新型冠状病毒肺炎疫情期间老年重症患者感染防护的管理机制研究  

Study on the mechanism of infection prevention and control in elderly severe patients during the COVID-19 epidemic

作　　者：王耀丽 肖洪 李鹏飞 雷洋 胡明冬 周健 姚娟 蒋东坡 夏世金 Wang Yaoli;XiaoHong;Li Pengfei;Lei Yang;Hu Mingdong;Zhou Jian;Yao Juan;Jiang Dongpo;Xia Shijin(Wound Trauma Medical Center,State Key Laboratory of Trauma,Burns and Combined Injury,Daping Hospital,Army Medical University,Chongqing,400042,P.R.China;Department of Geriatrics and Special Services,Xinqiao Hospital,Army Medical University,Chongqing,400037,P.R.China;Shanghai Institute of Geriatrics,Huadong Hospital Affiliated to Fudan University,Shanghai,200040,P.R.China)

机构地区：[1]陆军军医大学大坪医院战创伤医学中心,创伤、烧伤与复合伤国家重点实验室,重庆400042 [2]陆军军医大学新桥医院老年与特勤医学科,重庆400037 [3]复旦大学附属华东医院上海市老年医学研究所,上海200040

出　　处：《老年医学与保健》2020年第5期757-762,共6页Geriatrics & Health Care

摘　　要：目的分析新型冠状病毒肺炎疫情期间ICU老年重症患者感染防控的临床特点,为提高老年重症患者相关的新型冠状病毒感染防控工作提供参考。方法采用单中心回顾性病例对照方法,分析2020年1月24日-2020年2月24日大坪医院重症医学科收治的32例患者的临床资料,根据患者的年龄分为老年组(≥60岁)和非老年组(<60岁),评估并比较2组APACHE II评分、氧疗方式、插管次数、拔管次数、吸痰例数、雾化例数、纤支镜肺泡灌洗次数;对患者实施分类分区分级管理评估,根据患者风险程度不同进行分级分区防控,比较2组的临床特点、胸部CT影像和实验室检查等资料。结果32例患者随访1个月,男性21例,女性11例,年龄12~98岁,平均(58.65±21.6)岁,APACHE II评分为(19.247±6.59)分,其中非老年组14例,老年组18例。老年组接受机械通气患者13例,无创辅助通气2例,鼻导管吸氧3例,纤支镜吸痰7例,气管切开4例。非老年组吸氧转无创辅助通气1例。二级防护22例,其中老年组12例;一级防护10例,其中老年组6例。肺部感染者胸部CT影像学表现为双肺大片高密度阴影伴实变。2组患者进行分级分区防控管理后,均未出现COVID-19患者。结论老年重症患者以COVID-19潜伏期14 d进行分区管理,有利于老年重症患者院内交叉感染的防控,也有利于老年重症患者的及时救治,依据影像学的表现设置过渡区防护和COVID-19核酸检查可提高COVID-19确诊率,为临床救治提供依据。Objective To investigate the clinical characteristics and significance of infection prevention and control in elderly patients with severe illness in ICU during the COVID-19 epidemic,and provide reference for the prevention and control of COVID-19 infections in elderly critically patients.Methods The clinical data of 32 patients admitted to the critical care unit of Daping hospital from January 24,2020 to February 24,2020 were analyzed by single center retrospective casecontrol method.According to the age of the patients,they were divided into the elderly group(≥60 years old)and the nonelderly group(<60 years old).APACHE II scores,oxygen therapy methods,intubation times,extubation times,sputum suction cases,nebulization cases,and fiberbronchoscope alveolar lavage times were evaluated and compared between the two groups.The patients were assessed by classification,division and grading management,and then the prevention and control measures were taken according to the different risk levels of patients,and the clinical characteristics,chest CT images and laboratory examination results of the two groups are compared.Results All patients were followed up for 1 month.There were 21 males and 11 females with an average age of(58.65±21.6)years(12-98 years),including 14 cases in the onelderly group and 18 cases in the elderly group.Their APACHE II score was 19.247±6.59.In the elderly group,13 patients received mechanical ventilation,2 ones did noninvasive ventilation,3 ones did oxygen inhalation through nasal catheter,7 ones did sputum suction by bronchofibroscope,and 4 ones did tracheotomy.In the on-elderly group,only 1 case changed from oxygen inhalation to noninvasive ventilation.22 cases were treated with secondary protection,including 12 cases in the elderly group;10 cases were treated with primary protection,including 6 cases in the elderly group.Chest CT imaging of patients with lung infection showed large,high-density shadows with consolidation in both lungs.No COVID-19 patients appeared in the two groups.Concl

关 键 词：老年 新型冠状病毒肺炎 过渡区 重症 分级防护 

分 类 号：R459.7[医药卫生—急诊医学] R197.323[医药卫生—治疗学]