorrhagic stroke admitted to our hospital from January 22, 2020 to March 31, 2020 were retrospectively analyzed. Results All the patients were treated as high-risk suspected COVID-19 infection on admission. When the nucleic acid tests were negative twice, the operation was performed under tertiary protection in the negative pressure operation room. Of these 51 patients, 2 were diagnosed as COVID-19, and then transferred to the isolation ward of the infectious department after surgical treatment. Of 20 patients with spontaneous subarachnoid hemorrhage, 12 patients with intracranial aneurysms received endovascular intervention, 4 patients with intracranial aneurysms received clipping, 3 patients with moyamoya disease received conservative treatment, and 1 patient with arteriovenous fistula in the posterior fossa received embolization with OYNX and GRUB glue. Of 31 patients with hypertensive cerebral hemorrhage, 22 patients received craniotomy or stereotactic hematoma drainage, 9 with small hematoma received conservative treatment. No cross-infection of COVID-19 occurred. At discharge, 13 patients had modified Rankin scale (mRS) score of 0, 6 had mRS score of 1, 5 had mRS score of 2, 18 had mRS score of 3, 5 had mRS score of 4, 3 had mRS score of 5, and 1 had mRS score of 6. Conclusion In the high-risk areas of COVID-19, the treatment should be performed in the patients with hemorrhagic stroke according to three-level protective measures, which is the key to preventing COVID-19 cross-infection. However, waiting for nucleic acid testing may affect the surgical timing and efficacy of treatment of hemorrhagic stroke, and further optimization of COVID-19 nucleic acid testing is a top priority