COVID-19患者床旁内镜诊疗风险评估及防护体会  

Experience on estimating the risk of COVID-19 patients with bedside endoscopy and protecting the endoscopic operator

作　　者：徐风华 宋宇虎[1] 王二传 向雪莲 尚晓丽 张玲玲 宋军[1] 刘诗[1] 刘俊[1] 侯晓华[1] 金玉 XU Feng-hua;SONG Yu-hu;WANG Er-chuan;XIANG Xue-lian;SHANG Xiao-li;ZHANG Ling-ling;SONG Jun;LIU Shi;LIU Jun;HOU Xiao-hua;JIN Yu(Division of Gastroenterology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,430022 Wuhan,China)

机构地区：[1]华中科技大学协和医院消化内科,湖北武汉430022

出　　处：《临床消化病杂志》2020年第4期207-212,共6页Chinese Journal of Clinical Gastroenterology

摘　　要：[目的]评估COVID-19患者行床旁内镜诊疗的风险及操作医生防护体会。[方法]评估2020-03-02-2020-03-20期间于武汉协和医院西院行床旁内镜诊疗的10例COVID-19患者术前一般情况、内镜诊疗风险性、可行性,术中心电监护,术后密切观测生命体征并及时处理突发情况,同时关注内镜操作医生及助手有否不适症状。[结果]10例患者中9例危重症,1例重症,共行14例次内镜诊疗。其中胃镜下置人空肠营养管7例次,诊断胃镜5例次,诊断肠镜2例次;3例为清醒状态下行内镜检查,7例为机械通气状态下行内镜检查。空肠营养管一次置管成功率为100%;4例消化道出血病因分别为食管胃底静脉曲张出血、十二指肠溃疡并出血(Forrest Ⅱb)、内痔并出血、小肠出血各1例。操作医生在行其中2例内镜检查时(操作时间分别为40 min、35 min时)诉头晕、胸闷、恶心,后出隔离病房休息后好转。在随后患者的操作过程中,积极优化操作流程,将时间控制在30 min以内,操作医生未出现头晕、胸闷及恶心等症状。操作医生及助手均未发生感染。[结论]在规范防护下对COVID-19患者行内镜诊疗可行性及安全性高,但3级防护下行内镜操作时间不宜过长,以减少缺氧状况的发生及感染风险。[Objective]To share the experience on estimating the risk of COVID-19 patientvS with bedside endoscopy and protecting the endoscopic operator.[Methods]COVID-19 patients from 2 March 2020 to 20 March 20,2020 in Wuhan Union hospital who accepted bedside endoscopy were recruited,and to evaluate the general situation of patients,feasibility and risk of endoscopic treatment.All patients were performed under electrocardiogram and given a close observation of vital signs and timely treatment of complications.Paid attention to the endoscopic operator and assistant whether there were symptoms or discomfort.[Results]The 9 of the 10 COVID-19 patients were critical and 1 was serious.They accepted 14 endoscopic operations totally.Among them,7 cases were placement of intestinal feeding tube with gastroscope,5 were gastroscopy examination and 2 were colonic endoscopy examination.The average operating time of placement of intestinal feeding tube were(26±5)min,and(33±6)min for endoscopic diagnosis in digestive tract hemorrhage;The success rate of placement of intestinal feeding tube with gastroscope was 100%.Duodenal ulcers and bleeds(Forrest Ⅱb),inner slugs and bleeding,and small intestine bleeding were the cause of gastrointestinal bleeding of 4 cases.Endoscopist reported dizziness,chest tightness,nausea with a long operation time(40 min and 35 min)in 2 cases and recovered after having a rest.Both Endoscopist and assistant had no infection of COVID-19.[Conclusion]The rivsk of endoscopic diagnosis and treatment of patients with COVID-19 was high.Preoperative risk assessment,intraoperative close monitoring and timely handling of emergencies should be done.Endoscopists and assistants should operate under strict protection,and the endoscopic operation time should not be too long(less than 30 min)to reduce the occurrence of hypoxia and the risk of infection.

关 键 词：COVID-19 床旁内镜 风险评估 防护体会 

分 类 号：R373[医药卫生—病原生物学]