新型冠状病毒肺炎疫情不同阶段的急诊危重患者特征分析及应对策略

Characteristics and countermeasures of emergency critically ill patients at different stages of Coronavirus Disease 2019 epidemics

目的分析新型冠状病毒肺炎(COVID-19)疫情早期(应急处置阶段)和此后常态化防控期间地市级医院急诊危重患者的特征变化,并提出应对策略。方法统计自江苏省扬州市启动疫情应急响应后1年内(2020年1月26日—2021年1月25日)和应急响应前同期(2019年1月26日—2020年1月25日)本院急诊抢救室危重患者抢救例次变化情况,并观察住院占比和死亡占比变化。分别对疫情发生前后不同阶段急诊危重患者疾病种类构成情况进行比较,分析可能的变化原因并拟定对策。结果启动疫情应急响应后1年内本院急诊抢救室抢救危重患者15002例次,应急响应前同期为15139例次。启动疫情应急响应后1年内危重患者住院占比、死亡占比与应急响应前同期相比,差异均无统计学意义(P>0.05)。疫情早期(2020年1月26日—3月26日)呼吸系统疾病、严重创伤和中毒占比低于上年同期(2019年1月26日—3月26日),而精神急症和未分类疾病占比高于上年同期,差异有统计学意义(P<0.05)。疫情常态化防控期(2020年3月27日—2021年1月25日)急诊抢救室呼吸系统疾病、中毒占比低于常态化防控前同期(2019年3月27日—2020年1月25日),未分类疾病占比高于常态化防控前同期,差异有统计学意义(P<0.05)。结论COVID-19疫情期间地市级医院急诊抢救室需将工作重点向危重症急救方向倾斜,建议加强对多系统疾病和疑难危重疾病的处置能力,而疫情早期临床尚需多关注精神急症患者。

Objective To analyze the characteristic changes of critically ill patients in emergency department of municipal hospital during the early stage(emergency response stage)and regular prevention and control stages of the Coronavirus Disease 2019(COVID-19)epidemics,and to propose the strategies.Methods The changes of number of critically ill patients in the emergency department of our hospital within 1 year since the initiation of emergency response to the epidemic(January 26,2020 to January 25,2021)was counted compared with the same period before the emergency response(January 26,2019 to January 25,2020)in Yangzhou City of Jiangsu Province.The proportion changes of hospitalizations and deaths were observed.The disease types of critically ill patients at different stages before and after the epidemic were compared to analyze possible causes and formulate countermeasures.Results The number of critically ill patients in the emergency room of our hospital within one year of the start of emergency response was 15002,and was 15139 in the same period of emergency response before.During the epidemic,there was no significant differences in the proportions of hospitalizations and deaths of critically ill patients compared with the same period of emergency response before(P>0.05).The proportion of critically ill patients with respiratory system diseases and poisoning in early stage of the epidemic(from January 26 to March 26,2020)decreased,while the proportions of mental emergency and unclassified diseases increased compared with the same period of the previous year(January 26 to March 26,2019)(P<0.05).The proportions of respiratory diseases and poisoning in emergency rooms during the normal epidemic control period(March 27,2020 to January 25,2021)were lower than those before the normal epidemic control period(March 27,2019 to January 25,2020),and the proportions of unclassified diseases were higher than those before the normal epidemic control period(P<0.05).Conclusion During the COVID-19 epidemic,emergency rooms of prefecture-level hospitals should focus on the emergency treatment of critical diseases.It is suggested to strengthen the abilities to deal with multi-system diseases and difficult critical diseases,while more attention should be paid to patients with mental emergency in the early clinical stage of the epidemic.