新型冠状病毒肺炎疫情期间急诊创伤骨科患者特点和处理策略

Characteristics and management of emergency patients with orthopedic trauma during COVID-19 epidemic

目的探讨新型冠状病毒肺炎(COVID-19)疫情期间急诊创伤患者的损伤特点和处理策略。方法回顾性分析2020年1月20日至2月26日期间南方医科大学南方医院骨科收治的22例创伤急症住院患者资料。男18例,女4例;年龄4~66岁,平均年龄35岁。致伤原因:交通伤11例,锐器切割伤(含菜刀切伤)6例,重物压砸伤1例,机器碾压伤1例,跌倒摔伤2例,机器绞伤1例;损伤类型:高能量损伤13例,低能量损伤9例;损伤部位:上肢7例,下肢15例。医护人员诊疗过程中对于无新型冠状病毒(2019-nCoV)核酸筛查结果的1例患者采用二级防护,其余21例患者采用一级防护。记录患者和医务人员感染2019-nCoV的情况,总结疫情期间创伤急症的处理措施和经验。结果在诊治22例创伤急症患者期间,无一例医务人员和患者确诊COVID-19。紧急入院未做筛查的1例患者按疑似COVID-19病例对待,采用二级防护,术后排除COVID-19。结论COVID-19疫情期间,处理创伤急症的一线医务人员接诊过程均面临较高感染风险。创伤骨科急诊患者主要是交通伤和机器伤,老年患者主要由锐器切割及跌倒引起。通过完善院前筛查、选择合适的麻醉及手术方式、做好围手术期医护人员的防护及合理的术后病房管理和患者心理疏导,可降低院内COVID-19感染发生率。

Objective To investigate the characteristics and management of the emergency patients with orthopaedic trauma during COVID-19 epidemic.Methods A retrospective analysis was performed of the 32 emergency inpatients at Department of Orthopedics,Nanfang Hospital from January 20 to February 26,2020.They were 23 males and 9 females,aged from 4 to 66 years(mean,35 years).The causes for their injury included traffic accident in 14 cases,sharp cutting(e.g.by a kitchen knife)in 6 cases,heavy object crushing in one,machine crushing in one,fall in 2,and machine twisting in one.High energy injury occurred in 13 cases and low-energy injury in 9 cases.The injury involved the upper limb in 7 cases and the lower limb in 15 cases.GradeⅡprotection was adopted during the diagnosis and treatment for the one emergency patient who had not undergone nucleic acid screening for 2019-nCoV while gradeⅠprotection for the other 21 patients.2019-nCoV infection was recorded in the patients and medical staff as well.The measures and experience were reviewed in the management of orthopaedic emergencies during the COVID-19 epidemic.Results During the diagnosis and treatment of 22 emergency patients with orthopaedic trauma,none of the medical staff or patients was infected with COVID-19.As the one emergency patient was treated as a suspected case and protected by gradeⅡmeasures,COVID-19 infection was ruled out after surgery.Conclusions During the COVID-19 epidemic,front-line medical staff dealing with traumatic emergencies faced a higher risk of infection.The emergency orthopaedic traumas were mainly caused by a traffic accident or a machine,and those in the elderly patients by a sharp cutting or a fall.The incidence of COVID-19 infection could be reduced by COVID-19 screening before admission,appropriate anesthesia and surgical methods,protection of perioperative medical staff,postoperative wards care and psychological counseling.