新型冠状病毒肺炎疫情期间79例心脏大血管外科急诊手术的围术期管理  

Perioperative management of 79 patients'emergency cardiac macrovascular surgery during the COVID-19 epidemic

作　　者：肖红艳 祁明 宋来春 许铭 陶凉 XIAO Hong-yan;QI Ming;SONG Lai-chun;XU Ming;TAO Liang(Cardiac Macrovascular Surgery,Wuhan Asian Heart Hospital Affiliated to Wuhan University of Science and Technology,Wuhan Cardiomyopathy Clinical Medical Research Center,Wuhan 430022,China)

机构地区：[1]武汉科技大学附属武汉亚洲心脏病医院心脏大血管外科武汉市心肌病临床医学研究中心,湖北省武汉市430022

出　　处：《中国心血管病研究》2020年第6期507-511,共5页Chinese Journal of Cardiovascular Research

基　　金：湖北省卫生健康委员会基金(WJ20I9F024)。

摘　　要：目的总结突发重大传染病时心脏大血管外科急诊手术的围术期管理经验.方法对我院2020年1月23日至3月31日新型冠状病毒肺炎(COVID-19)疫情期间,79例心脏大血管急诊外科患者进行回顾分析,其中男性63例,女性16例,年龄8个月至77岁,平均(49.91±7.21)岁;武汉市内患者26例,市外53例;急性主动脉综合征(AAS)55例,急性冠状动脉综合征(ACS)合并机械并发症8例,心脏瓣膜病合并心内膜炎8例、难治性心力衰竭5例,左心房黏液瘤2例,婴幼儿高度房室传导阻滞1例.所有患者由120转运,市内患者在急诊科明确诊断,市外患者转运前均通过网络会诊明确诊断和确定急诊手术指征后再转运,在急诊完善肺部CT平扫初步排除COVID-19后收治隔离病区,紧急核酸检测和完善术前检查后行急诊手术,术后转运至监护室单间隔离直至排除COVID-19,住院期间出现发热时即行核酸检测和复查肺部CT.所有参与手术和围术期管理的医护人员均采取三级防护和医学观察.结果行急诊手术大血管外科手术29例,主动脉腔内隔绝手术24例,大血管杂交手术2例,单纯冠状动脉旁路移植3例,冠状动脉旁路移植联合瓣膜手术3例,急性心肌梗死室间隔穿孔封堵2例,瓣膜置换11例,瓣膜修复2例,左心房黏液瘤摘除2例,心外膜永久起搏器置入1例,同期心房颤动射频消融术3例.术前首次核酸检测均为阴性,肺部CT有COVID-19影像学表现12例,4例确诊为COVID-19,疑似病例5例.全组患者中因COVID-19危重型死亡1例,因合并肾功能不全和重症感染放弃出院1例,其余患者均康复出院.所有参与手术和围术期管理的医护人员无人感染COVID-19.结论急诊手术是救治心脏大血管急危重症的有效手段,在重大传染病期间,规范心脏急危重症患者收治流程,应加强院内感染的控制,做好防护,医护人员的个人安全是有保证的.Objective To summarize the perioperative management experience of emergency operation of cardiac macrovascular surgery in the case of major infectious disease epidemic.Methods The retrospective analysis was performed on 79 patients with cardiac macrovascular emergency surgery during the epidemic of COVID-19 in our hospital from January 23 to March 312020,including 63 males and 16 females aged 8 months to 77 years,an average age of(49.91±7.21)years.There were 26 cases in Wuhan and 53 cases outside the city.There were 55 cases of acute aortic syndrome(AAS),8 cases of acute coronary syndrome(ACS)with mechanical complications,8 cases of cardiac valvular disease with endocarditis,5 cases of refractory heart failure,2 cases of left atrial myxoma and 1 case of infant high atrioventricular block.All the patients from Wuhan City were diagnosis in the emergency department and others from outside the city were diagnosis and determined emergency operation indications through the network consultation before transshipment.After the primary exclusion of COVID-19 by pulmonary CT scanning in the emergency department,the patients were admitted to the isolation ward.Emergency surgery was performed after emergency nucleic acid test and preoperative examing.The patients were carried to a single room in the ICU for isolation after the operation until COVID-19 was excluded;nucleic acid test and reexamination of pulmonary CT were performed if they had fever during hospitalization.All medical persons involved in the operation and perioperative management took 3rd level of protection and medical observation.Results There were 29 cases of emergency vascular surgery,24 cases of aortic lumen isolated operation,2 cases of great vessels hybrid operation,3 cases of simple coronary artery bypass grafts,3 cases of coronary artery bypass grafting combined valvular surgery,2 cases of acute myocardial infarction ventricular septal perforation block,11 cases of valve replacement,2 cases of valve repair,2 cases of left atrial myxoma excision,1 case o

关 键 词：新型冠状病毒肺炎 心脏急危重症 急诊 外科手术 

分 类 号：R563.1[医药卫生—呼吸系统] R654.2[医药卫生—内科学]