摘要
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。
Objective To summarize the clinical experience in the prevention and treatment of novel coronavirus(2019-nCoV,SARS-CoV-2)disease(COVID-19)in the department of thoracic surgery of large grade A tertiary hospitals in Wuhan,and to provide feasible clinical practice strategies.Methods The clinical data of 41 COVID-19 patients in the department of thoracic surgery of 7 large grade A tertiary hospitals in Wuhan from December 15,2019 to February 15,2020 were analyzed retrospectively.There were 20 surgical patients(10 males and 10 females at an average age of54.35±10.80 years)and 21 medical personnel(7 males and 14 females at an average age of 30.38±6.23 years).Results The main clinical manifestations of COVID-19 patients were fever(70.73%)and cough(53.66%).Normal or reduced peripheral white blood cells and reduced lymphocyte counts were found in the COVID-19 patients,and some patients may have increased C-reactive protein.COVID-19 patients showed limited ground-glass opacities in early chest CT,which was evident in the edge band of lung.The disease could further develop into multiple pulmonary infiltrations,and pulmonary consolidation was found in severe cases.At the time of confirmed diagnosis,most of the medical personnel were ground-glass shadows and unilateral lesions,and even no obvious abnormalities were found in the lungs.The diagnosed COVID-19 patients were transferred to the isolation ward immediately and treated according to the"Diagnosis and Treatment Program of Novel Coronavirus Pneumonia",which was released by the National Health Commission of the People’s Republic of China.At the end of follow-up on February 20,2020,seven surgical patients(35.00%)were discharged and seven(35.00%)were dead,13(61.90%)medical personnel were discharged and no death was found.Conclusions Of all COVID-19 patients in the department of thoracic surgery of hospitals in Wuhan,the proportion of severe degree and mortality in surgical patients are significantly higher than that of the general population,and medical personnel are prone to nosocomial infections.Early oxygen therapy and respiratory support may improve prognosis.During the epidemic period of COVID-19,elective or limited surgery is suggested to be postponed and the indications for emergency operation should be strictly controlled.Emergency operation is suggested to be treated in accordance with tertiary prevention.On the consideration of specialty in the department of thoracic surgery,all people of the ward should be carefully investigated for infection once one case is confirmed with COVID-19.Early detection,isolation,diagnosis,and treatment are the best preventive measures to improve the prognosis of COVID-19.
作者
江文洋
熊锐
卢子龙
沈小康
张霖
唐政
平伟
张俊
开金丹
张永建
高威
邢昕
陈晓蓓
耿庆
JIANG Wenyang;XIONG Rui;LU Zilong;SHEN Xiaokang;ZHANG Lin;TANG Zheng;PING Wei;ZHANG Jun;KAI Jindan;ZHANG Yongjian;GAO Wei;XING Xin;CHEN Xiaobei;GENG Qing(Department of Thoracic Surgery,Renmin Hospital of Wuhan University,Wuhan,430060,P.R.China;Department of Thoracic and Cardiovascular Surgery,Zhongnan Hospital of Wuhan University,Wuhan,430071,P.R.China;Department of Thoracic Surgery,Tongji Hospital Affiliated with Tongji Medical College of Huazhong University of Science and Technology,Wuhan,430030,P.R.China;Department of Thoracic Surgery,Union Hospital Affiliated with Tongji Medical College of Huazhong University of Science and Technology,Wuhan,430022,P.R.China;Department of Thoracic Surgery,Hubei Cancer Hospital,Wuhan,430070,P.R.China;Department of Thoracic Surgery,Central Hospital of Wuhan,Wuhan,430014,P.R.China;Department of Cardiothoracic Surgery,Pu Ai Hospital of Wuhan,Wuhan,430032,P.R.China;Department of Infectious Diseases,Renmin Hospital of Wuhan University,Wuhan,430060,P.R.China)
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2020年第4期364-370,共7页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
