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  • 张航,赵佳琦*,张赛.新型冠状病毒肺炎疫情下急症介入超声的诊疗[J].第二军医大学学报,2020,41(5):487-492    [点击复制]
  • ZHANG Hang,ZHAO Jia-qi*,ZHANG Sai.Diagnosis and treatment of emergency interventional ultrasound under the epidemic of coronavirus disease 2019[J].Acad J Sec Mil Med Univ,2020,41(5):487-492   [点击复制]
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新型冠状病毒肺炎疫情下急症介入超声的诊疗
张航,赵佳琦*,张赛
0
(海军军医大学(第二军医大学)长征医院超声诊疗科, 上海 200003
*通信作者)
摘要:
目的 探讨新型冠状病毒肺炎(COVID-19)疫情形势下我院急症介入超声工作的诊疗过程及体会,为疫情期间安全有效开展介入超声工作提供参考。方法 总结回顾COVID-19疫情期间我院超声诊疗科紧急实施的3例急症患者介入超声诊疗经过,重点分析疫情形势下急症介入超声工作中对COVID-19重型患者的排查、介入穿刺适应证的选择、介入超声围手术期的防护及术后管理。结果 经流行病学筛查,患者1曾与COVID-19确诊患者有近距离接触史,胸部CT提示两肺下叶弥漫间质性渗出,经医院专家组会诊为COVID-19疑似病例,入院诊断为“咽后间隙感染”,需迅速清除感染灶;患者2经查排除COVID-19,入院诊断为“结石嵌顿性胆囊炎急性发作”,需迅速引流胆汁,解除胆囊梗阻;患者3经查排除COVID-19,入院诊断为“急性心包填塞”,需迅速引流心包积液。3例患者均经严格COVID-19排查流程,明确介入穿刺指征,术中患者1采用三级防护措施,另外2例患者采用一级防护措施。3例重症患者介入超声治疗均一次性成功,术后患者临床症状明显改善,术中平均耗时较短,出血量极少。结论 介入超声有微创、便捷、高效等诸多优势,非常贴合COVID-19疫情下急诊救治的需求,可成为某些急诊手术的替代方案或为重型COVID-19确诊/疑似患者提供一定的安全窗口期。我们的诊疗实践对于COVID-19疫情期间介入超声工作的安全有效开展具有一定的参考价值。
关键词:  新型冠状病毒肺炎  急症  介入性超声检查  诊断  治疗  围手术期  防护
DOI:10.16781/j.0258-879x.2020.05.0487
投稿时间:2020-03-12修订日期:2020-04-11
基金项目:
Diagnosis and treatment of emergency interventional ultrasound under the epidemic of coronavirus disease 2019
ZHANG Hang,ZHAO Jia-qi*,ZHANG Sai
(Department of Ultrasound, Changzheng Hospital, Naval Medical University(Second Military Medical University), Shanghai 200003, China
*Corresponding author)
Abstract:
Objective To explore the diagnosis and treatment process and experience of emergency interventional ultrasound in our hospital under the coronavirus disease 2019 (COVID-19) epidemic situation, so as to provide reference for the safe and effective implementation of interventional ultrasound during the epidemic. Methods This study summarized and reviewd the experience of interventional ultrasound for the diagnosis and treatment of three emergency patients in the department of ultrasound of our hospital during the COVID-19 epidemic, focusing on the screening of severe COVID-19 patients, the selection of indications for interventional puncture, the perioperative protection and postoperative management. Results According to epidemiological screening, patient 1 had close contact with the confirmed COVID-19 patient. Chest CT showed diffused interstitial exudation in the lower lobes of both lungs, and the patient was seen as a suspected case after consultation with the hospital expert group, who had retropharyngeal space infection on admission and needed to remove the infection focus quickly. COVID-19 was excluded in patient 2, who was diagnosed as acute episode of calculous incarcerated cholecystitis on admission, requiring rapid drainage of bile to relieve gallbladder obstruction. Patient 3 was excluded from COVID-19 and diagnosed as acute pericardial tamponade on admission, requiring rapid drainage of pericardial effusion. All 3 patients underwent strict COVID-19 screening procedures to identify the indications of interventional puncture. During the operation, tertiary protective measures were adopted for patient 1, and primary protective measures were adopted for the other two patients. Three severe patients were successfully treated by interventional ultrasound, with short average time, less bleeding and improved clinical symptoms. Conclusion Interventional ultrasound is minimally invasive, convenient and efficient, making it suitable for the emergency treatment during the COVID-19 epidemic. It can be used as an alternative to some emergency surgery, or provide a safe window period for confirmed or suspected severe COVID-19 patients. Our experience may provide a reference for the safe and effective practice of interventional ultrasound during the COVID-19 epidemic.
Key words:  coronavirus disease 2019  emergencies  interventional ultrasonography  diagnosis  treatment  perioperative period  protection