“突发公共卫生事件”期间静脉曲张出血急诊内镜诊疗策略

Emergency endoscopic diagnosis and treatment strategy of variceal bleeding during“public health emergencies”

目的:通过分析2020年“新冠肺炎”疫情期间食管胃底静脉曲张破裂出血患者在我院行急诊内镜治疗的病例特点及经验,为食管静脉曲张出血内镜下止血治疗、日常工作以及特殊时期的防护和洗消提供参考资料。方法:回顾性分析2020年02月21日至03月25日在包头医学院第二附属医院消化科就诊的食管胃底静脉曲张破裂出血并实施内镜下止血诊疗的46例患者的病历资料,并且收集2019年02月21日至03月25日内镜下止血诊疗的21例住院患者的病历资料作为对照组。分析两组住院患者的临床特点、住院时间、流行病学特点史、内窥镜诊疗技术、内镜术者及助手的防护、内镜相关设备和器械消毒方案。结果:疫情期间静脉曲张内镜下诊疗数为46例,入院前14 d无流行病学和特殊接触史。2019年同期内镜诊疗数为21例,数量增加119.0%。由其他医院转入患者20例,2019年由其他医院转入患者11例,转诊数量增加81.8%。46例患者中,临床医嘱下病危患者数量为10例,占患者总数21.7%;2019年同期患者下病危3例,占患者总数14.3%。疫情期间住院行急诊内镜下止血治疗10例,占患者总数21.7%;2019年同期行急诊内镜下止血3例,占患者总数14.3%。疫情期间行三腔两囊管置入患者15例,占所有患者32.6%;2019年同期三腔两囊管置入患者5例,占所有患者23.8%。2019年同期行曲张静脉内镜下诊疗活动时,两组之间的平均治疗时间间隔为30 min,中间为内镜消毒、内镜一次性医疗用品更换等;疫情期间两镜下诊疗平均时间间隔为64.3 min,时间增加114.3%。疫情期间外地患者下降8.9%。疫情期间,因曲张静脉死亡患者1例,医护管理人员均未出现发烧、咳嗽或肺部感染。结论:新冠疫情期间,内镜下诊断和治疗静脉曲张病例增多,急危重症患者明显增多,消毒洗消时长明显延长,异地住院患者大幅度减少。

Objective:By analyzing the special cases of the patients with the esophagogastric variceal bleeding(EVB)during the epidemic breakout of the coronavirus-led pneumonia to learn the necessary precaution that needs to take without violating the principles in diagnosis and treatment,and to provide a useful reference for similar conditions in the future.Methods:We performed retrospective analysis on 46 EVB patients who received medical care at the Second Affiliated Hospital of Baotou Medical College during the period of 2/20/2020-3/24/2020.We used the medical records of 21 EVB patients treated during the same period of time in 2019 as a control.The factors that were analyzed include:symptoms,personal history of health,hospital care,endoscopic diagnosis and treatment,precaution of the medical staff,and sterilization of the medical tools.Results:1)All 46 EVB patients of this year had no history of coronavirus-related pneumonia and no contact with the positive individuals.2)The number of EVB patients increased by 119.0%compared to the previous year.3)Out of the 46 patients,20 were transferred from other hospitals,81.8%increase compared to the previous year.4)Ten of the 46 patients required intensive care,which was higher than the previous year.5)Fifteen of the 46 patients had Sengstaken-Blackmore tube planted(32.6%),which was also higher than last year(23.8%).6)The time interval between two procedures was 64.3 min this year and 30 min last year,delayed by 214.3%.In addition,the number of patients from outside of Baotou was dropped by 8.9%.One EVB-related death occurred this year.Our medical staff all stayed healthy during this time.Conclusion:There were increases in the number of EVB patients,emergency care,intensive care,and sterilization time during the epidemic breakout of the coronavirus,compared to a regular time.Of course,the number of patients from outside of Baotou dropped clearly.Special care for those endangered individuals is always necessary,as long as conforming to the safety regulations.