新型冠状病毒肺炎疫情期间急诊眼外伤疾病谱特点及流行病学分析

目的 分析新型冠状病毒肺炎疫情期间眼科急诊眼外伤疾病谱变化趋势及流行病学特点。设计 回顾性比较性病例系列。研究对象 以2020年1月23日至3月31日北京同仁医院眼科急诊就诊的1209例眼外伤患者作为研究组，以2019年同期就诊的2444例眼外伤患者作为对照组。方法 通过医院信息系统调取数据，登记并整理患者的年龄、性别、就诊时间、眼外伤类别、致伤部位、就诊数量等情况，对眼外伤急诊疾病谱变化及流行病学特点进行分析。主要指标 年龄、性别、就诊时间、急诊诊断、患者数量。结果 疫情期间眼科急诊患者总数5978例，眼外伤患者1209例，占20.2%；2019年同期眼科急诊患者总数12776例，眼外伤患者2444例，占19.1%（χ2=3.111，P=0.078）。研究组男性患者835例（69.1%），对照组男性患者1743例（71.3%）（χ2=1.976，P=0.160）。研究组患者年龄37.0（26.5，52.0）岁，对照组患者年龄35.0（22.0，50.0）岁（U=1369248.50，P＜0.001）。两组间各年龄组的就诊患者均以青年组（18~44岁）占比最高（研究组561例，46.4%；对照组1090例，44.6%）（χ2=1.062，P=0.303）；未成年组（0~17岁）患者就诊例数及比例的差异有统计学意义（研究组199例，16.5%；对照组548例，22.4%）（χ2=17.854，P＜0.001）。疫情期间非机械性眼外伤患者例数增多，其中电光性眼炎患者较去年同期明显增多（研究组141例，81.0%；对照组53例，46.9%）（χ2=36.437，P＜0.001）。机械性眼外伤患者较去年同期明显下降（研究组1035例，85.6%；对照组2331例，95.4%）（χ2=106.619，P＜0.001）。机械性眼外伤最常累及眼睑（研究组599例，57.9%；对照组1351例，58.0%）（χ2=0.002，P=0.964）；研究组的结膜损伤较对照组增多（研究组213例，20.6%；对照组336例，14.4%）（χ2=19.959，P＜0.001）；葡萄膜损伤较去年同期减少（研究组39例，3.8%；对照组131例，5.6%）（χ2=5.125，P=0.024）；开放性眼外伤所占比例的差异无统计学意义（研究组101例，9.8%；对照组193例，8.3%）（χ2=1.966，P=0.161）。结论 新型冠状病毒肺炎疫情期间眼科急诊总量及眼外伤急诊量明显下降。男性、青年、未成年人仍是急诊眼外伤的高发人群，未成年人发病率较去年同期下降。电光性眼炎患者明显增多，机械性眼外伤患者明显下降。

Analysis of disease spectrum and epidemiological characteristics of emergency ocular trauma during outbreak of novel coronavirus pneumonia

Objective To investigate the trend change of ocular trauma disease spectrum and epidemiological characteristics of ophthalmic emergency patients during novel coronavirus pneumonia outbreak period. Design Retrospective comparative case series. Participants One thousand two hundred and nine patients with ocular trauma who admitted ophthalmic emergency department of Beijing Tongren Hospital from January 23, 2020 to March 31, 2020 were enrolled as the study group, and 2444 emergency ocular trauma patients in the same period in 2019 as the control group. Methods Data were extracted from hospital information system, including ages, genders, admitting times, ocular trauma classifications, injury locations, and number of patients. Disease spectrum distribution of emergency ocular trauma and epidemiological characteristics were analyzed. Main Outcome Measures Ages, genders, admitted time, emergency diagnoses, number of patients. Results The total number of ophthalmic emergency patients is 5978 during epidemic period, including 1209 ocular trauma patients (20.2%). The total number of ophthalmic emergency patients is 12776 in the same period in 2019, including 2444 ocular trauma patients (19.1%) (χ2=3.111，P=0.078). Male patients were 835 cases (69.1%) in the study group and 1743 cases (71.3%) in the control group (χ2=1.976，P=0.160). The age of patients was 37.0 (26.5, 52.0) years in the study group and 35.0 (22.0, 50.0) in the control group (U=1369248.50，P＜0.001). Young patients (age from 18 to 44 years) accounted for the most proportion in both groups (561 cases, 46.4%, in the study group; 1090 cases, 44.6%, in the control group) (χ2=1.062, P=0.303). The number and proportion of children (age from 0 to 17 years) showed difference between two groups with statistically significant (199 cases, 16.5%, in the study group; 548 cases, 22.4%, in the control group) (χ2=36.437, P＜0.001). The number of patients with non-mechanical ocular trauma was growing during epidemic period. The patients of electric ophthalmia were more than control group (141 cases, 81.0%, in the study group; 53 cases, 46.9%, in the control group) (χ2=36.437, P＜0.001). The patients of mechanical ocular trauma were less than control group (1035 cases, 85.6%, in the study group; 2331 cases, 95.4%, in the control group) (χ2=106.619, P＜0.001). Eyelid was the most frequently involved part in mechanical eye injuries (599 cases, 57.9%, in the study group; 1351 cases, 58.0%, in the control group) (χ2=0.002, P=0.964). Compared with the control group, conjunctiva injuries were increase (213 cases, 20.6%, in the study group; 336 cases, 14.4%, in the control group) (χ2=19.959, P＜0.001) and uvea injuries were decrease (39 cases, 3.8%, in the study group; 131 cases, 5.6%, in the control group) (χ2=5.125, P=0.024). The difference of open globe injury proportions between two groups was not statistically significant (101 cases, 9.8%, in the study group; 193 cases, 8.3%, in the control group) (χ2=1.966, P=0.161). Conclusion The numbers of ophthalmic emergency visits and ocular trauma patients were decreased sharply during novel coronavirus pneumonia outbreaks period. Males, young people and children were still at high risk of eye injuries. The incidence of ocular trauma in children was dropped. The incidence of electric ophthalmia was increased while the incidence of mechanical ocular trauma was decreased significantly.