新型冠状病毒肺炎疫情下急诊创伤骨科诊疗行为的建议和策略

Strategies suggested for emergency diagnosis and treatment of traumatic orthopedics in the epidemic of COVID-19

目的探讨新型冠状病毒肺炎(COVID-19)疫情下急诊创伤骨科诊疗行为的建议和策略。方法回顾性分析2020年1月21日至2月15日期间武汉大学人民医院骨外科收治的128例急诊创伤骨科患者资料,男71例,女57例;年龄为5~88岁,平均48.7岁。门诊处置107例;住院手术21例,其中急诊手术4例,择期手术17例。记录患者和医务人员感染COVID-19的情况,总结疫情暴发以来实施的一些措施和经验。结果107例接受门诊处置的患者中,3例确诊COVID-19,3例疑似COVID-19。4例接受急诊手术的患者中,1例疑似COVID-19;17例接受择期手术的患者中,1例确诊COVID-19,2例疑似COVID-19。医务人员感染COVID-19的情况:2名护士确诊COVID-19,但均为轻症患者;1名医生和1名护士均疑似COVID-19。医务人员感染COVID-19均发生在疫情防控措施执行之前,不排除社区感染的可能。结论各级医疗机构在做好COVID-19防控的同时,保证安全、有效的医疗行为正常运转尤为重要。在COVID-19疫情期间,参与急诊创伤骨科的一线医务人员的接诊过程均面临诸多挑战。通过健全急诊创伤分诊流程、住院患者分类管理、住院病房优化管理、围手术期标准预防、完善落实医护防护制度、患者及陪护宣教配合等措施,可降低院内COVID-19感染发生率,在疫情期间依然可以为急诊创伤骨科患者提供优质、安全的医疗服务。

Objective To suggest strategies for emergency diagnosis and treatment of trauma orthopedics in the epidemic period of COVID-19.Methods In the epidemic of COVID-19 from January 21 to February 15,2020,128 patients with orthopaedic trauma sought emergency treatment at Department of Orthopedic Surgery,The People's Hospital of Wuhan University.They were 71 males and 57 females with an average age of 48.7 years(from 5 to 88 years).Of them,107 cases were treated at the outpatient department and 21 hospitalized.Emergency operations were carried out for 4 cases and selective operations for 17 cases.COVID-19 infections were recorded in the patients and medical staff as well.Measures taken and experiences learned were summarized since the epidemic outbreak of COVID-19.Results Of the 107 cases treated at the outpatient department,3 had a definite diagnosis of COVID-19 and 3 a suspected diagnosis of COVID-19.Of the 4 cases undergoing emergency surgery,one was suspected of having COVID-19.Of the 17 cases undergoing selective surgery,one was diagnosed definitely as COVID-19 and 2 were suspected of COVID-19.Two nurses were diagnosed definitely as having mild COVID-19.One doctor and one nurse were suspected of COVID-19.Since the COVID-19 infections in medical staff occurred all before the preventive and control measures for COVID-19 had been implemented,is was not ruled out that their infections might have come from communities.Conclusions It is particularly important for medical institutions of all levels to maintain safe and effective routine services while doing well in COVID-19 prevention.In the epidemic of COVID-19,front-line medical staff in emergency traumatic orthopedics is faced with great challenges in the process of diagnosing and treating patients.High-quality and safe medical services can be provided as long as nosocomial COVID-19 infection is effectively controlled by rigid screening of patients newly admitted,classified management of inpatients,optimal management of inpatient wards,standard preventive measures in perioperative period,a perfect system for medical protection,and medical education for patients and their carers.